Rotations suck......not learn anything

[oms2]

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incidentally, there is a current article in the n.y. times on 3rd year rotations, specifically how they're being graded
http://well.blogs.nytimes.com/2013/02/28/why-failing-med-students-dont-get-failing-grades/
Why Failing Med Students Don't Get Failing Grades

 

[felix2929]

Lots of good info in this thread, lots of complaining, lots of insight into how clinical education is structured at various places.

But what's the cause of the problem and what's the solution?

Too many students? Should we cut back on class sizes?

Are schools paying rotation sites too little (or straight-up not paying them at all)? Are we willing to pay more in tuition for better sites? Should faculty/staff/admin take a pay cut so that we can buy better sites? Isn't a major criticism of Carib schools that they buy up all their rotation sites?

Are preceptors too afraid of litigation if they let students do things? Is this a legitimate concern or are they just coming up with excuses because they don't feel like teaching/are lazy/are only in it for the CME/cash?

Are there simply not enough quality preceptors willing to teach? What would it take to improve the quality AND quantity?

Did someone screw up at a rotation site and the rest of you are paying for it? If so, how do we prevent this from happening in the future? Do we have ANOTHER layer of competence to go through before we can move from MS2-MS3? Are we willing to sacrifice board prep/class time for this?

Ultimately, you have to ask: Do the schools legitimately not care what happens to you on rotations, or are they at the limits of what is reasonable, affordable, possible, and available?

And even more importantly: What would it take for you, after you graduate from residency/fellowship, to take on an unknown MS3?

Im still waiting to matriculate but it seems pretty clear that the cause is the rapid expansion of seats at DO schools without ensuring they have enough quality clinical sites/preceptors for students. The solution is that their should be stricter oversight of how many seats are available at DO schools. MD schools have expanded too but it doesn't seem to be producing the same kind of discord that we constantly hear about with clinical education at DO schools.

 

[Dharma]

Future move by ACGME: COCA institutional standards must match that of LCME or future access denied.

Maybe?

Just a thought.

 

[GUH]

Future move by ACGME: COCA institutional standards must match that of LCME or future access denied.

Maybe?

Just a thought.

If DO students are passing the USMLE Steps 1, 2, and 3 at 90+%, that sounds like a solution in search of a problem. Either that or the standards set for passing the licensing exams are too low, in which case they need to be raised. And that's not COCA's responsibility

 

[Dharma]

If DO students are passing the USMLE Steps 1, 2, and 3 at 90+%, that sounds like a solution in search of a problem. Either that or the standards set for passing the licensing exams are too low, in which case they need to be raised. And that's not COCA's responsibility

Standardized exams could be mastered via test prep. I'm not sure of the correlation between the competency of a clinician (or the quality of his clinical education) and Step scores though, especially 1 and 2.

COCA does have the responsibility of ensuring quality education. And one of the main concerns expressed by ACGME PDs in regards to DO students is possible lacking in quality clinical rotations, with fears of selecting grads who are not up to par clinically speaking. If COCA had the best interests of DO students at heart, they would place a greater focus on its institutions meeting a high standard of clinical education- one that would remove the level of doubt expressed by some of these PDs.

Would it not be better for COCA to jump on this and instill marked improvements as opposed to waiting for a third party to call the shots? With USMD grad numbers increasing, I'm not sure anything is completely out of the question when it comes to limiting residency access somewhere along the line in the future. What better reason to limit access than questioning one's clinical education?

Regardless, these issues seem to plague DO schools a bit more than our MD friends. Someone has to do something about it. Sooner or later, someone will. Just depends on who...

 

[KnuxNole]

First line of the article:

Tall and dark-haired, the third-year medical student always seemed to be the first to arrive at the hospital and the last to leave

Such a gunner

 

[dozitgetchahi]

Lots of good info in this thread, lots of complaining, lots of insight into how clinical education is structured at various places.

But what's the cause of the problem and what's the solution?

Too many students? Should we cut back on class sizes?

Are schools paying rotation sites too little (or straight-up not paying them at all)? Are we willing to pay more in tuition for better sites? Should faculty/staff/admin take a pay cut so that we can buy better sites? Isn't a major criticism of Carib schools that they buy up all their rotation sites?

Are preceptors too afraid of litigation if they let students do things? Is this a legitimate concern or are they just coming up with excuses because they don't feel like teaching/are lazy/are only in it for the CME/cash?

