Still Some Bias Against DOs

Discussion in 'Medical Students - DO' started by jkdoctor, Jan 1, 2019.

  1. SLC

    SLC A Punk rock Country doc
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    Aren’t you a preclinical student? Do you have evidence to support your assertion that DO clinical education is poor?

    Just trying to keep you honest here.

    Also, I’m a DO attending, does my experience in the system (which I think is more pertinent than a non-DO’s) carry weight with you?

    My experience as a former DO student, a former ACGME resident, and now an attending is that there’s plenty of variability in MD education. I saw it as a resident in an upper tier MD school, and I’ve seen and heard about it among my Coresidents at their schools and among posters here on SDN.
     
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    #101 SLC, Jan 6, 2019
    Last edited: Jan 7, 2019
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  2. doctorsdatdo

    doctorsdatdo Osteopathic Medical Student

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    Let’s see.

    The fact that many DOs rotate through no inpatient rotations while deemed good enough to graduate from experience in upper class classmates. The fact that many DOs do not get to work with residents in a teaching setting while being a student.

    first hand experience from family members who are now faculties, who have worked side by side with MDs and DOs through out their training.

    Just because I am a preclinical student doesn’t mean I can’t have detailed knowledge about DO clinical education, ACGME rules, or even knowledge pertaining to attendings.

    Like I am sure you are familiar with how to follow up a cirrhotic patient to screen for HCC despite not being a hepatologist, yes?
     
  3. AnatomyGrey12

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    Yes. I have close acquaintances at MD schools across the country in all tiers of school. There is quite a bit of variability in all clinical education whether MD or DO. Nowhere am I saying that DO schools shouldn’t be better, however to claim that NEOMED or TCMC students get the same clinical education as students at Harvard is simply a false statement. People also conveniently forget that a significant chunk of DO students rotate side by side with MD students.

    What a stupid comment.

    Lol and what rules are you claiming to have any relevance to this thread?

    Look dude. I’m no DO fanatic, and I definitely am the first to point out deficits in the DO training pathway and leadership, however your comments are simply fanatical and show how little you actually know or understand. I get it, your mad you found out late that you won’t be able to do radiology at Columbia. That’s on you for not doing your research. Stop using that as a basis to make asinine comments about things you don’t have any knowledge of.
     
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  4. Instatewaiter

    Instatewaiter But... there's a troponin
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    My experience were not from people from the "new rural schools" but older and more established schools. With the school expansion I can't imagine it has gotten better but rather worse.

    Requirements in COCA/LCME standards may be similar but the way those standards are interpreted by the respective accredidation bodies are clearly different.

    I disagree with your point about similar MD clinical variability: I have worked with people from the vast majority of US based MD medical schools in my training and the clinical education was nearly identical. You are right, I have not worked with people from the new schools but these places also have primary rotation sites which are 500+ bed hospitals with residencies.

    The DOs that were part of the residency where I did fellowship (a solid mid-tier IM residency) had an enormous clinical variability as I mentioned above. These weren't the bottom of the barrel DOs.
     
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  5. AnatomyGrey12

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    The wording is the exact same. Literally the same. I am not saying that there isn’t a big variability for DOs, or even that the variability that exists at MD schools is the same as the variability that exists at DO schools. Only that a variability exists even among MDs. All I know is that the multiple people I know at MD schools all describe a variability, with many of the complaints actually very similar to the many you hear from DO students, “all I did was shadow” “I never got to do anything” etc.

    The fact that the DO leadership allows such variability to exist is one of my biggest complaints, and I fully acknowledge it’s presence and I have structured my 3rd/4th year to overcome that.

    One observation I have seen is that an MD trainee is usually given the benefit of the doubt when they make a mistake and then a DO can make the same mistake yet it’s assumed their clinical training was deficient. Right or wrong it’s a bias that exists.

    Again you are discounting the fact that a large chunk of DO students rotate side by side with MD students.
     
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  6. Instatewaiter

    Instatewaiter But... there's a troponin
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    TCMC is part of the Geisinger system which is a massive hospital system. The main inpatient site is Geisinger medical center which is a 600 bed hospital, ranked in the top 100 hospitals (reuters) and has 24 residency programs... I know nothing about neomed but TCMC doesn't seem like it is really deviating from allopathic model of good clincial education.
     
  7. Neopolymath

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    The bolded is not true. The second statement is against the rules now anyways.
     
  8. Instatewaiter

    Instatewaiter But... there's a troponin
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    As you and I both know, wording means nothing. It is all in the enforcement of those standards. COCA has traditionally not enforced these sufficiently.

    I will agree there is some variability within MD training just that the variability is small.
     
