Preceptorship vs. Hospital-Based

[AviatorDoc]

Ok, folks. This is my first post with any real pragmatic substance. I need to decide between doing a preceptorship or hospital-based program for my clinical rotation years.

Let me explain a sec. Our school (KCOM) is so rural our students are sent to other parts of the country to do the 3rd & 4th years. Some sites are hospital-based, some are preceptor-based. As a general trend, Western states are preceptor-based, and Eastern-states are hospital-based.

The preceptorship program emphasizes an outpatient, one-on-one, hands on sort of training. Few residents & interns. Again, mostly clinics, except of course for internal med, surg, etc. When the doc goes home, you go home.

A hospital-based program is the traditional, floor-by-floor tour of the hospital (exceptions being family practice, etc.). Lots of residents & interns. May not get as much hands-on experience. When the doc goes home, you're off to another floor to learn about something else.

These are my impressions of the programs. I REALLY want to go to Arizona (preceptorship) based on location (I'm from AZ and my wife is from CA), but I think the hospital-based programs will offer a better education overall.

Any thoughts at all would be greatly appreciated.

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[yellowhat]

Be careful with your assumption that preceptor based rotations are "hands-on".

If it is a rotation with a private practice physician, they are likely unpaid by your school. They also depend on their practice for their livelihood. My experience has been that in rotations with a private physician, students get LESS hands on, and are excluded from any exam or procedure which may be sensitive or embarassing. Private physicians will often not even risk asking their patients if it is ok if the student participates in X exam.... They don't want to risk offending their paying patients by even asking.

I have heard on many occasions the thought that you will get to spend more one-on-one time with an attending with the preceptor based rotation. I really don't buy it. Maybe 20-30 years ago this was the case, but today private physicians are less willing to spend time with a student, let alone risk having a student learn on his patients and risk scaring away his income source. DO schools have clung to this outdated method of clinical education for far too long.

an easy test for you, ask to see students logs from rotations. How many procedures are they performing at the different sites? that will be a good barometer.

 

[njdevil]

There are certainly advantages and disadvantages to both.

For example, a preceptor-based you will work with an attending one-on-one, so if she/he is teahing oriented you will be taught by an attending. But then again in a residency program, it exists to teach, so you are going to get didactics and if the team of residents are competent they will teach.

Another thing is that private docs have private patients, you are more apt to do procedures in a hospital with less insured patients which usually has a residents.

The difficulty with Arizona, is that it has limited osteopathic residency programs. At the lattter part of third year, heading into fourth you will want to do "audition" rotations. Will that region, have enough or will you have to travel?

KCOM 2003

 

[AviatorDoc]

I'm torn between getting the absolute best education possible and lifestyle issues. One of the best teaching hospitals in the KCOM fold is in Detroit, but I don't think I'd ever want to go there.

I don't care specifically about going to an AOA residency. There are several ACGME residencies in the state, and my areas of interest right now (FP, Peds, Psych/Neuro, Ob, genetics) are not terribly competitive.

I'm actually one of those guys who said during the interview that I'm interested in primary care fields in a rural setting...

Ok, so maybe I'm the one guy who meant it.

 

[njdevil]

If residency isn't an issue...go where in the country will make you happy...KCOM will drop a site if the quality is not up to par. There are sick people everywhere to learn from.

 

[T. Michelle]

Originally posted by AviatorDoc
I'm torn between getting the absolute best education possible and lifestyle issues. One of the best teaching hospitals in the KCOM fold is in Detroit, but I don't think I'd ever want to go there.

As someone who grew up in the metro Detroit area, I can tell you that it's really not that bad. Seems like Hollywood likes to make it sound worse than it is.

 

[AviatorDoc]

Didn't mean to slight Detroit specifically. I haven't been there, and I'm not one to judge so quickly. People I've known that are from there have told me about it, and from their experiences, I don't think I'd want to live there. I wouldn't want to live in downtown Manhattan either, but that's just me.