Should the "rotating internship" come back?

[DrJosephKim]

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The concept of the rotating internship has practically disappeared in today's post-graduate training programs. Back in the "old days," interns were all doing a transition year internship. You would rotate through surgery, medicine, peds, etc. In many ways, it might feel like your 3rd year of medical school all over again, but you were the one writing orders, performing procedures, etc.

Would such an experience allow medical school graduates to make better decisions about future residency plans? Or, does the current system allow students to gain enough experience to make an informed decision regarding specialty selections?

 

[alwaysaangel]

The concept of the rotating internship has practically disappeared in today's post-graduate training programs. Back in the "old days," interns were all doing a transition year internship. You would rotate through surgery, medicine, peds, etc. In many ways, it might feel like your 3rd year of medical school all over again, but you were the one writing orders, performing procedures, etc.

Would such an experience allow medical school graduates to make better decisions about future residency plans? Or, does the current system allow students to gain enough experience to make an informed decision regarding specialty selections?

I don't really see how that would help. If they didn't figure out if they liked it or not during 3rd year why would doing it again in TY help? Not only that but if they were in a TY without an advanced program then those rotations wouldn't really help them decide what they wanted to do for their future residency plans because they would have to be applying that year already before really experiencing any of it.

 

[Law2Doc]

The concept of the rotating internship has practically disappeared in today's post-graduate training programs. Back in the "old days," interns were all doing a transition year internship. You would rotate through surgery, medicine, peds, etc. In many ways, it might feel like your 3rd year of medical school all over again, but you were the one writing orders, performing procedures, etc.

Would such an experience allow medical school graduates to make better decisions about future residency plans? Or, does the current system allow students to gain enough experience to make an informed decision regarding specialty selections?

I actually would argue that the transitional year should be phased out and replaced with a prelim year. While it conceptually was created so that folks might have another year to decide what specialty they wanted, because the TY is generally perceived as cushy, all of the spots are snared each year by the folks already on advanced specialty paths who simply want an easy year to endure before starting their already designated specialty paths. So the TY doesn't serve its purpose. I think there are good arguments for having an "intern" year where you get your feet wet running around the hospital making healthcare decisions on patients both in and out of the ICU, and learn how to be a generalist first, before you specialize, and the prelims in medicine and surgery both provide this. A number of fields which don't have intern year paths actually suffer from lack of skillsets (a handful of EM programs have recently come under fire because they simply order imaging, labs and call the admitting or consult team without appreciably examining the patient, a skill you can't get around learning during a more traditional intern year, and every year on the USMLE boards you hear about eg pathologists who feel at a severe disadvantage on Step 3 because they never learned any of the "doctoring" which the USMLE considers minimal necessary skills for licensure).
The advanced programs all require some form of intern year because it allows those programs to streamline -- the new residents become good generalists and are already broken in when they arrive. Other fields which don't require a prelim year, eg FM, often create their own mix of rotations which include surgery and ICU rotations so that their trainees effectively get a similar intern year experience.

But the TY doesn't really do a good job of giving folks an opportunity to pick a path because they are totally inhabited by folks who already picked their path early in med school when they went all out for derm or optho.
What would perhaps make sense would be to push the match back and give folks more time to take rotations in 4th year to help figure out what they want to be. The problem with getting ERAS done in september of 4th year is it really only gives you 2 elective months in 4th year to play with, so if you didn't fall in love with one of the 3rd year "core" electives, you don't have a lot of time to play around.

 

[Apollyon]

folks already on advanced specialty paths who simply want an easy year to endure before starting their already designated specialty paths. So the TY doesn't serve its purpose.

I have a good friend that was going into Rads and did a quite "cushy" TY, but she also did 5 rads rotations, by her own choice (they were not all the same, as that is not allowed, but she was in the Rads suite for nearly half the year). Anecdotally, she told me that others in her program did the same.

(a handful of EM programs have recently come under fire because they simply order imaging, labs and call the admitting or consult team without appreciably examining the patient

This is so egregious that you have to name names. Your perceptions of EM are well-known on this board, so either name them (or send them via PM), or this statement is branded specious and disingenuous.

 

[Neuronix]

because the TY is generally perceived as cushy, all of the spots are snared each year by the folks already on advanced specialty paths who simply want an easy year to endure before starting their already designated specialty paths. So the TY doesn't serve its purpose.

