****ty rotations, what do?

[doczebra]

So, I've 3 weeks into rotations now. I'm currently on IM. I have to say it's been extremely underwhelming. There's been zero didactics (besides the omm faculty forcing us to do a Omm review), done zero procedures, observed zero procedures, zero pimping.

It's essentially been 3 weeks of acting as a glorified MA for a private practice group at this hospital. Now the thing is this system takes 70 of my school's students. It's not just one ****ty site, it'll be my entire 3rd year.

By now, I'm a rockstar at writing SOAP notes on patients with decompensated cirrhosis, septic shock, and copd exacerbation, but no real skills learned. How can I mitigate the lack of exposure to any real medicine or procedure before audition rotations?

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[shadowlightfox]

I'm not a med student yet, so I apologize for not being able to help you, but if I may, I'm wondering. Did you pick your site or was it picked for you? Did you talk to any upperclassmen who went through similar experiences? They might be able to help you.

 

[FrkyBgStok]

This is the downside with DO schools. Some rotations suck, some are great. Some sites suck, some are great. Sometimes it is just the luck of the draw. Me and another intern at my program did most of the exact same rotations third and fourth year, went to the exact same school, and I got enough lumbar punctures to feel comfortable doing them unsupervised and she got none. A friend of mine was first assist at another site for surgery for half her rotation, and retracted once or twice at most. MD schools may have crappy rotations as well, but at least it is consistent.

 

[shadowlightfox]

Damn. Is there any way to ensure that this doesn't happen to you? Any way to maximize getting good experience?

 

[FrkyBgStok]

not a sure fire way i can tell you, but you also get the good with the bad. i had some rotations that were worse than other students, but i also had some rotations that were better than other students.

 

[padfoot777]

OP, hate to break it to you but there really isn't much you can do except keep a positive attitude. Third year will go by quickly anyway. I would just read as much as you can and prepare for your shelf exams well.

 

[hallowmann]

I mean learning how to do a fast good note is huge, but no seeing procedures, no didactics, and no pimping... I've only heard something like that from a guy at I think Orange. It sounds like it sucks. Try to branch out and take electives at better sites as much as you can. 3rd year goes by fast. Be sure to really use the extra time to study for shelfs and step 2, because you really need to be doing that the whole year. Good luck, you'll get through it, it just sucks.

 

[dozitgetchahi]

Study for steps and shelf exams.

The rubber hits the road in residency and that will be where you learn your trade. For now, read the books and get ready. You need to go to a good ACGME program in whatever specialty you want (unless it's something ultracompetitive). Avoid the DO residency programs. Buck up and earn the scores to qualify for good programs.

****ty rotations my 3rd/4th years of med school seemed like a big deal at the time, but ultimately they weren't.

 

[cbrons]

Comfort yourself with the fact that there are M.D. schools that have complete trash rotations as well.

 

[postbacpremed87]

Comfort yourself with the fact that there are M.D. schools that have complete trash rotations as well.

Is this more of a repudiation of the inefficiencies of Years 3-4? Idk.

 

[scpod]

So, I've 3 weeks into rotations now. I'm currently on IM. I have to say it's been extremely underwhelming. There's been zero didactics (besides the omm faculty forcing us to do a Omm review), done zero procedures, observed zero procedures, zero pimping.... How can I mitigate the lack of exposure to any real medicine or procedure before audition rotations?

Hate to break it to you, but the reality is that the majority of Internists rarely do procedures these days. Why? Because they don't want to. The quickest way to make sure your hospital doesn't get applicants for a Hospitalist job is to put "procedures required" in your advertisement. Procedures totally slow your day down and make you fall behind.

Here's what you can do. If you have a patient that is going for and endoscopy, ask the attending if you can go view that. That can at least give you an introduction into what is happening. When I have students I send them home each day with a list of things they need to know based on what patients they saw today. If you saw a COPD or CHF patient today, you should read everything you can on the topic. Pay careful attention to your physical exam, and look for the things you should be finding. If your attending isn't helping then just do it on your own. Be proactive. You get out of any rotation exactly what you put into it. Be enthusiastic. Come in early and see some of the patients in the hospital. Make some observations and ask questions from the attending about them. "I notice we have been giving him fluids a few days and he is eating and drinking fine. Does he still need them? Can we give him too much?" Act like you are involved and engage the attending in conversation. Show them you are interested and it will be better for them as well.