  9. AnatomyGrey12

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    And PCOM students rotate along side them....

    But that’s kinda part of my point. Many schools have these sites, this is true, however just like DO schools not every student does every rotation at these sites. Many MD schools have satellite sites and send many students there.
     
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  10. AnatomyGrey12

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    You are right, however COCA has forced schools to at minimum meet the baseline requirements. To be fair, the rules only became exactly the same like 3 years ago so we are still waiting to see the full effects of the change.
     
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  11. Neopolymath

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    My school (not in PA) sends some students to Geisinger and other places like it to further muddy the waters.
     
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  12. alprazoslam

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    I haven’t talked to a resident yet besides hey what’s up. As far as I know they are unicorns
     
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  13. ortnakas

    ortnakas DO PGY-1
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    Could we maybe agree that DO rotations aren't uniformly bad-- it's the variability that's the problem? And that's both between and within schools, because they tend to disperse us across multiple rotation sites, and those tend to overlap. At the same school, I had great rotations in IM and psych with crappy rotations in OBGYN and peds, while a friend at another site had the reverse experience. Within the same site, a friend had the same crappy peds rotation I did but wanted to do peds, supplemented with electives, and now is doing great as a peds resident in a very solid ACGME program. I rotated with students from other DO schools and from MD schools, and I didn't feel that the MD students were far ahead of me. I didn't feel behind when I started intern year either.

    It's a problem in the eyes of PDs, and it should be, since they don't know what to expect of us, but in my experience and the experience of my colleagues both here and in real life, it's not an insurmountable problem-- you catch on pretty quickly in residency.

    TL;DR it's a problem but the sky isn't falling, quit acting like the sky is falling.
     
  14. DrMcLovin

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    Curious about what you guys think about Florida State University COM? Their training is almost exclusively in community hospitals and physician practices without contact with residents. Only 2 of their clinical regions (out of 6) have a single residency program. 1 hospital has IM and the other has IM and general surgery.

    After reading this board I was under the impression all MD students exclusively rotated in tertiary centers... how did FSU slip through the cracks of LCME?

    Educational Program | College of Medicine

     
    #114 DrMcLovin, Jan 6, 2019
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  15. alprazoslam

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    I thought one with AT still as the profile pic would worship thy crown more feverishly.
     
  16. SLC

    SLC A Punk rock Country doc
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    Someone mentioned that their rotations were nearly identical to those at Harvard Med.

    Well true story, most of the Harvard grads in my program railed against the clinical education; claimed they felt it was really poor and they didn’t feel ready for internship. Their words not mine.

    In the end, MD and DO alike all generally did just fine. Including those guys. We had problem residents of both brands, and freaking legit residents from both brands. No appreciable difference, my observation and the words of faculty during interview season.

    Nobody hits intern year with much in the way of actual clinical acumen. But sharp folks (which basically everyone is) catch on quick.

    I think the types of blanket statements bandied about around this thread are pretty lame.
     
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    #116 SLC, Jan 6, 2019
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  17. Angus Avagadro

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    I agree no inpatient rotations is appalling . I went to an established school, had inpatient rotations and some rotations where I had no residents. I was full time with the attending! I dont see why no resident exposure would be a negative in those cases. As for little variability with MD training, I would respectively disagree. Wife is an MD, we were married as students. She and her classmates had some crappy rotations. Just what does a 3rd yr student do on a CVS rotation? Cant see the heart, just stare at the leg wound and cut sutures for.the resident. When I was at the university, we had an MD PG2 come from a regional level 1 trauma center where he did a TRI. He was so far behind, he would hide. He was made my advisee and nearly washed out. When I was a resident and attended the county medical society meetings, the attendings from the other programs in the city would try to out do each other with stories about which one had the dumbest residents. These were all MD university attendings.There is plenty of variability in MD training and I have seen it. Broad statements like DOs have inferior training dont serve a useful purpose other than to endorse continued bias. I do agree that having some in patient rotations should be mandatory. I also agree that Step scores are not the end all and that resources may not exist to perform due diligence on each applicant to the residency program . This is why it is so important to audition at your top choices for residency
     
  18. doctorsdatdo

    doctorsdatdo Osteopathic Medical Student

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    As you know, the measurement of a good CVS rotation isn’t how many time a student sees the heart.

    It’s things like, but not limited to
    - learning indication for CVS interventions, like when to do cath, when to image the vascular system and do angioplasty, when to stent, etc
    - learning physiology of normal and pathophysiology of the abnormal, as well as how do treatment affect them
    - learning appropriate exams like a good cardiopulmonary exam, peripheral vascular exams etc
    - some imaging like recognizing pulmonary edema on CXR
    - learning the basics in cardiovascular medication like the antihypertensives, ACLS algorithm, anticoagulation medications and basic guidelines like the BP guideline.
    - basic procedural skills like holding wires and cutting sutures, pulling (small) arterial sheath, witness things in action like the TR band, etc.