Practitioners in advanced specialty paths often see adult patients, pediatrics, and gynecologic conditions. Typically there is strong communication or procedural collaboration with other subspecialties such as surgery, pathology, and radiology. For example, in radiology, dermatology, and rad onc many children are seen. Also, physicians in those specialties are involved extensively with surgery and its effects. Further, for rads and rad onc there is plenty of genitourinary cancers or imaging. It therefore makes sense for the budding subspecialist to increase their skills in the patient groups they will see before they focus narrowly on subspecialty training.

Obviously, radiology, rad onc, anesthesia, optho, and derm are best served by different sets of skills, and thus the TY is often customized to best meet the case mix of these specialties. The requirements on transitional year programs are kept loose for this purpose, though it is required to spend 6 months in "direct patient care" activities. There are often other benefits as well. For example, rad onc is a very research heavy specialty, and many TYs allow for a research month, often time spent as an "away" at the intern's advanced program.

Conversely, it doesn't make sense for a resident who is going to spend all their time in an outpatient setting to focus heavily on inpatient medicine and ICU care, which constitutes the vast majority of prelim med programs. Transitional year interns are usually required to do several months of inpatient and a month of ICU to get a flavor of these disciplines. This is reasonable. I would contrast that with my home prelim medicine program that requires 9 months of inpatient medicine, 1 month of outpatient medicine, and a measly two electives. As a specialist that will not manage inpatients during their career, I believe it is a waste of time to spend nearly a whole year doing just inpatient adult medicine. Instead, the time is better served as described, in broad-based training with more outpatient exposure.

 

[Law2Doc]

There is very little to be gained by having those going into advanced specialties (Rads, Optho, Rad Onc, Derm, etc) doing prelim medicine/surgery years. Coming from Rad Onc, my TY year was perfectly set up for me. I had a month of med onc, and peds onc, urology (focus on oncology), ENT (to learn to scope), a month for research/radiology. These months were far more valuable to my future residency and knowledge than doing 8-9 months of medicine or surgery would have been because those skills have limited value in most advanced specialties.

The point (and the reason the advanced specialties resist eliminating the intern year) isn't to spend a year learning what you will directly use. It's to become a generalist first, and LATER to specialize. The notion is that folks who do this become better doctors overall, and ergo better specialists. (I am not aware that this has ever been studied or demonstrated, so it's more wishful thinking than proven fact, but such is the logic behind it). So yeah, it's appropriate to spend time managing very sick inpatients and ICU patients during intern year even if you will ultimately end up in an outpatient setting, given the underpinnings of retaining an intern year for the advanced specialties.

But I think the last two posters overlook the OP's original point -- that TYs were really meant for people who AREN'T already locked into a specialty. He was suggesting that TYs should be used to help people get more info on a variety of fields to make a more informed decision. My point was that this isn't happening, so if this was the point of TYs (which it certainly originally was when they were conceived), then they aren't being used for this purpose. TYs are being used as cushy years that satisfy the intern year requirement of advanced paths. That's who is populating these programs.

And given that fact, there isn't a good point for TYs. You can get a more significant experience managing patients in a prelim year IMHO. Might not be as tailored to your ultimate career, but the reason the advanced specialties want you to not start specializing until your second year out is precisely because they want folks to get a generalist exposure outside of the specialty, and learn how to manage patients. You learn to be a doctor first, so you still have that skillset when you focus down and learn how to be a dermatologist. Again, I didn't create this whole "generalist first, specialize second" concept. This is a holdover from the days when EVERY specialty required a medicine-ish intern year first. But I think the whole "limited value to my future" argument is flawed, because you aren't being asked to do an intern year because you are going to be a medicine doctor or surgeon, you are being asked to do it because it's good generalist training a specialty can use as a strong starting point.

 

[Neuronix]

L2D, I think you are missing a point here.

To me, generalist does not equal adult general medicine. That is an internist. Generalist is more broad and encompasses the basics of peds, OB/GYN, and surgical evaluation and management.

 

[Apollyon]

Generalist is more broad and encompasses the basics of peds, OB/GYN, and surgical evaluation and management.

Which is the "rotating internship" for the DOs.

 

[Neuronix]

Which is the "rotating internship" for the DOs.

Agreed. It's also the modern idea behind the transitional year for MDs too.

