Aren't you able to use 4th year electives to get teaching hospital experiences in the specialty you're interested in?
You'll have less than or equal to 4 months (thus only 4 attempts) to garner hospital LoRs if you're all preceptor for the clincal years. This is opposed to 16 months for hospital based. You can only really use july, august, sept and october for LoRs (you can use november for a rotation, but not a LoR) as applications **must** be sent in before november is over as interviews for residency run from october to early december so you wont have time to get a november LoR and sned it out before interview season is over.
I said before, and wish to reaffirm, that there are advantages to preceptor based: you can get an amazing teacher who does teach a lot, but its less likely than not, and you tend to be first assist on surgeries and very hands on, which gives you an honest and impressive advantage on your electives where you can show off your skills.
but it also leaves the knowledge end entirely up to you, and you run the risk of a single bad doc ruining the whole month for you, or simply getting a subpar experience regardless of the docs efforts due to patient flow. A busy month for a doc is still << cases than a slow month for a whole service at a hospital.
I wont sell short that very self-motivated people can make it out of preceptor based with a few solid LoRs in their 3rd year and enough clinical knowledge to make the hands on skills not look like a one trick pony, so they can shine the first 4 monhts of 4th year... but I greatly dislike the month-to-month variability potential and the fact that average-to-below-average motivated students get so little out of it. Maybe I'm biased. IDK.
as for the other guys question: ward based is another term for hospital based. Its probably a more appropriate term as plenty of preceptors are working out of a hospital, or have significant patient load through a hospital. The difference is preceptor-based is you attached to one attending, and perhaps, their PA(s). No other attendings and no residents. It also means no formal education structure. So if you go into a hospital, you're still under this guy. Ward/Hospital-based is the classic way.
My school (touro) offers hospital-based and a mixed preceptor/hospital system as some of our places are non-teaching hospitals that are attempting to switch over to teaching hositals. So they don't have residents, but also don't go full preceptor with our format. Its given me some insight into the preceptor-based model (and I read the 4-6 threads historically on this when I was trying to pick a 3rd year hospital, and the consensus was clear in all but one thread)
