Schools: best clinical training

[EvoDevo]

I'd like to discuss which schools have very good clinical training (MS3-4). Honestly, after cost, this is the most important criteria for a school. Your thoughts? Also, feel free to correct what you may see as erroneous information. 🙂

My votes (via personal research/friends):

1. Baylor/UT Houston (both in the TMC, tons of opportunities, little scut)
2. UT San Antonio: I hear that the students get a lot of responsibility as third years....
3. ????

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[Freakingzooming]

this is more a joke than anything so don't be offended by this: but when I was reading MSAR.... it seemed like the lower ranking schools or the ones we would consider the safety ones.. always had great clinical exposure and experience... like temple, rosalind franklin, vcu...etc. it seemed like if nothing else, you would be in the OR, closing up, in the ER, treating bulletwounds. i guess MSAR was trying to find a silver lining thru the AOA probation stuff and high tuition, rising student debt... etc.

 

[EvoDevo]

😕

 

[IndyZX]

this seems like a really difficult thing to research, and i feel like im going to have trouble with it. i would think that schools can pretty much tell you what they think you want to hear.

 

[drguy22]

NJMS! 👍

 

[W222]

Look at the primary care rankings and the reputation of the program as reflected by residency directors. This can tell you a little info, although the residency thing is fairly biased and scewed. I have heard from friends that institutions that train alot of residents dont have the best clinical education because the residents are getting alot of the better cases and med students are left with typical case work.

 

[Code Brown]

I'd like to discuss which schools have very good clinical training (MS3-4). Honestly, after cost, this is the most important criteria for a school. Your thoughts? Also, feel free to correct what you may see as erroneous information. 🙂

My votes (via personal research/friends):

1. Baylor/UT Houston (both in the TMC, tons of opportunities, little scut)
2. UT San Antonio: I hear that the students get a lot of responsibility as third years....
3. ????

Any school that has a county hospital and lets you practice (errr....learn) on patients. The only drawback is that it's going to be in the ghetto somewhere.

 

[Darko]

I agree with previous posters - seems like the primary care focused or urban ones give you a good background.

 

[Sweet Tea]

ECU!!! (not that i'm biased or anything 😉)

 

[taehong81]

Emory has Grady Memorial Hospital, one the biggest county hospitals in the US. Also it the number 1 tramua center for downtown Atlanta. You have lots of responsbility as a third year.

 

[principessa]

Ask a physician you respect, or ask students who go there, or ask your interviewer at the school what they think. This is difficult to judge objectively.

 

[MacGyver]

1. Hopkins (best hospital in the world, great responsibility because every patient there is indigent. Indigent patients = more student teaching opportunities)

2. Harvard (best COLLECTION of hospitals in the world, would be #1 if it had more indigent patients)

3. Baylor (downgrade a bit because of competition in the TMC with UT Houston)

4. Duke

5. Penn

6. UCSF

 

[DoctorG]

My vote would be for the UIC teaching hospitals especially Christ hospital and Lutheran. Of course, l'm biased 🙂

 

[slackerjock]

my vote: NONE.

After 4 years of medical school with a newly minted MD, how many procedures are you qualified to perform? Taking a blood sample or monitoring blood pressure?

I find it ironic that vet/dentists grads are VERY qualified to perform procedures (granted on low-er risk procedures on dogs and teeth), yet the average new MD is for the most part clueless. Here's my vote to making med schools more clinically oriented because its pretty pathetic that nurse/physician assistant could out perform a new MD in a hospital setting.

If i had to choose, i'd guess the lower ranked schools and urban schools.

 

[wishnhopn]

Best thread I've seen yet...

 

[Dr Dean]

1. Hopkins (best hospital in the world, great responsibility because every patient there is indigent. Indigent patients = more student teaching opportunities)

2. Harvard (best COLLECTION of hospitals in the world, would be #1 if it had more indigent patients)

What's with you and "indigent patients". A patient's a patient and is deserving of the same respect whether rich or poor. If your saying this because you think it's right to take advantage of the indigent- who easily go overlooked, then you are a fool and should reconsider what makes for a good learning experience. 👎

 

[pseudoknot]

What's with you and "indigent patients". A patient's a patient and is deserving of the same respect whether rich or poor. If your saying this because you think it's right to take advantage of the indigent- who easily go overlooked, then you are a fool and should reconsider what makes for a good learning experience. 👎

I agree with you 110%. However, it's possible that he was referring to the fact that county hospitals are often said to give students more responsibilities, presumably because those in charge have the aforementioned horrible attitude. It is still a potential benefit for students (although you're kind of profiting from their misfortune).

Please let this be as close as I ever come to agreeing with MacGyver. I need to shower now. 😉

 

[Shaz]

1. Hopkins (best hospital in the world, great responsibility because every patient there is indigent. Indigent patients = more student teaching opportunities)

2. Harvard (best COLLECTION of hospitals in the world, would be #1 if it had more indigent patients)

3. Baylor (downgrade a bit because of competition in the TMC with UT Houston)

4. Duke

5. Penn

6. UCSF

ahem...UCLA anyone? I'd say it's second to only JHU (and EVERYTHING is second to JHU)

 

[fourthyearmed]

my vote: NONE.