 

[Apollyon]

Agreed. It's also the modern idea behind the transitional year for MDs too.

But....but...no...nooo....it's not! It's not!

(I'm still waiting for the list of the EM programs that have 'come under fire'. I think that I shall be waiting a VERY long time for that.)

 

[Law2Doc]

...
To me, generalist does not equal adult general medicine. That is an internist. Generalist is more broad and encompasses the basics of peds, OB/GYN, and surgical evaluation and management.

That may be, but you are not really addressing THE OP's point, which is that TYs were meant to allow folks time to choose a field. In fact a TY cannot accomplish this because the folks who populate that path already have chosen a field.

 

[Flopotomist]

This is so egregious that you have to name names. Your perceptions of EM are well-known on this board, so either name them (or send them via PM), or this statement is branded specious and disingenuous.

So glad you called L2D out on this one, I had steam coming out of my ears when I read this.

 

[Law2Doc]

...
(I'm still waiting for the list of the EM programs that have 'come under fire'. I think that I shall be waiting a VERY long time for that.)

I'm not going to list programs on a public board and am not going to PM a stranger, sorry. It would be a violation of the TOS for me to do so, and it's inappropriate to demand such.

I also think you have misinterpreted some prior posts if you think I somehow have "well known perceptions" hostile to EM. I'm actually a fan of EM (and seriously considered it), but tend to agree with some close colleagues in that field who feel that some of the directions that field has taken in recent years are not beneficial, and are actively working to stem the tide. That some EM doctors these days are ordering too many tests and using too little hands on diagnosis is not exactly a state secret -- it was in Time magazine and the NY Times this past year. Whether that is a byproduct of a lack of an intern year in light of the move to a shift work schedule is subject to debate but there are definitely EM docs within the field who feel that their house is not in order.

 

[Apollyon]

I'm not going to list programs on a public board and am not going to PM a stranger, sorry. It would be a violation of the TOS for me to do so, and it's inappropriate to demand such.

Seriously? "Inappropriate to demand"? How do you figure? You make an unsubstantiated and libelous point, and refuse to name sources. Then, tell me how it is a TOS violation for you to state facts? Show me. And you are "not going to PM a stranger". What does that have to do with anything? Would you PM that list to someone you "know", who also "knows" me? I would wager 10 shares of Union Pacific that you would not. If, in your intricate barrister style, this is your way of insinuating I would take a private message and make it public, I publicly berate you for being a ******ing and ******ing liar.

Put up or shut up. You made a factual statement which you actively refuse to support with facts. That makes you a liar, which makes any other statements by you carry the stench of lie. I don't care how many gall bladders you may take out in your career; you will always be a lawyer, with all the attendant respect that that garners from physicians nationwide.

edit: and if this is the caliber of "the volunteer staff", then maybe you should turn in your stripes.

 

[smq123]

edit: and if this is the caliber of "the volunteer staff", then maybe you should turn in your stripes.

Or, maybe we should all just CALM DOWN.

Please, if you have some insight into the failings of some EM programs (or, would like to contest said insight), take it to PMs. Otherwise, if is just going to be more back-and-forthing, please keep it to yourself.

Thanks.

 

[Law2Doc]

...If, in your intricate barrister style, this is your way of insinuating I would take a private message and make it public, I publicly berate you for being a ******ing and ******ing liar....

Dude, I don't know you. That's not an insinuation of anything.

 

[Apollyon]

Please, if you have some insight into the failings of some EM programs (or, would like to contest said insight), take it to PMs.

No, that is not possible. As stated by the volunteer member of the moderation staff, s/he "doesn't know me", and refuses to do so. I've PM with several people over the past several days (I can show you a screen shot), and I am willing to do it, but the above poster is not. To wit: "am not going to PM a stranger, sorry".

 

[smq123]

Law2Doc and Apollyon -

When I said, "Please, no more back-and-forthing," I meant it. Either take it to PMs or JUST DROP IT.

Stop this rather childish bickering, or else the thread will be closed.

 

[Doctor4Life1769]

I like how L2D is free to say anything at will, but the moment he is called out, other mods have to come in and have his back... not the first time.

 

[Gute]

the biggest fallacy with L2D's opinion is that it is based off of his perception that all TYs are "cushy"

this is not the case (though the most sought-after ones outside of places like NYC, LA, other big cities are cushy). Many of the TY's I interviewed at were the ESSENTIALLY THE SAME as the prelim IM program at the institution with only trivial differences, such as requirements to do surgery or peds rotations.