Are there simply not enough quality preceptors willing to teach? What would it take to improve the quality AND quantity?

Did someone screw up at a rotation site and the rest of you are paying for it? If so, how do we prevent this from happening in the future? Do we have ANOTHER layer of competence to go through before we can move from MS2-MS3? Are we willing to sacrifice board prep/class time for this?

Ultimately, you have to ask: Do the schools legitimately not care what happens to you on rotations, or are they at the limits of what is reasonable, affordable, possible, and available?

And even more importantly: What would it take for you, after you graduate from residency/fellowship, to take on an unknown MS3?

I've discussed these issues a lot with people in my class over the last few years, and the conclusion we've come to is that it's a cultural issue within osteopathic medicine. I don't want to bash osteopathic medicine at all, but it's become pretty obvious during medical school that educational priorities are a bit different in the DO world vs the MD world. You can see this from med school all the way up through the respective residency programs (and honestly in the attendings as well). In allopathic medicine, competency, knowledge and frankly education are strongly prioritized at the undergraduate medical education level. As we've all heard, rotations are actually standardized and vetted so that everybody gets a good educational experience.

For whatever reason, this standardization of clinical education just does not seem to be a priority on the DO side. A lot of people assume this is because osteopathic schools are desperate to find clinical sites and will accept anything so that their students have somewhere to go. However, I go to an established DO school notable for having its own bona fide clinical affiliates, and we still have that tremendous unevenness in our rotations that many others have spoken of. In short, I just don't get it (and I don't want to be too critical, at least until I graduate), but I've come to accept it as a cultural reality of the DO side (which is why it doesn't seem to change). You can see it in the residencies on our side too - the same unevenness and questionable standards are often tolerated and/or essentially ignored.

 

[Oo Cipher oO]

Future move by ACGME: COCA institutional standards must match that of LCME or future access denied.

Maybe?

Just a thought.

ACGME needs to stick to post graduate training. Anything else would be way overstepping their grounds. I'm down for the merger of the residencies to the degree discussed but I would not be ok with my MD colleagues deciding on the accreditation status of my school.

 

[DrSpine]

Same thing with me, I had a horrible third year. 4th year I got drilled on my away rotations, and it was embarrassing...literally, when the residents and fellows were shaking their heads. But you know what, it was a rough time but I finally got everything down...and the residents and fellows were nice through it all, even with the frustration they'd express at times. I feel confident with intern year coming along doing an H+P.

 

[Oo Cipher oO]

In allopathic medicine, competency, knowledge and frankly education are strongly prioritized at the undergraduate medical education level. As we've all heard, rotations are actually standardized and vetted so that everybody gets a good educational experience.

You say this like no MD student has had bad rotations where they learn little or are barred from doing all but the most simple procedure. Those shadow rotations exist everywhere though it may be true that they exist more on the DO side. I'm not sure. All I can say is that at the hospital I worked at prior to medical school the biggest complaint of the rotating MD students was the lack luster learning environment provided them.

 

[Dharma]

ACGME needs to stick to post graduate training. Anything else would be way overstepping their grounds. I'm down for the merger of the residencies to the degree discussed but I would not be ok with my MD colleagues deciding on the accreditation status of my school.

That's the thing, the ACGME can decide who has access to their residencies and who does not. It already happens at the level of PD. PD says "hey, you know, I'm a bit hesitant on ranking this DO student high, because I'm not so sure about his clinical training." Boom, he gets ranked lower. Like it or not, this is one of the main reasons why we still see some DO discrimination. Who is to say that this doesn't eventually happen on a larger scale? If they expect AOA residencies to eventually meet ACGME standards or face termination, it could be possible, that one day, they apply a similar tactic in COCA vs LCME and only grant access to grads from institutions that meet a set standard. I'm just speculating, but is it that difficult to imagine?

So ACGME does stick to post graduate training, and it can decide who is in and who is out. Again, who is to say that in the future, they also take issue with the discrepancy in clinical training, and only admit those students from institutions with standards equivalent to that of LCME? What's to stop them? A pending merger (i.e. slow rate absorption?) where the AOA is at the mercy of the big guy in the room? I certainly don't think it's out of the question to say that eventually, someone will be highlighting the problems similar to those addressed in this thread as a reason to start requiring certain standards to met across the board in order to ensure access.

