Pacific's Clinical Downward Spiral

[lens 90 or 91]

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Opinions are totally accepted. Starting with the class of 2012, Pacific is implementing a new clinical rotation schedule for the 4th years. Though the details are not fully concrete, there are some major concerns with the new program. 4 rotations will be offered, all 4 can be outside of the school's clinic, or 3 external and 1 internal. To entice participation in the internal clinics, the curriculum was set to have specialty tracks that combined various emphases in the field to focus on- ie: contact lens/Oc. Disease, VT/Neuro, Peds/Lo Vision, etc. It was presented that the participants would receive increased experience with these "tracks", 3 full days of specialty track (ie: CL/OcD), 1 day of primary care, and 1 day of another specialty depending on the specific track (could be VT or Peds, etc). No one is sure of the exact schedule, though a schedule for the tracks was presented when the process began. After presenting this to the faculty and students, 48 3rd year students have been roped into a bait and switch for an internal rotation for their 4th year. It seems the incoming 3rd years will be directly performing eyecare with the specialty patients, while the 4th years will be "monitoring" 2-3 3rd years and acting as the go between between the exam room and the attending doc. Hmm, "monitoring," sure seems a lot like shadowing to me. Trust me, I have done plenty of shadowing already here at Pacific. Bottom line is, same amount of patients spread amongst more interns. So one might ask, what's the problem with this? Isn't this helping us to become better docs in our ability to micromanage staff in future settings? Well, I'd say yes...if Pacific had a strong clinical experience prior to 4th year, sadly it doesn't. It would be nice to see enough patients first to be confident in a high level of eyecare before learning to micromanage staff/associates. I can only imagine the contention this will create between 4th years trying to push out the designated 3rd years in the name of gaining experience. And why shouldn't this happen, tuition is pretty dang high here at Pacific, why pay $ to shadow a 3rd year and occasionally give advice, and present the case to the attending? ...Well you could always double check the 3rd years results. That is just what patients want, a >2 hour eye exam, while the 3rd yr, 4th yr, and attending blast away with High plus and BIO (can anyone say Lipofuscin?) in the name of clinical experience. There are myriads of other problems with this new model. Incoming 3rd years will know what's in store for 4th year rotations, I'm sure they will be lining up to be the carrier pigeon for 3 months of Internal. 3rd year-"Boy, this 21 point refraction is a beast, can you run and get me some Starbucks?" 4th year reply "I'd love to, I always dreamed to go further into debt to run errands," with glee. Pacific is only shooting itself in the foot with these changes. I better act fast and renew my subscription to Guns & Ammo to stay awake in the exam room. After this fails, at least I will know what tool to use to put myself out of misery (possibly a Barrett .50, -that would take a few alcohol pads to clean up). Well, I have to get back to studying Occupational Therapy, and diagnosing dyslexia even though we cant Dx. Your opinions do matter, please convince me that I am just being a negative douche, and there are rainbows and Unicorn boogers waiting to be had with this program.

 

[JAZZEYE]

Opinions are totally accepted. Starting with the class of 2012, Pacific is implementing a new clinical rotation schedule for the 4th years. Though the details are not fully concrete, there are some major concerns with the new program. 4 rotations will be offered, all 4 can be outside of the school's clinic, or 3 external and 1 internal. To entice participation in the internal clinics, the curriculum was set to have specialty tracks that combined various emphases in the field to focus on- ie: contact lens/Oc. Disease, VT/Neuro, Peds/Lo Vision, etc. It was presented that the participants would receive increased experience with these "tracks", 3 full days of specialty track (ie: CL/OcD), 1 day of primary care, and 1 day of another specialty depending on the specific track (could be VT or Peds, etc). No one is sure of the exact schedule, though a schedule for the tracks was presented when the process began. After presenting this to the faculty and students, 48 3rd year students have been roped into a bait and switch for an internal rotation for their 4th year. It seems the incoming 3rd years will be directly performing eyecare with the specialty patients, while the 4th years will be "monitoring" 2-3 3rd years and acting as the go between between the exam room and the attending doc. Hmm, "monitoring," sure seems a lot like shadowing to me. Trust me, I have done plenty of shadowing already here at Pacific. Bottom line is, same amount of patients spread amongst more interns. So one might ask, what's the problem with this? Isn't this helping us to become better docs in our ability to micromanage staff in future settings? Well, I'd say yes...if Pacific had a strong clinical experience prior to 4th year, sadly it doesn't. It would be nice to see enough patients first to be confident in a high level of eyecare before learning to micromanage staff/associates. I can only imagine the contention this will create between 4th years trying to push out the designated 3rd years in the name of gaining experience. And why shouldn't this happen, tuition is pretty dang high here at Pacific, why pay $ to shadow a 3rd year and occasionally give advice, and present the case to the attending? ...Well you could always double check the 3rd years results. That is just what patients want, a >2 hour eye exam, while the 3rd yr, 4th yr, and attending blast away with High plus and BIO (can anyone say Lipofuscin?) in the name of clinical experience. There are myriads of other problems with this new model. Incoming 3rd years will know what's in store for 4th year rotations, I'm sure they will be lining up to be the carrier pigeon for 3 months of Internal. 3rd year-"Boy, this 21 point refraction is a beast, can you run and get me some Starbucks?" 4th year reply "I'd love to, I always dreamed to go further into debt to run errands," with glee. Pacific is only shooting itself in the foot with these changes. I better act fast and renew my subscription to Guns & Ammo to stay awake in the exam room. After this fails, at least I will know what tool to use to put myself out of misery (possibly a Barrett .50, -that would take a few alcohol pads to clean up). Well, I have to get back to studying Occupational Therapy, and diagnosing dyslexia even though we cant Dx. Your opinions do matter, please convince me that I am just being a negative douche, and there are rainbows and Unicorn boogers waiting to be had with this program.