I also interviewe at prelim surgery programs that were pretty cush as well. I have no doubt that one could pick a variety of intern years with different titles and get a pretty easy experience. Perhaps the standards are too lax across the board, but I'll let L2D lead the charge to get the ACGME to crack the whip on all these programs.

 

[Law2Doc]

the biggest fallacy with L2D's opinion is that it is based off of his perception that all TYs are "cushy"

this is not the case (though the most sought-after ones outside of places like NYC, LA, other big cities are cushy). Many of the TY's I interviewed at were the ESSENTIALLY THE SAME as the prelim IM program at the institution with only trivial differences, such as requirements to do surgery or peds rotations.

I also interviewe at prelim surgery programs that were pretty cush as well. I have no doubt that one could pick a variety of intern years with different titles and get a pretty easy experience. Perhaps the standards are too lax across the board, but I'll let L2D lead the charge to get the ACGME to crack the whip on all these programs.

OK, that's a fair criticism. I too know of a few TYs that milk a bit more work out of their residents than the norm, and I certainly know of many prelims that fit solidly in the "benign" category. Every year there are a number of TYs that fall through to the scramble precisely because the word of mouth about them is that they aren't cush.

But I don't think that changes my overall suggestion that the majority of TY spots are filled by folks going into advanced programs, and thus they provide no real value in terms of folks selecting specialties. The guy going into derm or rad onc probably made his decision in the first two years of med school, and nothing he's going to see in his TY is going to get him to jump paths.

So my suggestion is really that it probably makes sense that there be a single standard intern year (or at least a single standard medical and a single standard surgical intern year) where you get exposed to inpatient, clinic and ICU care of patients. In my opinion such a year that resembles a prelim year rather than a TY probably makes more sense because some of the TYs have many electives that people spend within their comfort zones, and their residents experience too little continuity in services as compared to some of the prelims. TYs can be a lot more similar to 3rd year rotations than a prelim year, as the OP suggested, which I don't think generates the kind of independence of patient management that someone stuck on the same service for longer or having multiple stints in the ICU would involve. If that's really the goal of the intern year -- for folks to get general patient management skills before specializing, then I think this would give more value. Right now I think the TY in most cases (but not all, as Gute suggests) simply offers a relatively painless year for advanced residencies to get their year done. That was not the point of TYs, and probably not the point of advanced residencies requiring an intern year first.

 

[newbie04]

I like how L2D is free to say anything at will, but the moment he is called out, other mods have to come in and have his back... not the first time.

1st Rule of SDN: L2D is always right. 🙄

I usually scroll past the L2D posts, as they are usually tl;dr "you're wrong, I'm right" nonsense on any given topic.
____________________
I've actually overheard a few recent Attending conversations about how they wished there were more Traditional Rotating Internships (TRI) and how "residents were missing out on being well-rounded." Of course, some specialties have no need for a TRI, but it seems exposure in different specialities as an Intern would be a good thing.

TRI and TYs are not for everyone, but I like how they are structured. 9 months of inpatient IM, no thanks.

 

[Dwindlin]

I thought I read a poll not too long ago that questioned the happiness of specialty selection and on average those that had to do the rotating internship were more satisfied with their choices. I'll link it if I can find it.

 

[tkim]

A number of fields which don't have intern year paths actually suffer from lack of skillsets (a handful of EM programs have recently come under fire because they simply order imaging, labs and call the admitting or consult team without appreciably examining the patient, a skill you can't get around learning during a more traditional intern year,

How did these EM programs come under fire and by whom? Is this something known only to you? Doesn't sound like it, since it's more than just one, so there must be some trend being tracked. Sounds anecdotal or bull****. I expected better, even from a lawyer.

 

[turquoiseblue]

a rotating internship would be great to have back. it allowed everyone to have a vast knowledge of the entire system of the hospital. eg. fm and im needs to know surgery in order to know what to refer to surgery, surgery needs to know im in order to know how to deal with them. and so forth.i've don'e both IM and surgery and knowledge of both has helped me a great deal to know how to handle situations. it would also be great for passing step 3 as you have to know all about all fields of medicine and surgery.

