Rotation site Characteristics

[bond80009]

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Hi,
Given the following options which provides better learning and overall experience?
Site with residents vs no residents (only attendings).
Inpatient sites vs outpatient sites.
Long hours vs free time to explore hospital.

 

[Señor S]

Hi,
Given the following options which provides better learning and overall experience?
Site with residents vs no residents (only attendings).
Inpatient sites vs outpatient sites.
Long hours vs free time to explore hospital.

-The conventional wisdom is "no residents," but I've generally found the residents to be more sympathetic to students vs. the generally apathetic attendings. I vote residents.

-Inpatient. Better learning with people who are actually sick.

-Free time, but not to explore the hospital; go home and study for the shelf. This is what the grade comes down to for most of us.

 

[Morzh]

The best overall clinical education will give you a mix of all of the above environments, with the majority of your training being in a major academic tertiary center. The few months I had one-on-one with attendings were great - faster pace and more hands on stuff to do - but I wouldn't want an entire year of that. In general, the best cases to learn from are going to be wherever residents are. I also felt the best teaching - and I mean the sit-down-and-draw-it-out-for-15-minutes-so-you-never-forget kind of teaching was usually in such an academic setting. Often the residents were better at teaching than the attendings.

You need to experience a fair amount of both inpatient and clinic regardless of private vs academic. Hours should be reasonable and facilitate education: enough so you're there long enough to see the good stuff, but not so long that you're unable to read and augment the practical experience with theory.

 

[LaurenMD]

No it isn't

Agreed - that's definitely a matter of preference. At the beginning of my clinical year, for example, I felt a lot more comfortable when I had a resident who could answer my dumb questions.

 

[Ismet]

1. With residents
2. Both
3. Enough hours to put in a good amount of work, learn by doing, and participate as a member of the medical team, with enough hours of "free time" to study for the shelf and get life things done that need to get done. You don't need to "explore the hospital."

 

[Señor S]

No it isn't

Maybe from a residents' perspective. Most students I know opt for places with no residents when possible. It's considered a selling point.

 

[PL198]

Maybe from a residents' perspective. Most students I know opt for places with no residents when possible. It's considered a selling point.

because that usually correlates with easier hours. not better teaching

 

[Señor S]

because that usually correlates with easier hours. not better teaching

The logic I usually hear is that without residents you'll get to "do more." Which I don't agree with, and don't really think is relevant. But a lot of students do feel that way, at least early on.

 

[AlteredScale]

The logic I usually hear is that without residents you'll get to "do more." Which I don't agree with, and don't really think is relevant. But a lot of students do feel that way, at least early on.

But "doing more" doesn't impress anyone. That's why you go into residency in the first place, to learn the "doing" of medicine. You need to learn how to be a resident and how to work in a team....not first assist a private practice surgeon so you can show off you technical skills to a PD who in all honestly, really won't care if you don't know how to round or perform a simple H&P.

Third year isn't learning to work like an attending (which is done in a preceptor based model), it's learning to work like an intern and resident physician.

 

[Señor S]

But "doing more" doesn't impress anyone. That's why you go into residency in the first place, to learn the "doing" of medicine. You need to learn how to be a resident and how to work in a team....not first assist a private practice surgeon so you can show off you technical skills to a PD who in all honestly, really won't care if you don't know how to round or perform a simple H&P.

Third year isn't learning to work like an attending (which is done in a preceptor based model), it's learning to work like an intern and resident physician.

All true, hence why I said that I *don't* agree that "doing more" is important or relevant (see above). But for many/most third years and soon-to-be third years putting in lines and suturing is more important than rounding or writing notes.

 

[22031 Alum]

But "doing more" doesn't impress anyone.

It impresses students, which is why that can be used as a "selling point."

 

[URHere]

Hi,
Given the following options which provides better learning and overall experience?
Site with residents vs no residents (only attendings).
Inpatient sites vs outpatient sites.
Long hours vs free time to explore hospital.