    If this student didnt see a single surgery and only looked at wounds but was taught good clinical acumen about when to refer to cardiology/vascular surgery/IR for diseases in the cardiovascular system and the basics of approach to diagnostic and management side of CVS care I would argue it’s a good rotation.
     
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  19. Mad Jack

    Mad Jack Critically Caring
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    AMAs are a useful service because they allow you to ask people with certain positions exactly the things you would like to know.

    I prefer working with a PD that respects my credentials though. If you are so concerned with image quality versus resident quality, you're doing a disservice to your patients.
     
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  20. Angus Avagadro

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    Med students don't help close the chest. The skin maybe. All of the "Clinical Acumen" you mentioned has already been done before the patient sees the surgical service. The history, the PE, CXR,BP guidelines, all can and should be learned on Cardiology or IM service. CVS rotation is a pretty big waste time for med students, especially 3rd yrs.
     
  21. SLC

    SLC A Punk rock Country doc
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    Agree 100% with your message about when the stuff doctorsdatdo is learned.

    But I will say that on my surgery rotation, I spent a few afternoons with a CT surgeon. I was one on one with the attending because there were no residents, I got to help in the chest. I sewed in an artificial aortic valve (with the attending looking directly over my shoulder.
     
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  22. Mad Jack

    Mad Jack Critically Caring
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    The nice thing about not being at an academic center is the degree of responsibility and freedom afforded by working directly with surgical attendings. I got to do some very cool stuff on surgery
     
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  23. Mad Jack

    Mad Jack Critically Caring
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    Any program that can't provide its students with inpatient rotations should be shut down
     
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  24. Chibucks15

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    I feel like this is overlooked a lot on here...in my opinion its a lot easier to figure out the hierarchy with residents and working with a team more quickly than it is to learn skills you never did because you were 5th in line behind fellows, etc.
     
  25. SLC

    SLC A Punk rock Country doc
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    Yep, not to mention that the worst rotation I ever did was an inpatient IM rotation, at an ACGME program on a resident team. So disorganized, horrible teaching, bitchy residents, I felt my learning going backwards that month. Interestingly enough the other 2 students on the rotation with me were both OHSU students doing their core IM rotation. Seriously the worst experience of medical school.

    To be fair, another resident led rotation I did was excellent. But man that IM month a terrible waste of time. Well not a total waste, it was the final straw that pushed me into seriously considering Family Med.
     
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    #125 SLC, Jan 7, 2019
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  26. Goro

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    Having been on SDN for > 5 years, I can tell you that plenty of MD students complain bitterly about the poor quality of their rotations. More than one bitched about how much they shadowed and didn't get to actually do anything.

    You made your bed, now lie in it.
     
    #126 Goro, Jan 7, 2019
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  27. Angus Avagadro

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    That's quite an honor!. You must have been an ace for the surgeon to have such confidence in you.
     
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  28. SLC

    SLC A Punk rock Country doc
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    Yep, it was cool. Still didn’t turn my gears though, I’m just not surgery oriented. I also did a burr hole with neurosurgery, and I pinned a phalanx fractureunder fluroscopy, a few big lipomas, and 1st assisted in too many breast aug’s to count with plastics. It’s not the worst thing in the world to do some teaching without residents around.

    I’ve told this story before, but it’s worth repeating. This CT surgeon had me grasp the aortic root between my fingers before the patient went on bypass, to feel the thrill in the aorta from the severely stenotic valve. When we were done, and before we closed the chest; he had me do it again just as the circulating nurse started up BB-king’s “The thrill is gone” on the sound system.
     
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  29. DrWBD

    DrWBD Formerly 'wanna_be_do'
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    Any osteopathic student who is concerned about “anti-DO bias” against them in ACGME programs should consider the reality that this bias is completely voluntary and self-inflicted. The organization that purportedly represents you, the AOA, is more concerned with justifying its own existence with lies and nonsense about our “distinctiveness” rather than admit that osteopathic medicine as a completely separate system should not even exist. If all schools were “MD” schools and osteopathic medicine was taught in residency, DO bias simply wouldn’t exist.

    Want to get rid of anti-DO bias? Get rid of the AOA and merge our medical education system.
     
