Preceptor vs residency-based rotations

[Dr_Jan_I_Tor]

I'll keep it short and succint:

My school allows us to choose locale for M3/M4 years. Some are designated as the rotations being preceptor-based while others are considered residency-based.

Is there any major difference in experience between the two? Or does it not really matter?

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[Neopolymath]

Residency based. Hate to be that guy but there are probably one hundred+ threads on this exact discussion. Look at them.

 

[DOVinciRobot]

Residency based

 

[deleted1139416]

Residency based. Hate to be that guy but there are probably one hundred+ threads on this exact discussion. Look at them.

Residency based

Do you guys recommend this only to get experience in a residency environment or because residency programs specifically focus on performance in ward based rotations? Either way, if your school only gives you a couple of these in 3rd year, do you recommend doing residency based electives in 4th year to make up for it? Thanks!

 

[group_theory]

Residency based (if available)

Preceptor based clinical rotations are highly variable. You may receive great experience and education, with one-on-one teaching and lots of procedural experiences. Or you may be a glorified scribe or just shadowing an attending and learn by osmosis (and studying for the shelf)

With residents, you may be on the wards or even in a office/clinic environment BUT you are seeing/learning how residents interact with the attendings, and seeing the responsibilities they have. You will gain experience rounding, writing notes, presenting to teams on rounds, etc. You will be interacting with teaching attendings who interact/teach residents on a daily basis and know what to expect from residents (and students). Expectations from 3rd year med student is different from a PGY1, a PGY3, or a PGY6 fellow. Also not all teaching attendings are nice/great, but also something to learn/experience as well.

And when it comes to residency application, how will program directors (and associate/assistant program directors) know what type of education you received during your preceptor based rotation? While they can deep dive into your files/application to learn more - most likely they won't because they have hundreds/thousands of applications to go through.

The question is - on July 1, will you be ready to be the intern on service, taking over an inpatient team? Do you want your first inpatient ward experience to come as an intern on service on July 1?


Something else to keep in mind - some of your MD student colleagues will be presenting in department grand rounds, or presenting at regional or national meetings. Some are publishing with residents/attendings co-authors. They are your "competition" for residency.

 

[DrZoidbergDO]

Something else to keep in mind - some of your MD student colleagues will be presenting in department grand rounds, or presenting at regional or national meetings. Some are publishing with residents/attendings co-authors. They are your "competition" for residency.

My rotations are mostly preceptor based and I'm doing that. its not like there's some magic force field that only allows people in hospitals to do research.

also my 2 cents: i have tons of time to study for boards compared to my friends who are in the hospital. i'll take a excellent step score over spending 16 hours a day 6 days a week in the OR holding a retractor.

 

[AlbinoHawk DO]

Never do preceptor-based. I made that mistake. 99% of the time they take students to treat them like MAs and teach nothing

 

[deleted1139416]

Residency based (if available)

Preceptor based clinical rotations are highly variable. You may receive great experience and education, with one-on-one teaching and lots of procedural experiences. Or you may be a glorified scribe or just shadowing an attending and learn by osmosis (and studying for the shelf)

With residents, you may be on the wards or even in a office/clinic environment BUT you are seeing/learning how residents interact with the attendings, and seeing the responsibilities they have. You will gain experience rounding, writing notes, presenting to teams on rounds, etc. You will be interacting with teaching attendings who interact/teach residents on a daily basis and know what to expect from residents (and students). Expectations from 3rd year med student is different from a PGY1, a PGY3, or a PGY6 fellow. Also not all teaching attendings are nice/great, but also something to learn/experience as well.

And when it comes to residency application, how will program directors (and associate/assistant program directors) know what type of education you received during your preceptor based rotation? While they can deep dive into your files/application to learn more - most likely they won't because they have hundreds/thousands of applications to go through.

The question is - on July 1, will you be ready to be the intern on service, taking over an inpatient team? Do you want your first inpatient ward experience to come as an intern on service on July 1?


Something else to keep in mind - some of your MD student colleagues will be presenting in department grand rounds, or presenting at regional or national meetings. Some are publishing with residents/attendings co-authors. They are your "competition" for residency.

There are advantages to preceptor based rotations though.

The most obvious is having one-on-one time with a seasoned attending who knows that they are doing - I remember so many times when I would ask questions to residents and they couldn’t answer them, and some of them took it too personally and took it as a personal attack.