 

[lockjaw]

a rotating internship would be great to have back. it allowed everyone to have a vast knowledge of the entire system of the hospital. eg. fm and im needs to know surgery in order to know what to refer to surgery, surgery needs to know im in order to know how to deal with them. and so forth.i've don'e both IM and surgery and knowledge of both has helped me a great deal to know how to handle situations. it would also be great for passing step 3 as you have to know all about all fields of medicine and surgery.

It would be a pretty miserable experience for those of us going into pediatrics who are happy to never have to see an adult patient again. I don't think I could handle another year of rotating through general adult medical specialties which would have little to no bearing on my future career at all.

 

[Tiki]

I don't see the value in a standardized intern year that resembles a prelim year. For many specialists, including myself, I don't see the value in extensive medicine/ICU months. I am not going to be managing either set of patients and to assume even a working knowledge after a few months as an intern is ridiculous. So where's the value? I dont think most specialities need their residents to have a set of general management skills and would be better off using the TY year set up to get their residents knowledgable on things on the periphery of their specialty, for example subspecialty rotations. Further, while not the initial intention of TY years, it seems to make sense to have a painless internship for those who will have minimal use for it once they move on. I think you have to accept that the TY has gone from a catch all for the undecided to the specialists landing pad.

Agreed. It's funny how surgery and medicine think their fields are the most important and therefore we should all rotate through them extensively to become "generalists.". Wait....I did rotate through them, it's called medical school. Why do I need an extra year of watching appys or treating copd exacerabations when I will never need that knowledge in my real job? When I have a clinical question on a case and I can't figure out the answer, shouldn't I be able to consult my clinical colleagues?

If they ever made an intern year necessary for pathology, I would campaign long and hard to force pathology rotations on the folks in medicine and surgery. The 2nd year med school course does not give any insight into "real" pathology, and based off the ignorant questions/assumptions I get on a daily basis, it would be time well spent for them.

Examples of idiotic questions:

"Oh my god, my patients pottasium has dropped!!! It went from 3.6 to 3.3. Should I treat them?" Newsflash, there is no difference between those two results. The test has quite a large standard deviation.

One hour after submitting blood cultures, "Can we get the results of those blood cultures, we submitted them hours ago?" Uhh yeah, they are bacteria, they take time to grow, hence the word culture!

7 minutes after sending a frozen section, "Do you have the results on depth of invasion of the specimen we sent yet?" No. See I have to weigh it, ink the margins, carefully section the thing so as not to screw it up before I hack into it a million pieces and take sections for frozen. This is why we have 20 minutes. If you stop calling me, you'll get those results alot quicker.

1 day after submitting an undifferentiated spindled cell tumor, "Why does it take you so long to give me an answer? Can't you just look at the H&E and tell me what it is?" Let's see, the differential diagnosis of a spindle cell lesion has about twenty different entitites, hence the use of immunohistochemistry, which takes an additional day. Not to mention, the specimen doesn't magically get put on a slide, there is the whole concept of processing and embedding. Get it?


See? I can go on and on. Maybe a year of pathology should be mandatory for all clinicians. After all, it would make you a better doctor, right? Or, we can keep things the way they are, and you can just ask me those stupid questions, and I won't get angry because I'll understand that I probably ask you my fair share of idiotic questions as well.

 

[Substance]

Up here in Canada we all used to do a rotating internship after graduating medical school. Once that was done, anyone was free to practice as a generalist, or specialize. If one wasn't keen on specializing right away, they could set up a practice, work for a while, and then go back for a residency. It was all pretty flexible.

Then the geniuses up at the college of family physicians decided that they were a specialty too, and campaigned to make family medicine its own residency, which made residency applications a one-shot, zero-sum game much like it is in the USA. Medical school went from being about learning medicine to a fellatio contest. Students aren't dumb: if they have one shot to get a residency, most aim for one that is more prestigious and flexible than family medicine. As a result, primary care is severely understaffed now.

The rotating internship is only useful if a general license is borne of it. Learning how to recognize and treat common ailments and situations encountered on core rotations is essential for one to be a competent generalist. Otherwise, it serves no purpose but cheap resident labor for the hospital. Most advanced specialties would never touch any of those situations outside of that year.

 

[gutonc]

If they ever made an intern year necessary for pathology, I would campaign long and hard to force pathology rotations on the folks in medicine and surgery.

