schools with the toughest third/fourth years?

[leechy]

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Which med schools have the toughest 3rd and 4th years? One piece of advice I've encountered repeatedly is that you should evalute the quality of the 3rd and 4th year experience as one factor in choosing a med school. It's difficult to gather this information at interviews, though, so I'm wondering if people can give advice (either specific or general) about this.

I know the clinical years are tough everywhere, though I've also heard that factors such as quantity of scut work, the grading system / difficulty of achieving honors, and the quality of the attendings greatly influence the experience in the 3rd and 4th years.

Any thoughts are much appreciated.

 

[leechy]

Hate to bump my own thread, but anyone have insights on this? Even general, "watch out for this" kind of advice? Thanks.

 

[simoin]

Hate to bump my own thread, but anyone have insights on this? Even general, "watch out for this" kind of advice? Thanks.

its a tough choice because some of the great places to get clinical experience are not the top ranked schools mainly because you get good clinical experience at public hospitals where they let you do everything, that doesnt always equal lots of research money and a good US news ranking.

personally, i think you will learn most of your stuff in the first two years on your own anyway, so the teaching and clinical experience third and fourth year are more important when choosing a school. they will also be what prepares you for residency.

hope thats helpful
MS3 univ. of southern cal

 

[dancinjenn]

Ask the admissions or student affairs office to get you a list of the hospitals that students rotate at most often. Are you farmed out? Are they centrally located? Just one hospital or many? Use those lists to help you formulate a general picture about the type of experiences as well. Large public hospitals or smaller community settings...etc.

 

[snaklee]

You question is a curious one. At first I was tempted to ask why it even mattered at all. But after another moment of thought, I have decided that the places where a young student might find the best experience is where most students dread to go.

Why do I say that? Well, the more blood, guts, trauma, disease and carnage, the better the medical learning experience. Medical students are like most people and try to avoid difficulty when it can be avoided.

I find it curious that many of the offshore medical schools have some very difficult clinical rotations. In that I mean the hospitals where they aren't the first pick for the "US" schools. But this may be one of the key elements whereby these seemingly average students and no doubt US medical school rejects excel many times past their US counterparts.

If you want the most prestigious, well that is a different question... But in my opinion, prestigious may not be the most educational.

It is one thing to do well on a written test, but it is entirely different to manually do what mentally you have learned.

 

[monstermatch]

I've met some U Tennessee-Memphis students and it sounds like they have a very demanding 3rd year schedule.

 

[monkeyarms]

i actually think this is a great question and wish that more applicants were evaluating schools based on 3rd/4th year opportunities. i guess it's tough since the majority of people can only concieve of classroom experiences coming in while the hospital work remains more of a mystery. anyway, i'd say it's impossible to discuss which schools have "tougher" third year rotations, but it's relatively easy to discuss where the best opportunities for education lie. you probably want to try to find a school affiliated with many hospitals offering many diverse services. for instance, as mentioned above, the county hospital will have more of the"grunt" work in medicine available than the university hospital or high profile clinic. the latter institutions tend to act as tertiary care and/or research centers where the patients are more highly selected and you might see more experimental treatments offered (but they won't let you touch the patients!). another variation on the theme will be at va hospitals, where you get a pretty focused patient population but a lot of opportunity to get your hands dirty. truly, the more you have to choose from the more likely it is that you can tailor your experience to fit your needs and find the best clinical experiences.

 

[kappasigMD41]

I've met some U Tennessee-Memphis students and it sounds like they have a very demanding 3rd year schedule.

I'm an M2 here at UT-Memphis, and about to start rotations in May. I came here because of the clinical reputation- you won't see UT on any top lists because research is not really the priority here. Actually, we don't even submit the form to US News for the rankings, so there is no telling where we would rank. It really doesn't matter to me, I just want to learn. I don't need to have my ego stroked by going to a top 25 school. As far as rotations are concerned, I hear nothing but great things. Lots of autonomy, lots of procedures. You start seeing patients first year, and you can start suturing at the trauma center ("The Med") during the first week if you want. I hang around the Med shock/trauma unit sometimes to suture, watch surgeries, see patients, etc. It's amazing what you learn in a night. The Med is the 3rd busiest trauma center in the country (#1 busiest for penetrating trauma, ie gunshots, stabbings). If you do your OB/Gyn rotation at the Med you can expect to deliver anywhere from 20-30 babies, many of them solo. The Med, VA hospital and LeBonheur children's hospital are all within 2 blocks of school. Also, Memphis is FULL of sick people, and there is pathology here that you won't see other places (We rank in top 5 for just about every STD!!!) A recent study showed that over 80% of the patients we see will have diabetes or HTN. I look forward to a very demanding 3rd year.

