Osteopathic clinical education

Discussion in 'Medical Students - DO' started by Kent Ray, Apr 15, 2000.

  1. Kent Ray

    Kent Ray Member

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    I was wondering what all third and fourth year students thought of their clinical education. I would like you to respond to a few questions.
    1. Are you satisfied with your clincal rotations.
    2. Did your school do enough to make sure your rotations were quality.
    3. During your rotations did your attendings sit down with you at least one hour a day three to four times a week.
    4. During your rotations did your attendings teach at all.
    5. Does your school have paid faculty in every deparment or does your school rely on the generosity of private doctors to provide you your clinical education.
    6. Have you ever done rotations at alliopathic institutions with paid faculty and how do you compare this with the OPTI approach to Osteopathic medical education.
    7. Please provide me with your thoughts on how your clinical education can be improved.


    Thank for your participation. I will use this information to lobby for better clinical education from every school. Your personal profile will not be used. Please be honest.


     
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  3. RBorhani

    RBorhani Emergency Physician

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    Using this discussion forum to elicit this information will only lead to an inevitable flame war and no one will get anything out of it.

    If there is a need for improvement, it is best handled within the school, i.e. by students talking to their class president, etc...rather than utilizing these forums for this purpose.




    [This message has been edited by RBorhani (edited 04-19-2000).]
     
  4. Kent Ray

    Kent Ray Member

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    RBorhani,
    I am a fourth year Osteopathic Medical student. I have been working with my school for several years now. I have had meetings with the board members, president, and COMS dean. I have writen letter after letter to the AOA and the state osteopathic association.
    Most osteopathic schools do not have enough paid faculty for clinical education and we are suffering badly for this. I feel that it is an unethical way to operate and will continue to explore my options to change this until it is solved.
    This forum is for everyone and I can post whatever I like. So please, post your responces, bad or good hopefully I can use them to help future osteopathic students.

     
  5. ADRIANSHOE

    ADRIANSHOE Senior Member

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    1. Are you satisfied with your clincal rotations.
    No, there was a very large lack of oversight on my rotations, lack of organization and planning. Execeptions were OB/GYN, one month of internal medicine and both pediatrics rotations.

    2. Did your school do enough to make sure your rotations were quality.
    No, they seem to be divorced from this, in discussion with the dean, he does state that they are going to use the student evaluation to make decisions about future changes. The need to address the relationship between the HOSPITAL, the UNIVERSITY, and the attendings remains.

    3. During your rotations did your attendings sit down with you at least one hour a day three to four times a week.
    Five of ten did, the rest of the required rotations did not.

    4. During your rotations did your attendings teach at all.
    --several things come into play here, YOU the student must be aggressive and show interest, you must read and be ready to discuss patient care and the latest opinions about the diseases of the patients, doing this will help most attendings respect you enough to teach you somethings. You also must subjugate your ego and accept your ignorance, ask questions humbly and without phrasing them in such as way as to imply you are questioning the attending's abilities.

    5. Does your school have paid faculty in every deparment or does your school rely on the generosity of private doctors to provide you your clinical education.
    Volunteers
    6. Have you ever done rotations at alliopathic institutions with paid faculty and how do you compare this with the OPTI approach to Osteopathic medical education.
    This is a biased question, I have been in one allopathic rotation, it was very good and very well organized. I have been in a couple of osteopathic rotations that were pretty well organized also, having said that, a questionaire designed to gather information about particular programs is a good idea, but any juxtapositioning of osteopathic vs. allopathic residencies should NOT be done until enough information is gathered to compare programs of equal size, funding and longevity to make proper comparisons with.
    7. Please provide me with your thoughts on how your clinical education can be improved.
    1. pay attendings bonuses based upon ingenuity of teaching strategems
    2. have a compiled regularly updated bank of articles on the diseases most likely to happen during each rotation, have the student focus on the common diseases in depth with regular FOCUSED reading on the applied cases the student is seeing.
    3. Test off of these articles.
    4. practical exams, weekly evaluation by attendings with suggestions.
    5. Weekly exam on a patient by the student with the attending only as a witness to provide subsequent feedback.
    6. Recognize the need for reading time throughout the day and throughout the rotation.

    I disagree with my very good friend and colleague Rborhani that this is inherently inflammatory,
    these questions with the stated purpose of gathering information from a variety of sources with the expressed purpose as fomenting constructive change, is admirable.