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  30. Angus Avagadro

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    Excellence is the greatest deterrent to prejudice that exists. Bias will diminish if our product improves, we need to abandon the Caribbean model and reduce class size. There aren't enough quality candidates out there. Secondly, we must put schools on probation for failure to meet standards and close them if they dont. Eliminating the AOA is not the answer, creating better doctors is.
     
  31. jw3600

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    Is there a vote for that? Because it would be an overwhelming yes. Don’t be obtuse.
     
  32. Mad Jack

    Mad Jack Critically Caring
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    I work with MD students that complain about their rotations incessantly and have the exact same problems my school had
     
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  33. UnoMas

    UnoMas ASA Member
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    My clinical site also happens to be the clinical site of 2 other MD schools, more than half of my rotations I share with these MD students (IM, Surgery, Psych, ICU, electives etc.) Pretty sure the MD students don't have secret meetings with the attendings/residents after the end of the day so they can learn stuff that are not available to me. By that extension my clinical education is the same as the students from Harvard's. Yay now I feel less ****ty about my DO school

    On a more serious note tho, some students from my school (ok probably 10-15%) really did not have any inpatient IM experience or surgery experience until 4th year- rounding on 2 patients, leaving at 11 am during weekdays, getting a full week off to study for shelf exams. I don't envy them. Intern year will suck extra hard for these students. And these are at risk students (based on their first 2 years grades) to begin with.
     
    #133 UnoMas, Jan 8, 2019
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  34. Goro

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    What did jw3600 do to merit the Bansmack????
     
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  35. SLC

    SLC A Punk rock Country doc
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    I have an idea, but it isn’t important, nor appropriate, for me to speculate.
     
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  36. ThrowawayShmoaway

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    Pretty sure it had something to do with that thread over in the MD student forum about the UVA guy getting expelled
     
  37. MeatTornado

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    This whole discussion about rotations is completely worthless.
    If there's anything I've learned this past decade it's that all that matters is perception and connections.
    It's nice that you did a rotation as a DO with MD students from Harvard. Does it say that on your transcript? Is that written in your MSPE? No!
    You are judged by how your school is perceived which is partly made up of word of mouth and the performance of your predecessors.

    That brings me to connections. If during that rotation with Harvard students you got a LOR from Jeff Drazen (NEJM editor in chef) then that will turn heads and get a PD's attention. My guess is however that you rotated at some satellite community Harvard affiliate where you got a LOR from some unknown hospitalist.

    Furthermore that rotation that you did with the Harvard students is the holy grail rotation at your DO school while it is undoubtedly the "easy" rotation that the HMS students who don't want to go into that specific specialty do because it checks a box with minimal effort (yet meets ACGME requirements). However, they'll then go on to a rotation at BWH, BI or MGH while you might have 8 weeks with a private practice doc in an outpatient clinic for your next rotation.

    Since we're throwing around anecdotes (*cough* @SLC *cough*): during my IM rotation at the VA (didn't think I wanted to do IM so chose it cause it was 'easier') i had a DO resident who went to NYCOM. He would tell me how he didn't have any lectures during his IM rotation (we had them daily) and never had to write up H&Ps to hand in to the course director like my classmates and I did every week. I also had friends who went to NYCOM. One of them told me that his rotation at a community hospital in eastern Long Island consisted of showing up every morning with 6 of his classmates and mostly sitting around because there were very few patients on the service and nothing for them to do.
     
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  38. Matthew9Thirtyfive

    Matthew9Thirtyfive Class of 2023!
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    Friendly reminder to keep it professional, folks.
     
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  39. Goro

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    100% correct Meat, but the posts on this page were mostly about student's own perceptions of their own rotations, and that DO students are not alone in complaining about bad rotation sites. Of course, the pox on clinical education in the DO world that still hurts still is poor rotations. That's a given at a lot of schools

    This also isn't the first scary thing I've heard about NYCOM! I'm beginning to wonder about them.

    I wish to reiterate that what Meat says about connections is really, really important.
     
  40. UnoMas

    UnoMas ASA Member
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    Nowhere on my post did I say I did my rotations with Harvard students so I don't know where is all this coming from. Another poster said his rotations at a non-Harvard MD school were essentially the same as Harvard MD rotations so I made my comparison by extension.
    No doubt connections play a HUGE role in residency placement but nobody is arguing that.
    Either way it means very little to me as I already wrapped up my interview season.
     
    #140 UnoMas, Jan 10, 2019 at 9:15 PM
    Last edited: Jan 10, 2019 at 9:26 PM
  41. doctorsdatdo

    doctorsdatdo Osteopathic Medical Student

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    Agreed. This is especially important for the few dissenters among us who don’t agree that everything is all well and MD and DO students recieve equivalent education.

