Question about elective clerkships

[ncguy2005]

I'm currently researching the school I've been accepted to, and I just had a question that maybe 3rd and 4th year osteopathic med students can answer.

As far as elective rotations go, am I free to do them anywhere? By anywhere I mean, even at hospitals that aren't teaching hospitals. I mean, for example, a large 500 bed hospital serves my community and has no emergency medicine residency. If I wanted to rotate there for an elective rotation, would that be allowed? I know thats probably an ignorant question on my part, because admittedly I know little about what medical school will be like, but I'm still curious.

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[HopefulDoc1984]

I'm currently researching the school I've been accepted to, and I just had a question that maybe 3rd and 4th year osteopathic med students can answer.

As far as elective rotations go, am I free to do them anywhere? By anywhere I mean, even at hospitals that aren't teaching hospitals. I mean, for example, a large 500 bed hospital serves my community and has no emergency medicine residency. If I wanted to rotate there for an elective rotation, would that be allowed? I know thats probably an ignorant question on my part, because admittedly I know little about what medical school will be like, but I'm still curious.

You can go anywhere you want but you have to find a preceptor physician who will take you on for the month and then they have to fill out paperwork with the school and be approved.

 

[ncguy2005]

You can go anywhere you want but you have to find a preceptor physician who will take you on for the month and then they have to fill out paperwork with the school and be approved.

Are most doctors generally willing to take you? Also, does it matter if you do it outside of a teaching hospital? I mean... do PD directors for residency programs frown upon doing it this way?

 

[HopefulDoc1984]

Are most doctors generally willing to take you? Also, does it matter if you do it outside of a teaching hospital? I mean... do PD directors for residency programs frown upon doing it this way?

You dont have to do it at a teaching hospital but it is much easier to find a preceptor at teaching hospitals. I dont think PDs care whether or not you did the majority of your rotations at a teaching facility as long as you get good marks from your preceptors and you have good LORs. I am doing 6 months at a non-teaching hospital and the remaining 18 months at teaching hospitals. You will learn much more by being at a developed teaching institution rather than random hospitals throughout the country but it is also a good idea to do some rotations at non-teaching hospitals where you can get some hands on experience.

 

[LovelyRita]

I'd recommend seeking out teaching hospitals. Had a DO student rotate with us a few months back who had previously done a rotation with a private doc in the middle of nowhere. I'm pretty convinced they weren't actually taught anything, and that the doc probably treated it like "take your kid to work" day. At least at a teaching hospital you can be with residents and attend required didactics and have a more structured learning environment.

 

[nascardoc]

Yes, you can do rotations with docs that are not part of teaching institutions. Like a previous poster said, you have to find a doc who will be willing to be your preceptor and fill out the paperwork. From my experience, doing rotations at a non-teaching (i.e. hospital with no residency programs) can be a very good thing. Many times the docs will let you do a lot and be a major part of the team (much more so than rotating thru a huge teaching site). The downside is that they can be more protective of their patients, so they may not let you do certain things, like pap smears, breast exams, etc., especially if you are the opposite sex. For example, the hospital I am doing my core rotations at is a non-teaching site and we are 1st assist on surgeries, catching babies in OB, and doing tons of procedures. It's just the doc and us, so we get first-hand experience, which only helps come audition rotation time.

The biggest thing you want to know is if they will let you do procedures. Some places will let you do just about anything and others won't let you do anything. But doing a rotation with a private doc can be very beneficial, especially if they know the program directors at residency programs you are interested in and let you do a lot. I did a rotation with a private doc who knows a program director very well, and even though I may not have been able to do as much as someone at a major level 1 center, the LOR I will recieve is as good as gold come residency interview time

 

[Doctor Bob]

There are other drawbacks of doing an elective at a non-teaching hospital is the insurance issue. As a medical student having patient interactions you will be required to have malpractice insurance for all of your rotations. Your school will have a policy in place that will protect you throughout most of your four years (making it something you never have to worry about). But if you head out of state you may go somewhere that requires different limits than those provided by your school and then you'd have to pay for a malpractice bridge policy to make up the difference. These can be very pricey.

A teaching hospital has already determined liability for students and how the supervision process is structured, thus allowing you to do procedures, scrub in for surgeries, etc. A non-teaching hospital is going to have to do this from scratch, so the general counsel of the hospital will have to be involved at an early stage because this is not a quick process.

Next, if you're a patient who comes into a teaching hospital, there will be a piece of paper you sign at some point during the admission process stating that it's ok for a student to see you. Non-teaching facilities don't do this, so every patient you contact would have to consent to your participation in their care.

The rotation site will also have to provide your school with a curricula outlining the rotation objectives, how the didactic portion will be structured and so forth. This requires a bit of work on the part of someone at the site. For teaching facilities, this has been done long ago.

Going to a non-teaching hospital isn't as simple as going to a teaching hospital. If you want to do a rotation at a teaching facility it usually just involves calling the right person a few months in advance. Going to a non-teaching facility can be a process that needs to start up to a year prior to the rotation start date. Not to say it can't be done.

I wanted to go back and do an elective rotation at the hospital that I used to be an ED tech at before medical school. I found a doc willing to oversee me, they went through all the work to develop a curriculum that met my school's requirements for the rotation. The legal department at the hospital drew up some policies that would let me work in the department. But it all fell apart when it came to the malpractice insurance. My school in Florida had a policy which covered students for 1 million individual / 3 million aggregate. The hospital I wanted to go to was in Virginia which required all medical students have a 2 million individual / 5 million aggregate so I was going to have to pay for a one month bridge policy to cover the difference in order to do the rotation. The cost wasn't worth it to me, so I ended up making plans at another hospital.

 

[Doctor Bob]

So.. for example the school I'm going (Ga-PCOM) has rotation sites in NC, which is where I'd like to do most of my rotations... so... would that mean Ga-PCOM already meets the malpractice insurance standards of the state?

Yes it should

 

[scpod]

....I dont think PDs care whether or not you did the majority of your rotations at a teaching facility as long as you get good marks from your preceptors and you have good LORs....

They do, at least for AGME residencies. Every time I interviewed at an ACGME residency I was quizzed about the number of rotations I did at teaching hospitals and was asked to describe my rotations in detail on several occasions. This is because ACGME PDs know that many osteopathic rotations are just thrown together and aren't really good learning experiences. Never once came up in an interview at AOA spots, though.

 

[iowafarmstud]

So I am curious about the whole "Non-Teaching" Hospital vs. the "Teaching" hospital. During our 3rd year we do a lottery system to match where we are doing our 3rd year. I know that each can have their advantages (hands on vs being around residents/PD's), but I was wondering what the general consensus is on what is best for your CORE rotations? Does it matter much if it is at a non-teaching? Would you recommend trying to go to a teaching hospital or is it better to get hands on and not be around tons of residents/other med students? I guess the biggest thing for me is passing and doing well on each shelf exam after the core rotations...so is there any opinions out there what might be best? Thanks!!

 

[scpod]

So I am curious about the whole "Non-Teaching" Hospital vs. the "Teaching" hospital.

There are some attendings at "non-teaching" hospitals who really do love to spend the time with you teaching you and letting you do all kinds of things. There is nothing wrong with that because you can learn a lot from them. But, the only way you can really find out who these guys are is from your upperclassmen who have been there before. Ask them about their rotations and who were the good guys to rotate with. Ask them who they learned a lot from.