One may take issue with such a thing, but that doesn't mean it couldn't happen. I know there are whole bunch of DO folks in the AOA clan who are not too excited about the merger, but they didn't keep that from happening... if and when it happens that is.

Regardless of which, there should be a high standard of clinical education provided at all American medical schools, especially considering the price paid. It's frustrating to see enrollment increase and new schools being founded when issues of quality seem to be somewhat pervasive.

It's one thing to be known as the group that thinks they can heal with manipulation... but to be known as the one with shaky training... well that's just plain embarrassing.

 

[Dharma]

You say this like no MD student has had bad rotations where they learn little or are barred from doing all but the most simple procedure. Those shadow rotations exist everywhere though it may be true that they exist more on the DO side. I'm not sure. All I can say is that at the hospital I worked at prior to medical school the biggest complaint of the rotating MD students was the lack luster learning environment provided them.

True. But such allopathic schools seem to be in the minority, relatively speaking.

 

[dozitgetchahi]

You say this like no MD student has had bad rotations where they learn little or are barred from doing all but the most simple procedure. Those shadow rotations exist everywhere though it may be true that they exist more on the DO side. I'm not sure. All I can say is that at the hospital I worked at prior to medical school the biggest complaint of the rotating MD students was the lack luster learning environment provided them.

Yeah, this is true. In fact there was a thread on the allo boards not too long ago about how third year seemed like a waste of time because students didn't have any authority or clinical duties etc. Still, this phenomenon of 'garbage rotations' seems way more common on the DO side.

 

[DrBumblebee]

Yeah, this is true. In fact there was a thread on the allo boards not too long ago about how third year seemed like a waste of time because students didn't have any authority or clinical duties etc. Still, this phenomenon of 'garbage rotations' seems way more common on the DO side.

Could you please provide with that thread's link here for reference?

 

[dozitgetchahi]

Are they? And keep in mind you're answering for the entire nation, not just Philly where there's one DO school with a bunch of MD schools.

I'm not asking to be a jerk, but I'm genuinely curious, as I can't imagine that describes the majority of cases or that it can be generalized to describe most DO schools. PCOM has the benefit of being a well established DO school and it exists in a city chock full of MD schools.

But maybe I'm way off.

You're correct. I never rotated with MD students except on away rotations. The only time I've heard of this happening is at the DO schools located in big cities (PCOM seems to have rotations like this, as do NYCOM and CCOM). I think it's a stretch to say that most DO students are doing these types of rotations.

 

[felix2929]

You're correct. I never rotated with MD students except on away rotations. The only time I've heard of this happening is at the DO schools located in big cities (PCOM seems to have rotations like this, as do NYCOM and CCOM). I think it's a stretch to say that most DO students are doing these types of rotations.

My friends at MD schools in Chicago haven't specifically said anything about DO students rotating with them, but I know they have had a lot of Caribbean students. My point being, just because I went for a jog with my marathon friend runner doesn't mean I'm trained and ready for a marathon. A few rotations with MD students doesn't necessarily mean you are getting the same standard of clinical education.

 

[Lys Ile Glu Leu]

..

 

[Lys Ile Glu Leu]

.

 

[Lys Ile Glu Leu]

I give up.. 😕

 

[dozitgetchahi]

My friends at MD schools in Chicago haven't specifically said anything about DO students rotating with them, but I know they have had a lot of Caribbean students. My point being, just because I went for a jog with my marathon friend runner doesn't mean I'm trained and ready for a marathon. A few rotations with MD students doesn't necessarily mean you are getting the same standard of clinical education.

Nobody's saying they are.

 

[felix2929]

Nobody's saying they are.

on the previous page that seemed to be the intent when posters said stuff like, "most do rotations are with md students" and "while at pcom I was rotating at hospitals that have md students"

 

[cliquesh]

True. But such allopathic schools seem to be in the minority, relatively speaking.

I don't think its uncommon. I think it's the new medical education culture. I was doing an icu rotation and none of the IM residents (USMDs) i was with felt comfortable intubating a patient, so I did it, and the 3rd year students, who have been on rotations for 6months, never did a DRE or foley or anything really. This was at a top 50 medical school.

 

[Siggy]

I don't think its uncommon. I think it's the new medical education culture. I was doing an icu rotation and none of the IM residents (USMDs) i was with felt comfortable intubating a patient, so I did it, and the 3rd year students, who have been on rotations for 6months, never did a DRE or foley or anything really. This was at a top 50 medical school.