Extremely dark post..any reference to suicide, even if a joke should not be taken lightly
What is going on with this forum is way strange

 

[nc2tarheels]

Extremely dark post..any reference to suicide, even if a joke should not be taken lightly
What is going on with this forum is way strange

👍 This place has gotten worse. I used to log in a couple of times per day or once per day. Now, I'm just finding myself log in to check to see if the materials I have for sale have sold. This place is gloomy.

 

[KHE]

Your opinions do matter, please convince me that I am just being a negative douche, and there are rainbows and Unicorn boogers waiting to be had with this program.

First of all....when did the term "douche" re-enter the lexicon? The term "douchebag" was somewhat
common when I was like 7 years old and then it disappeared for decades.

Now it seems to be back in it's shortened form "douche." Where is this coming from? Does some celebrity or singer use the term "douche?"

Anyways.....I would not worry about the situation you described.

It does seem kind of annoying at first glance but it might be a good chance to make lemons out of lemonade.

I would discourage you from sitting in with the 3rd year students watching them fumble and bumble through exams. That would be a waste of time. You're right. There's going to be limited value to shadowing them.

Use the time to "drop in" on all the different patients of the clinic. If there's something intersting going on, just drop and take a look. It shouldn't take you more than a few seconds or minutes to look at a retinal lesion or a funny looking cornear.

Spend some time with the faculty members discussing cases with them, not necissarily the case that is in the chair at that moment. If your goal is private practice, seek out some faculty members who have or who have had private practices and ask them how they got started or what advice they have.

 

[thecgrblue]

Paragraphs are your friend.

Monitoring 3rd years could be pretty annoying...especially when you're trying to gain the experience yourself. KHE has a good point...just find the interesting case, pull rank, and take it over. Sounds like a sweet set-up to me in some cases. You can pick and choose the patients you want to see and make the 3rd years find something else to do.

Glad to find out about this...I will surely be doing my 4th years all external. If I recall there are quite a few externship sites at PUCO that are still in the Portland area so you should have plenty of options.

 

[KHE]

Paragraphs are your friend.

Monitoring 3rd years could be pretty annoying...especially when you're trying to gain the experience yourself. KHE has a good point...just find the interesting case, pull rank, and take it over. Sounds like a sweet set-up to me in some cases. You can pick and choose the patients you want to see and make the 3rd years find something else to do.

Yes, but experience doing what? Operating a slit lamp? You don't need that kind of experience as a fourth year. What you need is cases to see. And you don't necissarily need to see them from start to finish. There is little point in a 4th year student taking acuities or doing IOP readings or instilling drops. You need to see lesions and discuss the history and the plan with the attending. Watching 3rd years gather information will rarely be helpful.

I don't think you need to "pull rank" and take over a case. Simply pop in the room and say "Hey....I heard you have an interesting case of XXXXX. Let me take a look."

Glad to find out about this...I will surely be doing my 4th years all external. If I recall there are quite a few externship sites at PUCO that are still in the Portland area so you should have plenty of options.

That may not be the best idea. If handled correctly, there could very well be significant value to the type of "light" rotation described there.

 

[QueenieCSS]

Paragraphs are your friend.
Glad to find out about this...I will surely be doing my 4th years all external. If I recall there are quite a few externship sites at PUCO that are still in the Portland area so you should have plenty of options.

Half the class still has to do an internal so it will kind of be luck of the draw with that one. Ideally the goal was to get more clinic time, and the 3rd years have this. They basically doubled the time 3rd years get in clinic. But because of this the 4th years haven't had exposure to the specialty clinics.

In future years all of the 4th years will have gone through the specialty clinics (CL/ODST/Peds VT) and have a better idea of how to manage these patients (with the attending and 3rd years). To be fair, I think they are willing to alter how the 3rd year - 4th year balance goes as things play out. But I agree, it is tough to be the class that has to deal with the transition.

 

[lens 90 or 91]

A little clarification. 2012 is the transitional year, no need for other classes to worry (internal- all 3rd years, 4th year all externals). That's life though, I'm sure everyone has been dealt an unfair hand at some point. I feel it was a good choice to do this but wrongly implemented. The entering class of 2015 should have been the class to announce this transition to, and let them have the choice of whether to attend or not. Seems like I will be getting less bang for buck with an already high tuition. Non-issue after a year or two though.

 

[lens 90 or 91]

Forgot, paragraphs used to be my friend until info overload in formatting corrupted me. Dr. K's Ppt.'s to blame.

 

[lens 90 or 91]

Apparently my last post wasn't correct. There is still a lot of decisions up in the air and nothing concrete. There seems to be a bit of confusion with mostly the student side of things this transition is actually incorporated. More on this when we get concrete details.

 

[Busacca]

For you current opt students-
How many hours do you spend in clinic seeing patients during your third year? Just observing doesn't count. How different is the clinical experience between different schools?