 

[shadowlightfox]

Hate to break it to you, but the reality is that the majority of Internists rarely do procedures these days. Why? Because they don't want to. The quickest way to make sure your hospital doesn't get applicants for a Hospitalist job is to put "procedures required" in your advertisement. Procedures totally slow your day down and make you fall behind.

Here's what you can do. If you have a patient that is going for and endoscopy, ask the attending if you can go view that. That can at least give you an introduction into what is happening. When I have students I send them home each day with a list of things they need to know based on what patients they saw today. If you saw a COPD or CHF patient today, you should read everything you can on the topic. Pay careful attention to your physical exam, and look for the things you should be finding. If your attending isn't helping then just do it on your own. Be proactive. You get out of any rotation exactly what you put into it. Be enthusiastic. Come in early and see some of the patients in the hospital. Make some observations and ask questions from the attending about them. "I notice we have been giving him fluids a few days and he is eating and drinking fine. Does he still need them? Can we give him too much?" Act like you are involved and engage the attending in conversation. Show them you are interested and it will be better for them as well.

You said if your attending isn't helping then just do it on your own. Unless I'm misunderstanding what you mean, I was under the impression that you weren't allowed to do anything without the attending's supervision.

 

[Goro]

Yup. This is the one thing that gives the profession a bad name in the eyes of PD's. NOT OMM, not the "holistic " bit, but poor clinical education. Yet the AOA is immune to this fact.

OP, my advice to you is:
1) give your clinical education Deans an earful.
2) seek out ANY opportunity to actually do something. Do not settle for a year of glorified shadowing.
3) see if you can get out of this rotation for a better one.
4) network. Seek out you 4th year colleagues to see if there are things to do to make this experience more palatable.
And good luck!

This is the downside with DO schools. Some rotations suck, some are great. Some sites suck, some are great. Sometimes it is just the luck of the draw. Me and another intern at my program did most of the exact same rotations third and fourth year, went to the exact same school, and I got enough lumbar punctures to feel comfortable doing them unsupervised and she got none. A friend of mine was first assist at another site for surgery for half her rotation, and retracted once or twice at most. MD schools may have crappy rotations as well, but at least it is consistent.

Hh

 

[Goro]

Doc , can you PM me?

So, I've 3 weeks into rotations now. I'm currently on IM. I have to say it's been extremely underwhelming. There's been zero didactics (besides the omm faculty forcing us to do a Omm review), done zero procedures, observed zero procedures, zero pimping.

It's essentially been 3 weeks of acting as a glorified MA for a private practice group at this hospital. Now the thing is this system takes 70 of my school's students. It's not just one ****ty site, it'll be my entire 3rd year.

By now, I'm a rockstar at writing SOAP notes on patients with decompensated cirrhosis, septic shock, and copd exacerbation, but no real skills learned. How can I mitigate the lack of exposure to any real medicine or procedure before audition rotations?

 

[hallowmann]

You said if your attending isn't helping then just do it on your own. Unless I'm misunderstanding what you mean, I was under the impression that you weren't allowed to do anything without the attending's supervision.

If I understood scpod correctly, I think he meant make a list of pertinent topics related to your patients to study each day, so you're constantly busy and learning if your attending isn't doing it for you. You should be doing this regardless.

Obviously you shouldn't be doing anything procedure-wise without supervision, but you could always ask other docs if you can watch on downtime. Just don't be the guy that disappears from your rotation without telling anyone so you can "observe" procedures from some other doc.

 

[Seth Joo]

So, I've 3 weeks into rotations now. I'm currently on IM. I have to say it's been extremely underwhelming. There's been zero didactics (besides the omm faculty forcing us to do a Omm review), done zero procedures, observed zero procedures, zero pimping.

It's essentially been 3 weeks of acting as a glorified MA for a private practice group at this hospital. Now the thing is this system takes 70 of my school's students. It's not just one ****ty site, it'll be my entire 3rd year.

By now, I'm a rockstar at writing SOAP notes on patients with decompensated cirrhosis, septic shock, and copd exacerbation, but no real skills learned. How can I mitigate the lack of exposure to any real medicine or procedure before audition rotations?

Welcome to life as a DO student, this is a reality for students at many schools. I was lucky I was able to get quality rotations where I went but many DO students do not. Schools do not really care as long as they do the minimum to train a future primary care physician.

That is one reason why DO schools are generally easier to get into than MD schools.

