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So let me *attempt* to keep this as short as possible, but I think details may help elucidate my confusion as to what to do.
I'm a second year and we start picking our clinical rotation sites for 3rd year soon. While my school actually has a number of choices in a number of different 'types' of hospitals, pretty much everyone has fallen in love with schools on different ends of the 'education spectrum' and I have conflicted feelings on both. So I come to you, SDN, to tell me which one is best for my 3rd year experience.
The first option, which is really two different options, are the super classic, resident-heavy, teaching hospital. We have two of these that are vastly different in size (251 bed 10,500 admission and 672 bed 40,000 admission), but they both made a nearly identical pitch to us. They argue that you should be going to the 'classic' style hospital so that you can have the residents run your life. Learn by observing. Be pimped and have formal lecture structures set up. See an attending for 1-2 hours a day but really live off the scraps the residents leave you, but know that you're receiving the most full education possible through the classic system. One of them is a huge surgical residency location (the smaller) and the other is a level I trauma center with chances to observe crazy surgeries (larger one). They both argue that its a "earn the respect of the residents and become treated like one of them in what you get to do" situation. They both have lots of residencies in everything you'd expect and a few specialty residency options on site which dont really appeal to me so its a moot point that those exist.
The second option is three 'community hospitals' (I use it a little loosely, youll read why) that are packed together as one rotation since they are all run by the same DME and geographically very close. Its a true community hospital in a poor area (180/9,300), high-end hospital seeking future residencies (318/19,000) and a small affiliate hospital of Mt. Sinai with a small portion of Sinai's residency program (258/18,000). They are packaged together as one group unit with the majority of the time spent at the 2nd hospital (the 318 bedder). Because of this, unless you're at the third hospital, you pretty much never seen residents. They pitch this as being an opportunity to work directly with attendings who are assigned to you. They admit fully that you may sometimes be there for a few hours when the attending isnt, and you're expected to make friends of other attendings, nurses, PAs, etc to give you things to do, or to take the time to study on your own. When the attendings are there you get to be treated to hands on practice on patients, with no residents to steal procedures from you. This is especially prominent in surgery where you are literally given a beeper and you are the first assist on all surgeries as soon as you are capable of not causing malpractice due to clumsiness.
The students from the two places dont make it any easier with the students from the teaching hospitals insisting that having residents is the most certain way to be educated and that people who pay their dues get to experience things. (I dont like the phrase "pay your dues". I realize you have to. But I always feel like it hides how much is 'due' before you get to get hands on). The students from the community hospitals tell stories about how all the other hospitals they've visited since their time there have been astounded at how many techniques they feel totally comfortable with and have let them continue to do those techniques and procedures despite residents being at the other hospitals. But then again they do admit that there is less structure and 'downtime' that you have to be self-motivated to study in.
I was previously concerned about patient flow, but as the numbers show, the three community hospitals have pretty decent patient flow and bed size despite not being a 1,000 bed mega hospital. and are comparable 'enough' to the larger teaching hospital. and I was also previously concerned about a lack of residencies, but in 2012 the largest of the 3 "community hospitals" is supposedly adding a very large amount of residencies in pretty much every field under the sun.
So what do you guys think is best for my 3rd year. I'm well aware I'm going to be in a majority of "teaching hospitals" for my 4th year no matter what. So is it a mistake to skip out on this opportunity to work elbow to elbow with attendings 3rd year and have skills to show off? Or is it better to pick the teaching hospital system which seems to offer much less opportunity to hands on learn but should offer a more solid medical knowledge education because the the "lowest turd on the totem pole" and strictly scheduled lectures system.
I'm a second year and we start picking our clinical rotation sites for 3rd year soon. While my school actually has a number of choices in a number of different 'types' of hospitals, pretty much everyone has fallen in love with schools on different ends of the 'education spectrum' and I have conflicted feelings on both. So I come to you, SDN, to tell me which one is best for my 3rd year experience.
The first option, which is really two different options, are the super classic, resident-heavy, teaching hospital. We have two of these that are vastly different in size (251 bed 10,500 admission and 672 bed 40,000 admission), but they both made a nearly identical pitch to us. They argue that you should be going to the 'classic' style hospital so that you can have the residents run your life. Learn by observing. Be pimped and have formal lecture structures set up. See an attending for 1-2 hours a day but really live off the scraps the residents leave you, but know that you're receiving the most full education possible through the classic system. One of them is a huge surgical residency location (the smaller) and the other is a level I trauma center with chances to observe crazy surgeries (larger one). They both argue that its a "earn the respect of the residents and become treated like one of them in what you get to do" situation. They both have lots of residencies in everything you'd expect and a few specialty residency options on site which dont really appeal to me so its a moot point that those exist.
The second option is three 'community hospitals' (I use it a little loosely, youll read why) that are packed together as one rotation since they are all run by the same DME and geographically very close. Its a true community hospital in a poor area (180/9,300), high-end hospital seeking future residencies (318/19,000) and a small affiliate hospital of Mt. Sinai with a small portion of Sinai's residency program (258/18,000). They are packaged together as one group unit with the majority of the time spent at the 2nd hospital (the 318 bedder). Because of this, unless you're at the third hospital, you pretty much never seen residents. They pitch this as being an opportunity to work directly with attendings who are assigned to you. They admit fully that you may sometimes be there for a few hours when the attending isnt, and you're expected to make friends of other attendings, nurses, PAs, etc to give you things to do, or to take the time to study on your own. When the attendings are there you get to be treated to hands on practice on patients, with no residents to steal procedures from you. This is especially prominent in surgery where you are literally given a beeper and you are the first assist on all surgeries as soon as you are capable of not causing malpractice due to clumsiness.
The students from the two places dont make it any easier with the students from the teaching hospitals insisting that having residents is the most certain way to be educated and that people who pay their dues get to experience things. (I dont like the phrase "pay your dues". I realize you have to. But I always feel like it hides how much is 'due' before you get to get hands on). The students from the community hospitals tell stories about how all the other hospitals they've visited since their time there have been astounded at how many techniques they feel totally comfortable with and have let them continue to do those techniques and procedures despite residents being at the other hospitals. But then again they do admit that there is less structure and 'downtime' that you have to be self-motivated to study in.
I was previously concerned about patient flow, but as the numbers show, the three community hospitals have pretty decent patient flow and bed size despite not being a 1,000 bed mega hospital. and are comparable 'enough' to the larger teaching hospital. and I was also previously concerned about a lack of residencies, but in 2012 the largest of the 3 "community hospitals" is supposedly adding a very large amount of residencies in pretty much every field under the sun.
So what do you guys think is best for my 3rd year. I'm well aware I'm going to be in a majority of "teaching hospitals" for my 4th year no matter what. So is it a mistake to skip out on this opportunity to work elbow to elbow with attendings 3rd year and have skills to show off? Or is it better to pick the teaching hospital system which seems to offer much less opportunity to hands on learn but should offer a more solid medical knowledge education because the the "lowest turd on the totem pole" and strictly scheduled lectures system.