I would totally be for this. Not a year, but certainly a month or two over the course of residency and/or fellowship. I spend a lot of time over in the Path dept as it is...some formal learninatin' wouldn't hurt.

 

[Tiki]

I would totally be for this. Not a year, but certainly a month or two over the course of residency and/or fellowship. I spend a lot of time over in the Path dept as it is...some formal learninatin' wouldn't hurt.

Yeah, I was just being sarcastic, since some people in this thread think a year of preliminary medicine should be mandatory for folks like me. I will say, the oncology folks tend to be the most knowledgeable clinicians when it comes to pathology. We have a decent amount of attending surgeons who know their stuff as well.

 

[Sneezing]

The rotating internship is only useful if a general license is borne of it. Learning how to recognize and treat common ailments and situations encountered on core rotations is essential for one to be a competent generalist. Otherwise, it serves no purpose but cheap resident labor for the hospital. Most advanced specialties would never touch any of those situations outside of that year.

That is the key statement.

As it stands right now there isn't much utility in making us all generalists. I'm in psychiatry and I have no need or purpose to set foot in an ICU ever again. Now, if we wish to combat shortages of physicians in primary care we should push out the need for mid levels and encourage GP docs in the community. If we did that I would say we should have more traditional rotating internships available to feed that supply. However, some states have shifted away from a medical license after a single year of training now towards two years minimum. This would have to change back.

Secondly, to support an environment with GPs licensing exams cannot change. The NBOME for instance is planning on shifting to a "two decision point model." It may even include a portfolio for licensure. This new licensing process would eliminate the concept of a intern year trained GP entirely. http://www.nbome.org/docs/BRP_Report_on_Progress_December_2010.pdf

In the meantime (D)NPs are continuing to make headway in increasing their numbers with their sparse training...

 

[turquoiseblue]

i think that residency is a whole different ball game than medical school, so saying you've seen it all in medical school is an overstatement.

 

[Coastie]

If there are "several programs", this must clearly be public knowledge, right?

Please link to the websites or retract your statement, counselor..

I'm not going to list programs on a public board and am not going to PM a stranger, sorry. It would be a violation of the TOS for me to do so, and it's inappropriate to demand such.

I also think you have misinterpreted some prior posts if you think I somehow have "well known perceptions" hostile to EM. I'm actually a fan of EM (and seriously considered it), but tend to agree with some close colleagues in that field who feel that some of the directions that field has taken in recent years are not beneficial, and are actively working to stem the tide. That some EM doctors these days are ordering too many tests and using too little hands on diagnosis is not exactly a state secret -- it was in Time magazine and the NY Times this past year. Whether that is a byproduct of a lack of an intern year in light of the move to a shift work schedule is subject to debate but there are definitely EM docs within the field who feel that their house is not in order.

 

[danielmd06]

Would such an experience allow medical school graduates to make better decisions about future residency plans? Or, does the current system allow students to gain enough experience to make an informed decision regarding specialty selections?

An interesting point to bear on in your excerpted quote is not the first question but the second.

My own medical school had relatively huge blocks of time dedicated to internal medicine and general surgery in both the 3rd and 4th years. More areas (of potential residency or fellowship training) were left for students to cover in electives than could possibly be accomplished: dermatology, radiology, radiation oncology, sleep medicine, palliative medicine, pain medicine, pathology, emergency medicine, physiatry, sports medicine etc. It didn't take me multiple weeks in my 3rd and 4th year to figure out I didn't want to do general surgery. Those were weeks I could have spent on CT surgery, ophthamology, otolaryngology, etc.

This system of standard rotation essentially forced some of us to make long term career choices based on limited information and very targeted thoughts, goals, and tentative USMLE-matching.

Now it is impossible to rotate through every possible specialty, but I would suggest that the current system does not allow enough information to be gathered for some students prior to making this decision.

 

[Tiki]

i think that residency is a whole different ball game than medical school, so saying you've seen it all in medical school is an overstatement.

I never said I saw it all, I said I rotated through (quite extensively) and have a general knowledge of both fields. The more complicated questions I have, I can just ask my clinical colleagues.

 

[mTOR]

1st Rule of SDN: L2D is always right. 🙄

I usually scroll past the L2D posts, as they are usually tl;dr "you're wrong, I'm right" nonsense on any given topic.

lmao