One of the hospitals at my school used to require a DRE for every admission (3 exceptions: The patient doesn't have a rectum, the student or resident doesn't have a finger, or the patient is under 18). The apocryphal story on why that changed was a student (from a different school) did one on a female without a chaperone and somehow ended up in the wrong hole.


I also don't get how students can go through an OB/Gyn rotation without doing speculum or pelvic exams.

 

[DrBowtie]

Relevant to this thread:
http://www.tulsaworld.com/opinion/article.aspx?subjectid=211&articleid=20130210_211_G1_CUTLIN422671
OSU Hospital again facing crisis

 

[Bacchus]

Relevant to this thread:
http://www.tulsaworld.com/opinion/article.aspx?subjectid=211&articleid=20130210_211_G1_CUTLIN422671
OSU Hospital again facing crisis

While relevant, not DO specific.

 

[DrBowtie]

While relevant, not DO specific.

One of the few schools with its own hospital at risk of closing or pruning whole departments. Obviously this happens at other places (Drexel) but everyone points to the state schools as the gold standards of DO education.

 

[Bacchus]

One of the few schools with its own hospital at risk of closing or pruning whole departments. Obviously this happens at other places (Drexel) but everyone points to the state schools as the gold standards of DO education.

I agree. And, the DO radiology residency at Barnabas was closed as well. I think this (OSU) comes down to poor management and low support from the government.

 

[ferning]

OP, I feel your frustration. I signed up for third year rotations in a remote town, not knowing that my school didn't really have established rotations up here yet. There isn't a residency program for hundreds of miles. All the hospitals up here are in the process of shifting to a new EHR system, too, so everyone is 'too busy' to take med students. Basically this means that whoever can take me will take me, but they mostly don't teach much and don't necessarily feel comfortable letting me do much more than shadow. I do worry a lot about being ready for audition rotations.

Fortunately, I had a great IM preceptor who asked me to write extensive SOAP notes and email them to him, and we'd go over them the next day. I'm also finally writing some notes directly now that I'm on my surgery rotation. It feels awkward, but hopefully by the end of the rotation it will feel better.

Basically, ask your attendings if there are ways for you to practice. Even if they won't let you write in the chart for real, write your own note and ask them to give you feedback on it. It's not always going to go great, but just get the most out of each rotation that you can and make sure you visit some kick-ass hospitals for your sub-internships next year. 😉

What if I decided to email them my soap note, but also a picture of my shaved scrotum? Would they help me with that later?

; )

 

[Mosonik]

One of the few schools with its own hospital at risk of closing or pruning whole departments. Obviously this happens at other places (Drexel) but everyone points to the state schools as the gold standards of DO education.

I always find this ironic because it's about the one place people are convinced the government/public sector does a better job than the private sector (not that I am saying I am for or against any particular side).
I find it interesting that some of the public school- private hospital partnerships are some of the most successful for all parties. Look at MSU-COM for example. They do a majority of their clinical/residency placements at private institutions and the quality is arguably very solid while the school itself doesn't funnel money down the drain to run it itself.

It would be a disappointment from a community health standpoint to see OSU Health Science Center in Tulsa close but perhaps the reorganization into something that is sustainable (i.e. not a publicly dependent entity) and name change (while maintaining its OSU affiliation) may be a good thing in the long run.

 

[JustAGuy]

.

 

[OR4life]

I feel like I am getting shafted big time on rotations, I do not feel like I am learning much, if at all and am really worried If I am going to be able to keep pace when I do away rotations later. I try to be proactive, but theres nothing for me to do, I "round" on the patients but tbh, since i've never really done it before, i'm not even sure what that entails, I just go into the room and ask the patients how they're feeling and basic questions. I have done 0 hands on stuff, I still don't know how to interprete auscultation findings.

 

[DubVille]

Wow, this thread made me happy I went to Ohio. It was a pain at the time being forced to resident conferences everyday, writing notes on every rotation (except family), spending most of my time inpatient, etc..... But I guess its for the best overall. Our school had almost no choice for 3rd year, they schedule it all. 4th year you could go away for electives, but you never "had" to leave your hospital for any rotations.

 

[MalachiConstant]

Wow, this thread made me happy I went to Ohio. It was a pain at the time being forced to resident conferences everyday, writing notes on every rotation (except family), spending most of my time inpatient, etc..... But I guess its for the best overall. Our school had almost no choice for 3rd year, they schedule it all. 4th year you could go away for electives, but you never "had" to leave your hospital for any rotations.