After 4 years of medical school with a newly minted MD, how many procedures are you qualified to perform? Taking a blood sample or monitoring blood pressure?

If i had to choose, i'd guess the lower ranked schools and urban schools.

I agree with both these statements. I hardly even know how to draw blood, that's what nurses are for. I also have heard the higher ranked the schools, the less patient contact because there are more fellows and residents who come first.

 

[Fusion]

What's with you and "indigent patients". A patient's a patient and is deserving of the same respect whether rich or poor. If your saying this because you think it's right to take advantage of the indigent- who easily go overlooked, then you are a fool and should reconsider what makes for a good learning experience. 👎

In MacGyver's defense, I do not believe that he meant that indigent people are any less deserving of the best medical care. It's just that hospitals located in primarily underserved (i.e., "poor") areas are typically very busy and usually have a large patient population. This translates to more responsibility given to medical students.

I would agree that attending an urban medical school will generally provide medical students with a better clinical foundation than would a school that is affiliated with hospitals that receive a lower patient volume. From what I hear, the clinical experience at the University of Miami is amazing. An anesthesiologist I worked with who graduated from there told me that as a fourth-year med student, she was often performing procedures without supervision. Granted, she knew her stuff and the attendings trusted her skills, but such a thing is practically unheard of at many other medical schools.

 

[jetskigirl]

Though I'm not qualified to assign which school is the top, I would definitely put Mayo somewhere up there. Clinicals are done one-on-one, rather than in a group, and you're with a doc rather than with residents. Of course, you do lose 13 weeks to do research, but the reputation of Mayo grads doesn't seem to be suffering because of this. Also, Mayo is the top hospital for neurology, so if this is what you want to go into (like me), I see Mayo as the best place to get exposure.

 

[Bear1220]

1. Hopkins (best hospital in the world, great responsibility because every patient there is indigent. Indigent patients = more student teaching opportunities)

2. Harvard (best COLLECTION of hospitals in the world, would be #1 if it had more indigent patients)

3. Baylor (downgrade a bit because of competition in the TMC with UT Houston)

4. Duke

5. Penn

6. UCSF

Reputation doesn't matter when it comes to clinical training. Plus, have you gone through the clinical training at each of these schools? Also, each student has different experiences during his/her clerkships.
We don't need to rank everything...

 

[Mumpu]

IMHO, procedures are not clinical skills.

Your experience in 3rd and 4th years depends on your intern, your resident, your chief resident, and your attending much more than on what school you go to. At the same time my friends at certain high-ranked traditional East Coast schools report soporific rounds, severe pimping, and massive scutting as established routines and part of the "traditional" education. I think my school (U Colorado) has so-so 1st and 2nd years (not that it matters... they are bad everywhere... Step 1 scores are affected by your efforts, not by the curriculum) and really strong clinical education. We have extensive early patient contact (half-day clinic with a preceptor every week starting the first month of first year... better than almost every other med school I've heard of). You also rotate through a wide range of hospitals from a level 1 trauma center (Denver Health -- the original Knife and Gun Club if you've seen the book) to private hospitals and indigenous clinics.

I think extensive early patient contact is one of the most important parameters for picking a school. First two years suck and doing real clinics with real patients every week helps you to stay focused on why you went into medicine in the first place.

 

[EvoDevo]

That's the kind of info I'm looking for. Thanks!

Too bad U Colorado practially rapes out of state students. 👎

 

[Mumpu]

It's only for a year, you become in-state after that. It still sucks (the high tuition is the actual cost of education) but the state keeps taking away funding from all higher education.

 

[Johnisit1234]

I agree with the fact that reputation doesn't necessarily equal great clinical teaching. Yes, Harvard has an incredible array of hospitals -- great for various specialities, etc -- however, their clinical education is 'incredible.'

Someone mentioned before, schools with county (or very urban) hospitals and a rural focus give good clinical training. USC, Emory, Tulane, Hopkins offer incredible opportunities because of the types of hospitals and patients they serve.

 

[citygirl]

Just to add my two cents to the "indigent patient" issue...

Indigent patients also tend to seek their primary care from the ER. Not only do you see gunshot wounds but you will also see the run of the mill stuff like upper respiratory infections. That translates into more experience with everything, not just true emergencies.

 

[asianpride]

At Mayo Medical School students start a significant amount of clinical experiences during the second year. They spend 1/2 day everyday in the clinic. THey spend a few weeks in all of the major departments from pediatrics to general surgery.

 

[VienneseWaltz]

1. Hopkins (best hospital in the world, great responsibility because every patient there is indigent. Indigent patients = more student teaching opportunities)

I take it you've never heard of the Marburg ward? While we do have a large population of indigent patients, we also have a large percentage of national and international patients who are far from indigent.