 

[Quijotemd]

I am a MS3 at Univ. Texas Medical School-Houston. We have a tough third year. Part of the reason for this is because we get ample exposure to a busy indigent county hospital, but we mostly have it tough because we take a lot of overnight call. I have been asking around and the word I hear is that most Texas med schools don't require their MS3s to take overnight call, except for occasional surgery overnight call. We take call, Q4 and Q5, for two months of medicine, Q4 for one month in surgery, Q5 for two months of OBG, and Q5 for one month of inpatient peds. Our students are scutted out quite a bit, although some of us are fortunate enough to end up on teams with interns and residents that teach rather than scut. The bad thing is that post call many of us don't get to leave till 3-5 in the afternoon because they sometimes make us attend conferences and lectures post call. So while the residents get protected limitations on their work hours, we don't really have any choice or protection.

So I am wondering what call is like around the country. Is this typical or unique? On the upside our graduates are supposed to be viewed as tough by residency programs for our work schedule, but perhaps they tell us this to make us feel better.

 

[Dr.Evil1]

DancinnJen and I go to a school that has an excellent clinical reputation (Wayne State Med in Detroit). I don't know though if I would call it the toughest because even within the same hospital different attending physicians can be tough or easy.

I don't know the point of this question...is it to find somewhere good or tough? I would argue that tough is a function of work hours, scut and other things that really aren't benificial. Good is a function of teaching, autonomy and pt acuity. I think for learning purposes big is better than small and urban is better than suburban

 

[BUmmedic]

I am a MS3 at Univ. Texas Medical School-Houston. We have a tough third year. Part of the reason for this is because we get ample exposure to a busy indigent county hospital, but we mostly have it tough because we take a lot of overnight call. I have been asking around and the word I hear is that most Texas med schools don't require their MS3s to take overnight call, except for occasional surgery overnight call. We take call, Q4 and Q5, for two months of medicine, Q4 for one month in surgery, Q5 for two months of OBG, and Q5 for one month of inpatient peds. Our students are scutted out quite a bit, although some of us are fortunate enough to end up on teams with interns and residents that teach rather than scut. The bad thing is that post call many of us don't get to leave till 3-5 in the afternoon because they sometimes make us attend conferences and lectures post call. So while the residents get protected limitations on their work hours, we don't really have any choice or protection.

So I am wondering what call is like around the country. Is this typical or unique? On the upside our graduates are supposed to be viewed as tough by residency programs for our work schedule, but perhaps they tell us this to make us feel better.

I just finished my M3 year at Boston University Medical Center, and our call schedule is different because there are multiple placements for each clerkship (different hospitals/services = different team size = different call schedules). Mine went like this (overnight unless otherwise stated and always includes weekends):

Pediatrics: (North Shore Children's Hospital) q4d for 1 month and gone by 4pm the next day.

Family Medicine: (Cape Cod private practice) no call

Surgery: (BUMC - Vascular service) q3d for 3.5 weeks with no post-call allowances; (Cape Cod Hospital - Gen/Trauma service) q2d for 1 week and q4d for 2 weeks with post-call case selection allowances (you could pick and choose which cases to take the next day... so you could choose to take the early cases and go home early or choose to sleep the morning and then take late cases); (BUMC - Gen/Trauma service) q4d for 3.5 weeks with no post-call allowances; (West Roxbury VA - Cardiothoracic service) no call for 1.5 weeks.

OB/GYN: (BUMC - wards) q3d for 3 weeks with post-call off after morning rounds; (BUMC - clinic) no call for 3 weeks.

Psychiatry: (Solomon Carter-Fuller State Mental Health Center) no call for 6 weeks.

Medicine: (BUMC wards x 2 teams) No overnight call, but had alternating long call and short call days for admitting team purposes and could stay as late as the early morning on long call days. Basically, if on long call, may stay into the wee hours, and were on long call every 4th day or so. However, had call duties five days of the week with one no-call day and one day off per week.

 

[scootad.]

nyu has a pretty benign 3rd and 4th year. only 1 mo of medicine subI, one mo outpt medicine, 2 mo IM, 2 mo surg, 6 wks peds, 6 wks obgyn, 1 mo neuro, 1 mo critical care. the rest is all electives which amounts to the majority of your 4th year. grading is inflated, pretty much everyone gets A or A minus, you'd have to do something really bad to get less than an A minus.

its pretty nice for people who dont want to do primary care.