1) With residents unless there is a good reason to avoid them. For example, the surgery rotation at our university hospital is one where students get to scrub but rarely do more than stand at the foot of the bed. At our rural hospitals (without residents) students first assist on every surgery. Honestly, that was the only thing that kept me from driving my head through the wall on my surgery clerkship. Otherwise, residents tend to teach more often which can be very helpful for general hospital skills, especially on something like IM.

2) Inpatient. More rigorous with sicker patients.

3) Depends on the rotation. It's nice to have shelf study time but some rotations (e.g. ICU) should have long hours if you are going to learn properly.

 

[AlteredScale]

All true, hence why I said that I *don't* agree that "doing more" is important or relevant (see above). But for many/most third years and soon-to-be third years putting in lines and suturing is more important than rounding or writing notes.

Right, I wasn't trying to call you out because you said you disagree with it. Just making a comment.

A lot of my classmates at a DO school preferentially choose to go to a site with a small inpatient exerience, stating doing more and being first assist is more attractive to residency programs.......

 

[PL198]

Right, I wasn't trying to call you out because you said you disagree with it. Just making a comment.

A lot of my classmates at a DO school preferentially choose to go to a site with a small inpatient exerience, stating doing more and being first assist is more attractive to residency programs.......

when are they going to hear about that? when you tell them in an interview? "oh cool, anyway blah blah blah"

small inpatient experience = all bread and butter. seeing 100 COPD or CHF exacerbations doesn't teach you much more than seeing 30 + some zebras, same thing for surgery. after a few appys you've learned as much as a medical student can learn relevant to the procedure. smaller the place you go to, it'll probably be easier and less consuming but you'll learn less. so that's the trade-off and for each person to decide for themselves

 

[scoKraz4]

Was at a place with no residents. Was first assist for a majority of surgeries, did all procedures that were going on, hours were easier for sure but I balanced it with shelf studying. Learned a ton directly from attendings, especially old school tricks which you wouldn't get from many residents. I figure I will be a resident and be around them enough when in residency.

 

[22031 Alum]

Was at a place with no residents. Was first assist for a majority of surgeries, did all procedures that were going on, hours were easier for sure but I balanced it with shelf studying. Learned a ton directly from attendings, especially old school tricks which you wouldn't get from many residents. I figure I will be a resident and be around them enough when in residency.

If I were evaluating you for my residency, my concern would be that you'd be behind on stuff I would already expect you to know from Day 0. You're not going to be "around residents enough" in residency, you will BE one.

 

[scoKraz4]

If I were evaluating you for my residency, my concern would be that you'd be behind on stuff I would already expect you to know from Day 0. You're not going to be "around residents enough" in residents, you will BE one.

I mean I learn a lot of valuable stuff from my experience and if I have any gaps in my knowledge I fill it in by doing a bunch of away rotations at different hospitals for my 4th year. If there are still some stuff I have to learn, as there always is, then I learn in residency.

 

[Ismet]

I mean I learn a lot of valuable stuff from my experience and if I have any gaps in my knowledge I fill it in by doing a bunch of away rotations at different hospitals for my 4th year. If there are still some stuff I have to learn, as there always is, then I learn in residency.

It's not exactly knowledge that's the issue. It's skill, which is somewhat intangible (not surgical or procedural skills). No one's gonna care that you did X number of Y procedure if you can't work well in a team, are inefficient, are unable to manage several patients at once, etc.

When I was on surgery, the intern rarely got to scrub in. They're managing the pre and post op patients on the floor, and the list was massive (30-40 patients). On inpatient services, interns can be juggling upwards of 10 patients each if the census is high. Do you get the chance to follow several patients at once, making assessments and plans for them day to day? Working with nursing and support staff to get the patient where they need to be?

Something I've heard from many residents and attendings: The purpose of 3rd and 4th year is to learn how to be an intern. In 4th year, you get to "act" as an intern in your sub-I's. Intern year is where you learn to be a resident, and residency is where you learn to be a doctor by building on all that scaffolding you laid down over the previous years. You don't jump from 3rd year to practicing physician with a little knowledge from residency thrown in. Residency is where the majority of the knowledge and skill comes in.