     
  6. 12R34Y

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    I'm absolutely horrified. I was very very excited about the D.O. profession and I've read many books, shadowed several physicians, and have been gathering as much info as possible on the field, but now i'm really upset by what I'm hearing on various boards about the sub-par clincial education experience. i was under the impression that your clinical education should be excellent and very well organized. What good is it to go into a rotation with a doctor who doesn't even care that you are there? doesn't spend time with you? What's the point? I used to work @ the University of Iowa in the ER and I was used to seeing med students very involved in whatever rotation that they are doing. Is this just something that happens at major university teaching hospitals? I hope that someone can please calm my fears about a possibly substandard clinical education at osteopathic schools. Please explain to me the difference between the preceptor based and the other. thanks a ton.
     
  7. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved

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    I don't think that you have to worry. Basically, it is very fashionable for medical students (both DO and MD) to complain about their rotations, their interns, and/or their attendings. You have to be skeptical about what you hear and keep in mind everyone's experience is a little different.

    Every medical school has good and bad rotations for a variety of reasons. And, you can't please everyone all the time. Every student learns differently and every student expects something different from a rotation given their interests, motivation, and work ethic. Sometimes you get attendings who like to teach, other times you don't. Sometimes you get a rotation that's *SO* heavy on the didactics it's like being back in the classroom, other times you're running your butt off doing scut work all the do'da'day.

    In general, there are preceptor-based rotations (where you follow one doc in his office, on his rounds, at the hospital, to the post office, and to his kid's softball game...) and ward-based or service-based rotations where you're "clerking" (hence the term "clerkship") for a team usually comprised of an attending, a resident, and a chain-smoking, coffee-guzzling haven't-slept-in-12-days intern. Each kind of rotation is organized differently. Students benefit from exposure to both.

    The ward-based rotation is the traditional medical education experience that comes to most people's mind where the responsibilities are usually very sharply delineated and hierarachal. The student gets to hospital at 5:30AM, does pre-rounds on the patients assigned to him or the whole service, goes to morning report, checks with the intern (who usually dumps more work on him/her), and then rounds later with the resident and attending. The student presents each patient ("Mrs. Smith is a 65 y.o. African-American woman who blah blah blah with blah blah and so on and so on...") The intern chimes in with the latest change in therapy, the resident posits some very intriguing and somewhat esoteric question, there ensues plenty of pimping all around, delegation of new tasks, the attending signs the chart and off to the next patient...

    The preceptor-based rotation can vary widely in scope, responsibility, and academic instruction. Sometimes you just follow around some grumpy attending who lets you do nothing, ocassionally drops some clinical pearl with half-hearted disgust and usually just responds to every question with "look it up." Other times, you show up and meet the doc's staff who hand you a chart, smile and say, "Dr so and so is late this morning, he said to get started, his first patient is in room 3." Some preceptors are on the ball and have compiled a list of articles they want you to read, set aside a specific amount of time per week to discuss specific educational issues, etc. Others barely realize you're there...

    There are pluses and minuses to each kind of rotation not to mention the huge individual variation from attending to attending. The traditional ward-based rotation, which used to be the dominant model of clinical medical education worldwide, is comforting in its clear expectations and roles, but can get mind-numbing once you finally "catch-on" to the system. The preceptor-based rotation can be a wonderful mentoring, nurturing experience or a trial-by-fire hell.

    Likely, regardless of where you decide to attend medical school you'll have plenty of experience with both kinds of rotations, good and bad. My personal opinion is that it should be 60/40 in favor of outpatient, preceptor-based learning. Others will disagree. I just think that more and more medicine is being "turfed" to the outpatient setting and only sickest of the sickest get into the hospital these days---usually endstage or near endstage disease. The days are long gone when patients were admitted to the hospital to be "worked-up." Now, cardiologists will do just about everything except actually cath the patient right there in the waiting room.

     
  8. UHS2002

    UHS2002 Senior Member

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    Well, I hope I can do a little bit to reassure you that clinical education at DO schools do not have to be subpar.

    I am an MS2, so I have yet to start my rotations, however, up to this point I have had great oportunities to do a lot of "hands on", rather than just tag along after a physician who doesn't have the time to teach me. From talking to many of my classmates, I know my experience is not unique. There are PLENTY of oportunities for quality hands on learning at DO schools.

    Obviously, I am fully prepared to encounter some rotations which will fall short of my hopes and expectations (that is, rotations that will go down in infamy). I am sure that this happens at MD rotations too. There simply are some physicians who do not make good teachers, period.

    Keep in mind, however, that often how much or how little you are allowed to do depends on you. If you show lukewarm interest (gosh, here you are rotating through peds and you REALLY only want to be a cardiothoracic surgeon...), little initiative and mediocre knowledge, there aren't many residents or attendings that are going to feel thrilled at giving you more of their time and assigning you more than marginal responsabilities. It doesn't matter if you are at a large university hospital or a small community clinic.