 

[Geronimo]

I've met some U Tennessee-Memphis students and it sounds like they have a very demanding 3rd year schedule.

Yeah, I've heard that UT is pretty rough as well. They say the training is excellent but can be really tough.

 

[erin682]

Emory - great prestige and really great research money has rotations at Grady which is a huge public hospital with cases that are totally crazy and unusual and you can do just about anything.

Plus lots of schools let you do away rotations so you are not totally stuck at your one school.

 

[dancinjenn]

I agree with Dr. Evil. and...Why would you want easy rotations with grade inflations? The whole point of your third and fourth year is to get your hands in the mud. See if you like sand or clay. How can you do that in programs where you can't write orders, get in the OR, and generally are hand held like you learned how to walk yesterday? I know that the sink or swim method may be scarier but IMHO it is the best way to actually see what each specialty is like and if it appeals to you.

 

[monstermatch]

I've been told by several residents that once intern year starts you learn everything you need to know pretty quickly - apparently the first month evens out all the differences between people who went to tough vs. cush programs. Anyone else hear this, anyone disagree?

 

[dradams]

Miami Jackson = awesome experience. Not there yet, but that is what I hear. 😀

 

[alumafly]

Miami Jackson = awesome experience. Not there yet, but that is what I hear. 😀

i've heard the same; i can't wait to get down there 👍

 

[mfrederi]

Disclaimer: I am stupid second year. Now, with that out of the way, from my talking to MS III / IV they have expressed that their best rotations were not necessarily the busiest, the ones with the most call, or the ones where they did the most procedures. Their best rotations were the ones where they were adequetly challenged clinically, yet still provided with some type of extra time to learn / relearn the pathophysiology of the dz. Although all the procedural / management aspects of medicine are the cool parts that we went to school for, the knowledge behind it is pretty important too. If you have spent all your time closing in the OR or suturing up some drunk in ED but don't have sufficient study time, then you are becoming a techinician but not a clinician. (IMO which is worth... well, not very much at all)

 

[Suprahelical]

I'm an M2 here at UT-Memphis, and about to start rotations in May. I came here because of the clinical reputation- you won't see UT on any top lists because research is not really the priority here. Actually, we don't even submit the form to US News for the rankings, so there is no telling where we would rank. It really doesn't matter to me, I just want to learn. I don't need to have my ego stroked by going to a top 25 school. As far as rotations are concerned, I hear nothing but great things. Lots of autonomy, lots of procedures. You start seeing patients first year, and you can start suturing at the trauma center ("The Med") during the first week if you want. I hang around the Med shock/trauma unit sometimes to suture, watch surgeries, see patients, etc. It's amazing what you learn in a night. The Med is the 3rd busiest trauma center in the country (#1 busiest for penetrating trauma, ie gunshots, stabbings). If you do your OB/Gyn rotation at the Med you can expect to deliver anywhere from 20-30 babies, many of them solo. The Med, VA hospital and LeBonheur children's hospital are all within 2 blocks of school. Also, Memphis is FULL of sick people, and there is pathology here that you won't see other places (We rank in top 5 for just about every STD!!!) A recent study showed that over 80% of the patients we see will have diabetes or HTN. I look forward to a very demanding 3rd year.

This wouldn't happen to be Scott would it? Just another UT-M2 wondering? 😎

 

[automaton]

the answer to this question is universal, and it's MMS. (my medical school)

 

[davedavedave]

this is a good topic... how can we get in contact with current students (beside this anonymous forum) to get to know firsthand the 3rd+4th year experience? it's pretty frustrating how much of an emphasis each school places on the curricula of the first two years when they're selling their school.

 

[Powder]

The question i would ask students on interviews is do you observe care or actually particpate in it?

Surgery: Hold a retractor or cut and suture
Medicine: Observe or take your own patients and work up a differential diagnosis
OB/GYN: help out or catch babies

This will give you an idea as what the 3/4th year will be like.

MS4 soon to be ER doc (if the match works)

 

[Neuronix]

the answer to this question is universal, and it's MMS. (my medical school)

Exactly, or the medical school the applicant really wants to attend. Why they always plug them, I dunno... Trying to justify their top choice to themselves I guess?

Rotation experience varies so much even within a school depending on where you do your rotations and with whom you do your rotations. It's kind of impossible to judge the relevant inter-school factors from where the applicant sits, because all the students that you meet will cheerlead.