The second is seeing more patients - the residents on my IM rotation just took the ICU patients for themselves because they didn’t want to be slowed down, whereas I saw plenty of ICU patients on my preceptor based IM rotation.

The third is having a solid boss-employee relationship without having to deal with the hierarchy (I made a post several weeks ago about getting caught in the middle of a resident and attending who disagreed with each other).

Any rotation can be great or terrible regardless of whether it’s preceptor or ward based. But I just wanted to highlight some of the advantages of a preceptor rotation.

 

[deleted1139416]

Never do preceptor-based. I made that mistake. 99% of the time they take students to treat them like MAs and teach nothing

This is 100000% the fault of the school. The school should be monitoring for preceptors like this. Not to mention that MANY residents do this also because they are learning their own specialty and don’t want to be bothered by a medical student.

 

[MDMechEngr]

i'll take a excellent step score over spending 16 hours a day 6 days a week in the OR holding a retractor.

this happened to me at my MD OR clinical rotation, but regardless, I too as well as most of my class mates will have excellent step scores as our arverage is around 250. LMAO.

 

[Ho0v-man]

Residency based. Not the end of the world if you end up preceptor based. But you need to learn what residency is like and what the typical expectations for residency are. You don’t learn that from preceptor based rotations and you’ll be behind in your subi’s come 4th year if you go that route.

That said, you could probably get away with just residency based in IM +/- the field(s) you’re interested in. But it kind of cheats you out of knowing what you’d actually like.

For instance, you might really think your chill preceptor based rotation with a community general surgeon who doesn’t take call or work weekends is awesome and make you consider the field. Then you do a general surgery sub-I and quickly realize it’s not for you. Had your 3rd year rotation been residency based, you could’ve saved yourself a lot of time.

 

[DOVinciRobot]

Residency based (if available)

Preceptor based clinical rotations are highly variable. You may receive great experience and education, with one-on-one teaching and lots of procedural experiences. Or you may be a glorified scribe or just shadowing an attending and learn by osmosis (and studying for the shelf)

With residents, you may be on the wards or even in a office/clinic environment BUT you are seeing/learning how residents interact with the attendings, and seeing the responsibilities they have. You will gain experience rounding, writing notes, presenting to teams on rounds, etc. You will be interacting with teaching attendings who interact/teach residents on a daily basis and know what to expect from residents (and students). Expectations from 3rd year med student is different from a PGY1, a PGY3, or a PGY6 fellow. Also not all teaching attendings are nice/great, but also something to learn/experience as well.

And when it comes to residency application, how will program directors (and associate/assistant program directors) know what type of education you received during your preceptor based rotation? While they can deep dive into your files/application to learn more - most likely they won't because they have hundreds/thousands of applications to go through.

The question is - on July 1, will you be ready to be the intern on service, taking over an inpatient team? Do you want your first inpatient ward experience to come as an intern on service on July 1?


Something else to keep in mind - some of your MD student colleagues will be presenting in department grand rounds, or presenting at regional or national meetings. Some are publishing with residents/attendings co-authors. They are your "competition" for residency.

My rotations are mostly preceptor based and I'm doing that. its not like there's some magic force field that only allows people in hospitals to do research.

also my 2 cents: i have tons of time to study for boards compared to my friends who are in the hospital. i'll take a excellent step score over spending 16 hours a day 6 days a week in the OR holding a retractor.

I was asked point blank in more than one interview if my 3rd year surgery rotation was residency based. One PD went as far to say he doesn’t take DOs who only did preceptor rotations because he’s seen them struggle too much at the start of residency.

It’s pretty obvious when the DO 4th year sub I’s come if their previous experience was just 1 on 1 with an attending vs working in a resident team. And it’s pretty much only a DO thing, as the MD students unanimously have done resident rotations and know what the expectations are.

We can teach a new intern surgery things, but we don’t want to have to teach them the basics of how to perform in the team and what their role is. That’s the learning you miss out on in preceptor rotations.

 

[Goro]

My rotations are mostly preceptor based and I'm doing that. its not like there's some magic force field that only allows people in hospitals to do research.

also my 2 cents: i have tons of time to study for boards compared to my friends who are in the hospital. i'll take a excellent step score over spending 16 hours a day 6 days a week in the OR holding a retractor.

I get where you're coming from, but the risk in this is that will you be adequately prepared for residency? I fear that this is what leads residencies to be leery of DO grads.