The bolded was certainly not the case at my CORE site. Things are working out ok for me, but I had a quite a few rotations that were disappointing.

Some sites are stronger than others overall. I don't know of any that are terrible, but it's probably a good idea to stay in the more metropolitan areas if you're interested in things like peds or psych which tend to be bottleneck rotations that can be of dubious quality at smaller community places.

 

[DocMonty]

I have to say that reading these posts I am amazed at how much things still have not improved for many students in years 3-4 . My school had issues like this 20 + years ago but I must say they have definitely improved the number and quality of core rotations since.
For me, being an FP DO, it is a pleasure to give back to my professsion but I am often amazed at how many students that I see rotating through my office have to really be encouraged to "dive in" and be hands on instead of just watching me. Watching OMM or an exam/procedure a few times is good but you really need to jump in and get your hands dirty too. Practical experience trumps all! Trust me. The more you do now ...the better you will do in residency. More importantly it builds confidence too.
If you are in a rotation that your school setup and you are not doing anything at all ...complain to your school! After all you are being robbed of valuable time and hands on learning.
If your attending is not really asking you to do some of their work it is probably that they feel that you are not comfortable yet? Well...ask them... tell them you want to do things and make it clear that you would very much like to and I'll bet most of them once they see you do things competently a few times will be more comfortable letting you do even more. OMM especially needs to be practiced you can't just watch. Best of luck all and PM me if you have questions.

 

[cliquesh]

I'm at a MD program. The students here get ignored by almost everyone. They write notes, but im the only one that reads them. They present, but after like 15 seconds the attendings cut them off and ask me whats the deal with the patient. If they get to a procedure it's because I (or another resident) shows them how to do it. I think medical education, in general, is just messed up, and it's not a problem exclusive to DO schools.

 

[SurgeDO]

I always find this ironic because it's about the one place people are convinced the government/public sector does a better job than the private sector (not that I am saying I am for or against any particular side).
I find it interesting that some of the public school- private hospital partnerships are some of the most successful for all parties. Look at MSU-COM for example. They do a majority of their clinical/residency placements at private institutions and the quality is arguably very solid while the school itself doesn't funnel money down the drain to run it itself.

It would be a disappointment from a community health standpoint to see OSU Health Science Center in Tulsa close but perhaps the reorganization into something that is sustainable (i.e. not a publicly dependent entity) and name change (while maintaining its OSU affiliation) may be a good thing in the long run.

MSUCOM pays for these partnerships...something that other DO schools need to start doing. 3rd and 4th year students who rotate at MSUCOM hospitals are given a boat load of autonomy and SOAP all day er'day. ****, i've been learning to SOAP since first year, first semester.


what i do not understand is how some DO schools do not have rotations set up for you during 3rd and 4th year. this is complete and utter bull ****. i would refuse to attend/pay a school hundreds of thousands of dollars if i had to call around 3rd and 4th year and beg hospitals to take me in. while i am sure there are some success stories, i am sure they are rare. honestly, schools that do this are just setting their students up to fail.

for those of you who think rotations at MD schools are all fine and dandy and incapable of flaws, you are delusional. typical "grass is always greener" syndrome combined with insecurity.

 

[dagubananas]

d

 

[LaughingMan]

This thread has been immensely helpful.

Ty to everyone contributing. Will look more into rotations.

 

[SLC]

Is it really common for students not to write SOAP's in 3rd year?

My rotations have been super demanding so far, the only one I didn't do anything "official" was radiology, and even then I was being pimped and asked to interpret radiography with my attending while he was dictating the studies right next to me.

If I wasn't being allowed to practice SOAP's, PE skills, procedures etc, my school would be getting an earful by now.

Hell, on my oncology rotation I've been asked to chart review on patients that primary care docs ask questions about. The attending generally just reads my summary and recommendations and adds/edits anything he/she thinks needs help and sends the report on.

I'm honestly a little shocked to hear some of the stories on here.

 

[dagubananas]

d

 

[Siggy]

If I wasn't being allowed to practice SOAP's, PE skills, procedures etc, my school would be getting an earful by now.

You think your school cares? They've got your money, and once you're a year in, they've got you by the gonads anyways. What are you going to do? Transfer? Bad talk them on SDN? Bad mouth them to a bunch of non-medical people?

