The best in clinical skills

[La Presse]

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Hi.

There was a point in time when I had a conversation with a fellow SDN member about his/her selection of schools during the application cycle. One of his remarks regarded the level of clinical skills being taught to the MS3/4 students as "poor" or "subpar." What particularly surprised me was that this school was a top tier institution.

Which medical schools are typically known for their superior clinical skills? Does anyone one know or have first-hand knowledge?

 

[mimelim]

Typically schools with a history of scut, trauma, county hospitals and VAs will have the most hands on, clinical skill derivation. For example, I am at the largest trauma hospital in the country right now, on the Trauma service. I walked two students through how to remove a chest tube 3 days ago on their first day of their Surgery rotation. I did the entire procedure explaining step by step why I was doing things and why I was explaining what I was saying to the patient (told the patient I would be doing this ahead of time). I told the students that they would be pulling every chest tube that was available on the floor from then on. The next day they each pulled one chest tube, I helped them get supplies and talked them through it step by step again, but their hands doing everything. Now (day 4) they have each done 3+ with them going to the room, getting everything setup, texting me, I show up in the room, and say, "go for it". They explain to the patient what they are doing and then pull the chest tube.

We follow this model for pretty much everything on the floors/ER/trauma bay/OR. Now if you contrast this to the private quaternary hospital that I work at normally, medical students are pimped a lot, get to see "the best in the field" do immensely complex things, but aren't allowed to really do much of anything. At the same time, they don't get scutted on nearly as much because we have more NPs/PAs to do most of the floor stuff.

 

[xffan624]

Hi.

There was a point in time when I had a conversation with a fellow SDN member about his/her selection of schools during the application cycle. One of his remarks regarded the level of clinical skills being taught to the MS3/4 students as "poor" or "subpar." What particularly surprised me was that this school was a top tier institution.

Which medical schools are typically known for their superior clinical skills? Does anyone one know or have first-hand knowledge?

When I interviewed at EVMS, they claimed that was one of the benefits of their school, but as I'm a MS0 and got the big fat reject from them, I cannot personally attest to that.

 

[music2doc]

Typically schools with a history of scut, trauma, county hospitals and VAs will have the most hands on, clinical skill derivation. For example, I am at the largest trauma hospital in the country right now, on the Trauma service. I walked two students through how to remove a chest tube 3 days ago on their first day of their Surgery rotation. I did the entire procedure explaining step by step why I was doing things and why I was explaining what I was saying to the patient (told the patient I would be doing this ahead of time). I told the students that they would be pulling every chest tube that was available on the floor from then on. The next day they each pulled one chest tube, I helped them get supplies and talked them through it step by step again, but their hands doing everything. Now (day 4) they have each done 3+ with them going to the room, getting everything setup, texting me, I show up in the room, and say, "go for it". They explain to the patient what they are doing and then pull the chest tube.

We follow this model for pretty much everything on the floors/ER/trauma bay/OR. Now if you contrast this to the private quaternary hospital that I work at normally, medical students are pimped a lot, get to see "the best in the field" do immensely complex things, but aren't allowed to really do much of anything. At the same time, they don't get scutted on nearly as much because we have more NPs/PAs to do most of the floor stuff.

This is what I have heard as well. Having an underserved population nearby is helpful since they are more likely to be willing to accept care from a med student and let you practice. Our large underserved population here in Richmond is one reason my M1/M2 clinical preceptorships/"mini-rotations" are so strong compared with what I have heard other med students describe here.

 

[Hoagie]

I have no personal insights but from what i was told at an interview at a comparable institution, a student told me that one of his residents said that the clinical training at hopkins med ran like a ferrari. This is third-hand information, but it did strike me as something interesting that i hadnt considered before. I would love to hear from more experienced people on what schools combine a superior training infrastructure/talented teachers with a varied and interesting patient base to provide an exceptional clinical training experience for medical students...

 

[music2doc]

I have no personal insights but from what i was told at an interview at a comparable institution, a student told me that one of his residents said that the clinical training at hopkins med ran like a ferrari. This is third-hand information, but it did strike me as something interesting that i hadnt considered before. I would love to hear from more experienced people on what schools combine a superior training infrastructure/talented teachers with a varied and interesting patient base to provide an exceptional clinical training experience for medical students...

The problem is that unless someone has been faculty at multiple places (or transferred med schools, which almost never happens) no one really knows what to compare their school to. All I can compare our training to is what friends at other programs tell me and/or what I read online. My experience is that a lot also has to do with what you put into it and whether or not you pursue the best opportunities your school has to offer.

 

[NickNaylor]

Hi.

There was a point in time when I had a conversation with a fellow SDN member about his/her selection of schools during the application cycle. One of his remarks regarded the level of clinical skills being taught to the MS3/4 students as "poor" or "subpar." What particularly surprised me was that this school was a top tier institution.

Which medical schools are typically known for their superior clinical skills? Does anyone one know or have first-hand knowledge?

This is a pointless question as you're going to learn a majority of your clinical skills on the wards. I have been told my multiple attendings that the best way to get that experience is to simply be proactive and express interest. If you see a resident going into a room to do something involving ultrasound, for example, tell him/her that you're not familiar with ultrasound techniques and ask if he/she would mind teaching you as they're working. Sure, maybe they'll say no, but for the most part residents seem extremely willing to teach med students. On the other hand, if you're one of those people that always sits on the sidelines and never takes opportunities to learn about/do procedures, then you might expect that your clinical skills will be weaker.

 

[Geebeejay]

The big academic supercenters (such as the hospital I work with) are allegedly notorious for "subpar" clinical exposure, at least from what I hear.

I'll give an example: Earlier this week a patient needed a chest tube, yet was relatively stable. The EM resident was not allowed to place the chest tube because, according to hospital policy, the thoracic surgery fellow, who is inhouse during the day, places all chest tubes in the ED (the exception is acute, code situations).

Now, if an EM resident can't even place chest tubes (something I consider a pretty prominent EM clinical procedure) in these situations, my thought is that medical students must only get the shaft even more in what they can't do on the wards. Concurrently, I often observe the medical students that venture to the ED with the medical/surgical teams in a very shadow-like role.

Big academic hospitals practicing "cutting edge" medicine usually have high doctor😛atient ratios. More residents/attendings throughout the hospital = less need for medical students to pick up the slack, and consequently the medical students suffer from less exposure to hands-on clinical practice.

This is only my basic understanding based on observation and word-of-mouth from residents and attendings coming from other programs.