That being said talk to the people at your school's clinical education department, maybe they might help you depending on your school.

 

[Drrrrrr. Celty]

Welcome to life as a DO student, this is a reality for students at many schools. I was lucky I was able to get quality rotations where I went but many DO students do not. Schools do not really care as long as they do the minimum to train a future primary care physician.

That is one reason why DO schools are generally easier to get into than MD schools.

That being said talk to the people at your school's clinical education department, maybe they might help you depending on your school.

It isn't tho. It's easier to get into because they're DO schools and because many students don't know they exist.

Besides, it's not like Allo isn't rittled with tons of bad experiences too. Either way, as it was mentioned above by one of the Fellows, 3rd and 4th year don't exactly make you into a physician either.

 

[shadowlightfox]

It isn't tho. It's easier to get into because they're DO schools and because many students don't know they exist.

Besides, it's not like Allo isn't rittled with tons of bad experiences too. Either way, as it was mentioned above by one of the Fellows, 3rd and 4th year don't exactly make you into a physician either.

And even then, it's changing. DO schools are now getting more and more students applying each year because more and more pre-meds are now starting to see DO as practically being the same thing as MD now, which is why I won't be surprised if in several years DO schools will be just as competitive and subsequently hard to get into as MD schools.

Also, I'd like to point out that DO schools are easier not because of the rotations or bare minimums, but because the average statistics of accepted students are lower than those of MD schools.

 

[Drrrrrr. Celty]

And even then, it's changing. DO schools are now getting more and more students applying each year because more and more pre-meds are now starting to see DO as practically being the same thing as MD now, which is why I won't be surprised if in several years DO schools will be just as competitive and subsequently hard to get into as MD schools.

Also, I'd like to point out that DO schools are easier not because of the rotations or bare minimums, but because the average statistics of pre-med students getting accepted to DOs is lower than MD schools.

I think by the end of 5 years medical school admissions will either plateau or beginning to fall. The economy will likely either stabilize and or 4year college will continue to consecutively see decreases in admission volume.
So I don't believe DO schools will ever really hit MD levels outside of NYC, CA, Chicago, and Miami.

 

[Seth Joo]

It isn't tho. It's easier to get into because they're DO schools and because many students don't know they exist.

Besides, it's not like Allo isn't rittled with tons of bad experiences too. Either way, as it was mentioned above by one of the Fellows, 3rd and 4th year don't exactly make you into a physician either.

Medical school is a long hard experience whether you go to Harvard or a small rural DO school. I never said nothing was easy but the clinical education at many DO schools have issues, while the vast majority of MD schools do not.

If you read the mission statement of most schools they exist to create primary care physicians in areas of need not Doc 90210, so many will just do what is required for their students to become that, most DOs go into primary care.

Actually many people these days know about DO schools, they were obscure maybe 10 years ago or so.

 

[Drrrrrr. Celty]

Medical school is a long hard experience whether you go to Harvard or a small rural DO school. I never said nothing was easy but the clinical education at many DO schools have issues, while the vast majority of MD schools do not.

If you read the mission statement of most schools they exist to create primary care physicians in areas of need not Doc 90210, so many will just do what is required for their students to become that, most DOs go into primary care.

Actually many people these days know about DO schools, they were obscure maybe 10 years ago or so.

It's a progressive development. But I'm saying that I think ppl on SDN might be overdoing it on trying to claim that 3rd and 4th year clerkships are what's holding back DOs from going into some ACGME fields or that they're probably majorly significant in the long run. I think it's simply the fact that they're DOs.

 

[Seth Joo]

It's a progressive development. But I'm saying that I think ppl on SDN might be overdoing it on trying to claim that 3rd and 4th year clerkships are what's holding back DOs from going into some ACGME fields or that they're probably majorly significant in the long run. I think it's simply the fact that they're DOs.

Its just harder to match in certain programs as a DO but not impossible, a good number of my classmates were aiming for specialties but settled for primary care, that is just the reality.

 

[Drrrrrr. Celty]

Its just harder to match in certain programs as a DO but not impossible, a good number of my classmates were aiming for specialties but settled for primary care, that is just the reality.

I imagine it was their second choice either way. There are tons of uncompetitive or totally in reach specialties in the ACGME and the AOA world that people wouldn't touch over FM. Ex me, I'd go FM before I went EM.

 

[shadowlightfox]

Damn. As a prospective DO student wanting to get into specialty, these are very discouraging posts for me.