 

[dagubananas]

d

 

[costales]

The shortcomings in 3rd year were mostly in the time my preceptors were willing to spend with me and the products I produced. There isn't much good writing notes and examining patients (especially early on) if there is little critique.

I have had some rotations that basically boiled down to shadowing, but thankfully they haven't been too frequent and I was able to change preceptors on a few before things got really bad.

All preceptorships? Is this a new school? Did they let your gloves get wet on surgery?

 

[Siggy]

I think this is an important point. Part of the reason this is allowed to continue is because students are afraid to say anything when they have a bad rotation. It makes sense- no student wants to repeat a rotation (losing vacation or an elective) or damage their reputation by complaining.

We all know that something is broken here, but we're all too invested in the middle of it to do anything substantial to address the problem. By the time we get out of school and those pressures are removed, most people have forgotten, are busy, or simply no longer care.

It's even more fundamental than that. My psych rotation 3rd year was at a location that was notorious for a terrible learning environment. I spent more time doing IM (IM morning report, lunch lectures and 2 IM overnight calls) than I spent doing things at the psych hospital... and even there it was mostly just sitting in on process sessions. I didn't do a single mental status exam my entire 4 weeks there.

The schools response? It's a perfectly good site... or else we wouldn't have approved it.

 

[dagubananas]

d

 

[SLC]

You think your school cares? They've got your money, and once you're a year in, they've got you by the gonads anyways. What are you going to do? Transfer? Bad talk them on SDN? Bad mouth them to a bunch of non-medical people?

Yes, my school does care. They ask for detailed feedback of the student's experience at the end of every rotation. And I've already had one of my rotations changed because the school wasn't happy with the experience the hospital was providing to the students.

I'm a little saddened that you would think your school doesn't care about your education. And I hope you would spread the word in whatever way you can if that's really the case. Even on here, there are a lot of kids who would be well served in having that info during application season...

I hear a lot of bad stuff about your school, which amazes me because I always thought it was one of the better ones.

 

[JediZero]

Yes, my school does care. They ask for detailed feedback of the student's experience at the end of every rotation. And I've already had one of my rotations changed because the school wasn't happy with the experience the hospital was providing to the students.

I'm a little saddened that you would think your school doesn't care about your education. And I hope you would spread the word in whatever way you can if that's really the case. Even on here, there are a lot of kids who would be well served in having that info during application season...

I hear a lot of bad stuff about your school, which amazes me because I always thought it was one of the better ones.

Western has its ups and downs, just like every other place. I do really wish things could be a little more transparent, and that students could have more of a voice. I think at the end of the day I'm still happy I came here, but I see so many things that could be made so much better. I see a lot of things in the Northwest campus that give me hope, especially with the new leadership (the Northwest associate dean was just named dean of both campuses). Time will tell, but I know will be much more interested in giving them rotations than money until things change.

 

[Siggy]

Yes, my school does care. They ask for detailed feedback of the student's experience at the end of every rotation. And I've already had one of my rotations changed because the school wasn't happy with the experience the hospital was providing to the students.

We have a site online for rotation evaluation. If it's negative, it doesn't get posted. Hence why some sites haven't had any reviews in years.

 

[Bacchus]

I'm at a MD program. The students here get ignored by almost everyone. They write notes, but im the only one that reads them. They present, but after like 15 seconds the attendings cut them off and ask me whats the deal with the patient. If they get to a procedure it's because I (or another resident) shows them how to do it. I think medical education, in general, is just messed up, and it's not a problem exclusive to DO schools.

I'm glad you're teaching your students. I'm attempting to when they're with me on rotations. Sometimes I think we take something as simple as admission orders for granted. Until I stopped and realized, "Hey, the student should be doing these H&Ps because they haven't had medicine yet" I was taking it for granted. I became aware quickly of what simple skills as an intern I take for granted. That said, if I only teach them the basic of how to survive I think I've done a good thing for them. They need to be able to function before they get a jackass who reams them out for not knowing the simple things.

 

[dozitgetchahi]

My current allo program is actually very medical student oriented...med students are expected to present competently, have a good handle on what's going on with their pts, write notes, propose plans, and write admission H&Ps and discharge summaries. I write all of those independently, but sometimes I'll use portions of the medical student work in my documentation if it's good enough. It's the polar opposite of most of my medical school experience, which was me standing around with the medical students watching residents and attendings write notes and engage in patient care.