Hey Plasticman,
I can definantly see where you are comming from. I think the biggest issue right now is quality control of AOA residencies. I won't name any school or program, but I was looking through a listing - and there was an orthopedic surgery program and also an ENT program that was located at a hospital with only 90 beds. Also, this hospital only had 55% occupancy.
The size of a hospital has very little to do with the number of cases or pathology you see. Not only that, but there are no residency programs that are located at a single location, certainly not one with such a small number of beds. Besides...ENT and Ortho programs dont need large hospitals. An Ortho can do 8 cases at a surgicenter...NONE of those patient stay over. ENT is similar with many office based cases.
Now, I am not an expert or anything - but I think this is a problem when you then scroll down a little further on the AOA website and see like an orthopedic surgery program at a 650 bed hospital with dual AOA/ACGME. Do you see what I am trying to get at? There is no standardization. One program maybe completely phenomenal - another needs to be shut down. There's no control over our GMEs.
Of course there is control. The AOA sets standards for number of cases a resident must have before being able to complete their residency program. And there is also a break down so that the resident must complete a certain number of cases in a particular area. General surgery does this...# of neck, # of thyroid, # of pancreas, etc.
Going back to that 90 bed hospital thing I saw...at the school I go to, they have this one family practice program at a 220 bed hospital with like 75% occupancy - it is a very small program and takes only 2 people a year. The administration thought it was too small of a hospital - so they will not allow anything else besides the FP program; not enough patients etc - so they had to open other prorams and lobby for funding at larger hospital for other residencies...etc etc..
...Do you see what I am try to get at? 220 beds is a little too small even for an FP program - yet there are some other schools who think that a 90 bed hospital will serve just fine to base orthopedic and ENT programs at?
You NEED that many patients in-house for a FP, IM, Peds, etc. Again...as a surgeon where are your patients coming from?
Most of your list will be consults for patients who will likely not go to the OR. Thats for general surgery.
Who consults Ortho in-house? Not often are they consulted. Occasionally for a bone mass or a fracture that happens while the patient is in-house, but most of their stuff comes through the ER or, as I said before, are outpatient cases.
There's no regulation what so ever!
Absolutely there is. # of beds doesnt list a standard of care.
If I were to tell you which hospitals in Philadelphia did the most number of major surgical procedures in a year you would be very suprised. Tops 3 are NOT "Jeff, Penn, Temple" like most people, even medical people, would guess.
Now about COCA (the committee that "accredits" so to speak all the new schools) - well I am not familiar with their standards, but I have read somewhere that all you need to have is, correct me if I am wrong, $5 million dollars in revenue over a period of 5 years.
I hope what I have just written above is wrong - cause the recent rebuilding and renovations at my small school alone costed close to $ 12 million and probably close to $ 20 million by the time all is done and said.
At just $5 million any small group can open up a DO school. Look at some of the recent branch campuses that have opened up. I won't mention any names, but when a school is less than 10 years old or hasn't even graduated a single class and opens up a new branch campus, that just says that perhaps we need to sit down and rethink where this profession is going.
While I am not a big fan of all the new schools opening, I cant argue with the financial aspect of things. There is no lack of technology at these schools. There is no lack of accredidation and the tuition is in line with schools that have been around for 100 years.
And now there is a for profit school opening up in Colorado! They'll have shares on the NYSE before you know it. I can smell it already, the IPO will be set at $35 a share and they'll pay 4% dividens!
What school ISNT for profit?
Now lets talk about 3rd and 4th year rotations. All you PRE-MEDs please listen up. Some schools have completely structured clinical rotations - others will leave you fending for youself and calling this physician's office who is across the country.
True
There is no standardization - and you don't know if you met all the criteria of that rotation until your preceptor hands you the grade - they could fail you on a whim - and you wouldn't be able to argue.
Seems like you deserve to fail if you are working for a month and suddenly learn you werent doing what you were supposed to be doing. Lack of communication...cant blame the absence of communication between a student and the attending/preceptor on the school.
With structured rotations, you report to a director of the hospital you are in - you must fullfill X, Y, Z. The program you are at must have this standard and that standard. If a problem arises, you report to the director of that program for your school.
I guarantee each school has standards for each rotation. I know this for a fact.
You have a group of your class mates from 1st and 2nd year with you to cover your asss when you screw up.
Holy crap...dont let THAT be a determining factor on the quality of a rotation. Some of the best learning experiences I had were when it was me and an attending and NONE of my classmates around. If you screw up, you screw up. You dont learn by having people cover your ass...that sure as hell wont happen once youre in charge.
There must be didatics and reports done by you in order for them to check off all the things they want.
Even the bigger, "structured" rotations often fall short on this.
With no structured rotations - hell you're on your own - pick up your bag and move across the country every 2 months. You must set up your own rotations and contact whoever's in charge over there across the country - and there's a chance that you'll have to pay a fee just to rotate at that site. And its much harder to get a good letter of recommendation after its all said and done. etc etc.
Harder to get a good letter of recommendation? How? I disagree completely. If you are the ONLY student and you do a damn good job, you will get a good letter. Its easier to stand out when youre the only one standing in the first place.
As for years 1 and 2, well I don't see how Dale Dubin or Robbin's can be different at any other school. And I think we do this very well as a profession. Of course we need good faculty and facilities for the students. However at some anatomy labs you have 6 or 7 people at a cadaver table - and you don't get the chance to dissect. It should be 4 at a table and everyone digging for those cranial nerves.
I agree with you, but there is no evidence that shows dissection is superior to prosection when it comes to learning anatomy.
So if I had to critique the osteopathic field, my chief complaint would be the lack of standardization. One school maybe top notch, another average, and another that needs a lot of improvement.
Sounds like life. This is why the students must make informed decisions. But your critique is not unique to the osteopathic field but can be applied to MD schools, hospitals, residency programs...anything.
What if all of a sudden tommorrow....a law was passed mandating that all DO schools fullfill LCME requirements? What do you think would happen.
They would adapt to do so.
Perhaps some of the older private and public schools could do it - but I think we'd get hit really hard.
Almost like MD schools fulfilling AOA requirements?
😕
I remember a few years ago when Temple Univeristy was on the verge of loosing accrediation...Temple! And I had a relative who went to what was MCP Hannheman - and for a moment she thought everything she did was in vain. They thought they'd come in and find bolts and chains on the school door!
A lot of people were worried.
I think Drexel bought out MCP Hananmen at the very last moment.
Now granted MCP had some serious budget problems..but at least someone (LCME) called them out for it.
Yes they did. Not last moment though.
And I don't know if there is any osteopathic school with a revenue in excess of 100 million dollars.
Dont know. That would be a major "for profit" school though, wouldnt it?
I know some schools come close to this, but not over this amount of money. So if there was a Flexner II....we'd still get hit hard.
In 1911, there was only one osteopathic school that got "ordinary/accepatble ratings" so to speak - and that was what is now UC Irvine.
The Flexner report was designed with the intention of closing DO schools. Were you suprised with the outcome? Especially at that time when the DO schools were being held to standards that the MD schools were being held to...but they werent teaching the same things!
It would be like closing pharmacy schools because they were not up to par with medical schools.
Now the two are far closer in their educational curricula and, OMM excluded, you could look at the courses and timetable for a DO school and compare it to an MD school and not be able to tell which is which.
Note: If anyone sees something wrong with what I have written, flame me please. I don't want to be misleading people.
Done.