But you're right, though, it is the best hospital in the world. 😉

Someone else mentioned that at prestigious programs, the "best" cases go to the residents--this is great for med students, because the "boring" bread-and-butter cases are exactly what we should be working on. I should also mention that Hopkins students rotate through a community hospital, Bayview, which is great for this sort of thing. OK, advertisement done. 😀

First-year clinical contact can be overrated. While I really enjoyed seeing patients once a week with my preceptor and working at the free clinic, you simply don't know enough at that point to get much out of it. Yes, it's fun, but I wouldn't make a school decision based on it.

 

[Mumpu]

Opportunities does not equal education. Many schools with "great opportunities" and "best hospitals in the world" do not have a framework for teaching students clinical skills because they are too busy cranking out academic physicians.

As for first-year patient contact, I learned pharmacology, pathophysiology and exam/interview skills. The whole idea of education is to actually learn something you didn't know before and learning about medicine (the art of taking take of sick people) from patients is far better than learning about Kreb's cycle from droning PhDs. I kicked butt on Step 1 because of my clinical skills, not because of lectures.

IMHO making med students in their third year take bread-and-butter cases is total scutwork. I carry almost exclusively ICU patients and difficult ward patients. The routine cases need to be worked through once (you will have them a thousand more times as intern/resident). After that, you are learning didley-squat and you are not challenging yourself.

 

[VienneseWaltz]

I kicked butt on Step 1 because of my clinical skills, not because of lectures.

IMHO making med students in their third year take bread-and-butter cases is total scutwork. I carry almost exclusively ICU patients and difficult ward patients. The routine cases need to be worked through once (you will have them a thousand more times as intern/resident). After that, you are learning didley-squat and you are not challenging yourself.

Why do I have trouble believing a lot of this?

 

[W222]

THE RUNNING JOKE IS THAT HARVARD STUDENTS REALLY DONT KNOW HOW TO USE THEIR STETHOSCOPES. This is a joke that has some truth behind it according to friends who are residents now. Brilliant people, who just cant seem to get everything together.

 

[agp4]

At Mayo Medical School students start a significant amount of clinical experiences during the second year. They spend 1/2 day everyday in the clinic. THey spend a few weeks in all of the major departments from pediatrics to general surgery.

Absolutely! I've been very impressed with the amount of clinical experiences that we have at Mayo. Not only are some of the doctors here the best in their field, but they are genuinely interested in introducing us to clinical medicine. I have no idea what other med schools are like, but gross anatomy has been a treat so far with visiting orthopedic surgeons and neurosurgeons taking their time to teach us about dissecting. Not only that, but many of those surgeons are eager to give us their pager numbers so that we can scrub in and watch procedures.

 

[Mumpu]

Viennese, what do you have a hard time believeing?

My Step 1 was almost entirely clinical -- patient based questions rather than biochem or cell bio. I have enough basic clinical training to work through patient-based questions as opposed to what's catalysed by carnithine monkey explodinase.

I always pick up the most difficult (both medically and socially/emotionally) patients on the team. Maybe it's just me.

 

[VienneseWaltz]

Viennese, what do you have a hard time believeing?

My Step 1 was almost entirely clinical -- patient based questions rather than biochem or cell bio. I have enough basic clinical training to work through patient-based questions as opposed to what's catalysed by carnithine monkey explodinase.

I always pick up the most difficult (both medically and socially/emotionally) patients on the team. Maybe it's just me.

How can you handle almost exclusively ICU patients unless you're almost exclusively in the ICU? Don't you rotate at your school?

I have trouble believing that the most difficult patients on the team go to the med student.

And I have trouble believing that anyone who knows what he or she is talking about really thinks that once you've seen one case of X, you've seen them all ("The routine cases need to be worked through once"). You shouldn't be waiting to see more of them when you're a resident--you need to see them NOW so that you don't kill your patients when you're a resident, which brings us back to a discussion of why it's not a drawback for med students to be given routine cases while the residents get the unusual stuff.

 

[Iwy Em Hotep]

... I have enough basic clinical training to work through patient-based questions as opposed to what's catalysed by carnithine monkey explodinase.

That's a great quote! I think I'll use it for my signature.

 

[Cerbernator]

At UT Memphis you get a lot of hands on experience, so thats one. I'd say MSSM is good too because they are affiliated with a ton of hospitals/

 

[patzan]

Just about every suggestion here has been biased. If not stated explicitly, just look at where they are located (Baylor is the best!...location - Texas, etc.) Pre-meds only know what US News tells them and med students only know that the school they are at is the best.

 

[Mumpu]

About half the hospitals we rotate through have the medicine team as the primary team for ICU, so medical students routinely follow ICU patients. Working up the most difficult patients on the team is extremely challenging. However, being a med student, I can spend two hours reading up on bizarre diseases, then present them to my team and work with them on narrowing the differential diagnosis.

As for the routine cases, common things are common. Therefore, difficult patients almost always have the usual suspects (COPD, asthma, afib, diabetes, obesity) as part of their problem list.

 

[winstonm]

McGill - It's what the school is famous for.

Too bad the government is a b**** to out-of-province Canadians!

 

[Garuda]

The best ones are out in the suburbs. Ones that let you work easy hours.