    We must post with the utmost professionalism so our voices are continuing to be heard on this forum and students can glimpse a glance of reality in some areas of the country.
     
  42. doctorsdatdo

    doctorsdatdo Osteopathic Medical Student

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    I believe old post from SLC suggest that he scrambled on to a family medicine program where some ivy league students may go. I believe he has experience with those students.
     
  43. Chibucks15

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    how very noble of you! We should all lead by your example. Cmon now get off your high horse

    Basically it comes down to this, as it always does, but people ignore it. If you want any of primary care, neuro, EM (sometimes), and the rest of the DO-friendly specialties, and you'd be fine living in the dreaded middle of the country (i know that's insane for some of you NYC/LA or bust people on here), you'll be fine DO. If you're a prestige junkie who needs to say they got Harvard educated, then make yourself a competitive applicant and go MD. No idea why people go DO expecting to have no hurdles to get into specialties that even MD students have a very hard time getting into.

    There will be bias for at least another generation, and probably longer in the ivory towers. It all depends on how quickly the glaring problems in DO world become normal problems that MD students deal with all the time. Some schools already are close, but many aren't. It sucks, but it is what it is.
     
    #143 Chibucks15, Jan 11, 2019 at 5:37 AM
    Last edited: Jan 11, 2019 at 7:18 AM
  44. SLC

    SLC A Punk rock Country doc
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    Nope, instatewaiter said something along the lines of “as an MD student, my rotations were indistinguishable from students at HMS” to which I replied “my coresidents who went to HMS said their rotations often sucked and they claimed they got a poor clinical training”.

    I think the admonition to keep it professional was directed at posts like yours. That and a few other who won’t be singled out directly with long and illustrious histories of trolling this forum.
     
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    #144 SLC, Jan 11, 2019 at 5:47 AM
    Last edited: Jan 11, 2019 at 5:52 AM
  45. doctorsdatdo

    doctorsdatdo Osteopathic Medical Student

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    Curious to see where the unprofessionalism come in in my post. Any specific examples?
     
  46. Dwan

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    You don't have to try to bash on top schools in order to defend yours, just makes you look like you have a chip on your shoulder for not getting into MD or anything prestigious. BID, BWH, and MGH are all excellent and average evaluations from their med students are very high for all 3 sites, in particular the medicine rotations. The fact there are 3 major teaching hospital sites so that students can be spread out, while still having a quality training experience, is huge, and I've never met anyone who didn't have significant responsibility on these rotations. This is partly why top residencies will continually take HMS students with low step scores - they know the quality of the residents they are getting.
     
  47. SLC

    SLC A Punk rock Country doc
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    No chips here, my career has turned out better than I ever hoped it would, especially this early on. My school doesn’t need to be defended or other schools bashed; I got where I wanted to be in the end, that’s what matters.

    My comment was just an interesting anecdote I experienced in residency; and that was pertinent given the specific post I responded to.
    Instatewaiter mentioned his rotations were indistinguishable from HMS ones, I think he was trying to use that statement to prove that MD clinical education is basically uniform (and by extension excellent) across all schools.

    Given the discussion we’ve had, I thought it was funny in context that I’d been told by a HMS grad that he thought his clinical education had left a lot to be desired. Which may say something about the clinical education of those who claim theirs (and that of all MD school’s) is “just like Harvard’s”.


    Lighten up Dwan.
     
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    #147 SLC, Jan 11, 2019 at 8:57 AM
    Last edited: Jan 11, 2019 at 10:35 AM
  48. DrWBD

    DrWBD Formerly 'wanna_be_do'
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    An actual practicing physician such as yourself should have enough awareness to understand that residency matching process is not based on merit. At least not in any way that your suggestions would matter an iota for any truly competitive program. If you don’t grasp that then discussion is pointless.
     
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  49. Angus Avagadro

    Physician Faculty

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    Residency matching is NOT based on merit? Are you kidding?What's it based on? Popularity? Your number of followers on social media? Of course its merit based. Class rank, board scores, preclinical and clinical grades, LORs, your interview, research, publications. I thought my point was pretty clear. Create a better product, favorability goes up. Better product means better board scores fewer class and board failures, better clinical rotations. If you dont grasp that, and apparently it's about an inch beyond your grasp, then discussion is pointless.
     
  50. Dwan

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    Extrapolating the comment of 1 unhappy person (for which you don't even know the reason) to an entire school's education, and embedding it into your memory to recite it in case someone talks about "Harvard" - seems like you definitely have a chip, as this is what people who have insecurities like to do when they see someone from a fancy school (especially once they are in a position of more experience). I don't think that's the best way to argue about the clinical training disparity among MD schools.
     
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