    I truly believe that, if your resident or attending gets to the hospital at 6 am and tells you you can be there at 7, you should be there to greet him when he walks through the door (if he can get by with 4 hours of sleep, so can you). If you do not know something, then you should look it up the next time you get a chance. You should study for the rotation you are doing and try to know as much as you can, not only the bare minimum to get you by.

    As I mentioned, keep in mind that I haven't started my rotations yet. However, the above approach really worked super for me during my first two years of med school. I got a ton of experience, which I would probably not haven't gotten otherwise because I was not an upperclassman. So I am not tinkering with a good method and I will try to give it my 110%.

    At a large university hospital there is a food chain and you, as a med student are at the bottom. So there is a procedure to be done, the resident gets first dips, if he doesn't want it then the intern gets it, if he doesn't want it then the MS4 gets it and if he doesn't want it then you get it. At a small hospital, there may not be anyone between you and the attending or you may be the only med student assigned to that resident. If you do things right, you should have no trouble in keeping meaningfully busy.

     
  9. DO Boy

    DO Boy Senior Member

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    DAMN, am I glad to hear people supporting this idea of sub-par osteopathic clinical rotations!

    This is probably the biggest fear that I have about going to DO skool in August.

    But, now that I think about it, Drusso and UHS 2002 make good points. Also, it's in residency where you really hone your doctor skillz so here's to good training no matter what school you go to!

    DO Boy,
    TCOM '04

    p.s. WHAT? Do you really get to the hospital at 5:30A? A big WHOA if you do.
     
  10. ADRIANSHOE

    ADRIANSHOE Senior Member

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    Drusso and UH2 have really made the salient points, each rotation has unique qualities made up of the expectations of all parties and the requirements of the individual rotation. To get the best experience, you have to be COMPLETELY HONEST with yourself, look at what your needs are and attempt to gravitate (within the allowable parameters of your institution) toward those rotations that you feel will help you the most.

    regarding up at 5 am....
    during three months of internal medicine (one of which was an elective) i was on the floors between 3:30 and 5:00 am every day, usually about 4 to 4:30 being the average. It's not the getting up that should worry you, you are given the opportunity to learn all there is to know about the patient, this is an area that medical students can really shine in if they take advantage. Instead of wasting time showing ignorance by blurting out answers to questions you are just guessing at, say I dont know to those questions you dont know, but use your time with the attending to explain any family issues the patient may have including past medical history that may not be documents, family fears, death/dying issues, etc....The physician will be more impressed because you are operating from a position of strength, having pertinent information for him to discuss with the patient, it will save him time, you will become more involved and by extension the physician may feel like teaching you the medicine, which is your weak point usually. obviously, certain rotation time constraints can come into play, but try to work it so that you are a detective regarding family matters.
    there are always exceptions, but if you act like a detective regarding family and PMH, while not chasing zebras openly with the attending, you will save time, energy, face, and will feel more bonding between you, the family and the attending. Third year particularly, you really have a chance to learn PATIENT CARE AND COMMUNICATION, the medicine will get there through sheer exposure, but the communication habits and the bedside manner can either grow or take a nosedive depending upon how you approach it early.
     
  11. ADRIANSHOE

    ADRIANSHOE Senior Member

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    Having said that, there is a ton of areas that can be improved, should be improved and need to be improved, and its not going to happen by burying our heads in the sand or pretending that just because its always been this way (it hasn't) that it always has to be this way (it doesn't)
     
  12. mj

    mj Senior Member

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    For a minute there Adrianshoe, I was beginning to think that you had gone soft on us, offering up all those warm fuzzy do better suggestions. Thanks for your last post, restoring my faith in your fighting spirit once again. LOL [​IMG]
    mj
     
  13. SKA

    SKA New Member

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    ska, yu reeeelly outtta make surrrre your name isn't lef on da computer mahn.
     
  14. ADRIANSHOE

    ADRIANSHOE Senior Member

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    MJ, In all fiestiness (so you don't think this I am taking your comments too overseriously) i think by now you know that I feel that both sides need to work to find common ground and improve the overall quality of the experience, this includes student's taking more individual responsibility for their actions and their education, while it also include better and more consistent oversight and planning, curriculum development by the institutions. I don't think it is fuzzy warm feeling to point out that often students are their own worst enemies any more than it is inflammatory for me to point out instances where the institutions actions are counterproductive to their mission statements and reputations.
    ...PS, I am smiling at the moment. thanks for the comments.
     

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