 

[deleted1139416]

Would 3 residency based rotations during 3rd year be solid enough to prepare me for auditions and have residency programs be happy with?

 

[DOVinciRobot]

Would 3 residency based rotations during 3rd year be solid enough to prepare me for auditions and have residency programs be happy with?

Probably. A good rule of thumb is to try and have residency based rotations for IM and whatever specialty you are interested in.

 

[deleted1139416]

Probably. A good rule of thumb is to try and have residency based rotations for IM and whatever specialty you are interested in.

I'll have all 3 of them in IM and FM. I want to go into neuro but my neuro rotation won't have residents but it will have rounds with multiple attendings and med students. Unfortunately I can't change it at this point but I hope that I can make up for it with my electives and SUBIs. I am planning on doing a neuro elective at an academic med center with residents in July followed by a SUB-I in August. I will also be doing electives with residents in the latter half of my 4th year to get more wards based experience for intern year.

 

[Dr_Jan_I_Tor]

Thanks all.

The school does post the eval results for all rotations but that doesn't tell us much. None of the preceptors are rated below 4/5 on average, but that tells you nothing as you don't know if it was a great rotation or if those students were happy to be sent home early.

They only have 12 seats in the one region that is residency-based and I'm sure plenty of people will put in for it. However, for the rest, they do ensure you do at least 2 rotations with a residency program, one of them is IM and the other you can select.

So, if I'm considering surgery to any degree, I'm guessing I should request my second residency-based rotation be gen surg? And then try to arrange early 4th year to be largely residency-based if possible?

 

[DrZoidbergDO]

I get where you're coming from, but the risk in this is that will you be adequately prepared for residency? I fear that this is what leads residencies to be leery of DO grads.

i agree that you absolutely should do multiple residency based rotations in the field you want to do. but i personally think for the vast majority of rotations spending tons of time like that is just stupid. Like i have no interest in surgery or obgyn. if i had been forced to retract for 16 hours a day my career would not have been any different, i just would have been much more miserable that month.

 

[DrZoidbergDO]

I was asked point blank in more than one interview if my 3rd year surgery rotation was residency based. One PD went as far to say he doesn’t take DOs who only did preceptor rotations because he’s seen them struggle too much at the start of residency.

It’s pretty obvious when the DO 4th year sub I’s come if their previous experience was just 1 on 1 with an attending vs working in a resident team. And it’s pretty much only a DO thing, as the MD students unanimously have done resident rotations and know what the expectations are.

We can teach a new intern surgery things, but we don’t want to have to teach them the basics of how to perform in the team and what their role is. That’s the learning you miss out on in preceptor rotations.

if you're a psychopath who wants to do surgery, absolutely do residency based. but if someone is going into peds it literally will not affect their life in any way.

 

[DOVinciRobot]

if you're a psychopath who wants to do surgery, absolutely do residency based. but if someone is going into peds it literally will not affect their life in any way.

Lol that’s fair.

 

[DrZoidbergDO]

Lol that’s fair.

yeah i totally get the reasoning behind doing residency based rotations. absolutely do those in the field you want to go into. but imo this site has a hardon for prestige and university programs when some of us want to match at a nice community site and just live our lives

 

[DOVinciRobot]

yeah i totally get the reasoning behind doing residency based rotations. absolutely do those in the field you want to go into. but imo this site has a hardon for prestige and university programs when some of us want to match at a nice community site and just live our lives

Oh for sure. I fully admit my perspective is skewed because community or not surgery programs want to see you do residency based surgery rotations. Hell, even my home DO program wanted to see them.

For stuff like FM and peds it doesn’t really matter

 

[Kardio]

Halfway through M3 and my residency-based rotations have been superior to my preceptor-based ones in just about every way.

 

[Niwrad]

I guess doing both would be better.

Also there are both not so great residency based as well as preceptor based rotations. The variability is very high

 

[NeuroHopeful1]

I liked having residency based core rotations since they were more standardized and I feel they prepare you well for residency.

Preceptor based was all over the place, I had some treat me like a scribe or premed shadow and others that treated you like an intern. The best rotation I had was with a preceptor that just gave you 3 new patients in the morning and wanted you to round, present and have notes done when he rounded in the afternoon.

I also felt like my stronger, more personal letters of recommendation came from preceptor based rotations vs the chair. I got to know the attendings better and vice versa to where they'd offer to make calls to PDs me.

Residency based core rotations + preceptor electives seems to be a good middle ground.