 

[Drrrrrr. Celty]

Damn. As a prospective DO student wanting to get into specialty, these are very discouraging posts for me.

I mean it's not the end of the world. But if you want surgical sub-specialties your chances are going to be very very low going on from now.

 

[shadowlightfox]

I mean it's not the end of the world. But if you want surgical sub-specialties your chances are going to be very very low going on from now.

Well, in that case, I'm just gonna have to work my butt off and start planning from the very beginning rather than at the end if I want it, I guess.

 

[AnatomyGrey12]

Well, in that case, I'm just gonna have to work my butt off and start planning from the very beginning rather than at the end if I want it, I guess.

That's why I keep telling myself that I'm going to aim for neurosurgery, that way when I do decide what I want to be i'll be competitive for most things and maybe have an outside chance at something really competitive. Even if I do something like Peds I'll be able to go to a great program. I really don't want neurosurgery but I feel like it will motivate me to work as hard as I can and not slack off. You just have to know that at the end of the day you still might not get Derm, ENT, Ortho, etc. That's just the realty of going DO, but for me it's a chance that I wouldn't have had otherwise and I will be perfectly content to be a rural FM doc if that's where life takes me.

 

[shadowlightfox]

That's why I keep telling myself that I'm going to aim for neurosurgery, that way when I do decide what I want to be i'll be competitive for most things and maybe have an outside chance at something really competitive. Even if I do something like Peds I'll be able to go to a great program. I really don't want neurosurgery but I feel like it will motivate me to work as hard as I can and not slack off. You just have to know that at the end of the day you still might not get Derm, ENT, Ortho, etc. That's just the realty of going DO, but for me it's a chance that I wouldn't have had otherwise and I will be perfectly content to be a rural FM doc if that's where life takes me.

I plan on doing that, too, but with cardiology. Except I think I really do want cardiology.

 

[ortnakas]

@Seth Joo -- you're an intern this year, right? Hope you landed in the field you were hoping for.

Well, in that case, I'm just gonna have to work my butt off and start planning from the very beginning rather than at the end if I want it, I guess.

This is a good plan. It's not as terrible for DOs as people make it out to be-- you're still a physician and you still have a good shot at a lot of specialties-- just be realistic as far as the most competitive specialties and the most competitive places go.

 

[bowjangles]

Damn. As a prospective DO student wanting to get into specialty, these are very discouraging posts for me.

Although I respect your ambition, this is not the forum for you. You are WAY ahead of yourself. Go focus on getting into medical school. Then focus on taking step1/comlex 1.

 

[shadowlightfox]

Although I respect your ambition, this is not the forum for you. You are WAY ahead of yourself. Go focus on getting into medical school. Then focus on taking step1/comlex 1.

Wait, where the hell did you get the fact that I still need to apply to med schools? My status says medical student and I have a white coat ceremony this Sunday. Focusing on getting into medical school was a thing of the past...

And ortnakas, not that it's a big deal, but why did you like his post? I was under the impression that you already knew about my getting ready for med school seeing as how you answered couple of my questions pertaining to textbooks and such.

 

[Siggy]

Wait, where the hell did you get the fact that I still need to apply to med schools? My status says medical student and I have a white coat ceremony this Sunday. Focusing on getting into medical school was a thing of the past...

Probably because you used the word "prospective," and that was not an unreasonable interpretation of your post.

 

[shadowlightfox]

Probably because you used the word "prospective," and that was not an unreasonable interpretation of your post.

Oh, in that case, my mistake. I thought it simply meant people who haven't started med school yet. I didn't know prospective meant specifically people who have yet to apply.

Live and learn.

 

[ortnakas]

And ortnakas, not that it's a big deal, but why did you like his post? I was under the impression that you already knew about my getting ready for med school seeing as how you answered couple of my questions pertaining to textbooks and such.

Same answer as @Siggy. I'd thought you were an incoming first year, but when you said "prospective" on this thread I wondered if you weren't admitted yet after all. Didn't mean to offend. Usually prospective means not-a-student-yet.

 

[Dustbowl12]

LOL at myth that MD schools all have great/solid rotations. Inconsistency is everywhere across both MD and DO programs, with variation


You people freak others out with your exaggerations over reactions and misrepresentations

 

[postbacpremed87]

I am just a third year so feel free to completely ignore everything I say. Be that as it may, I have heard several attendings state that physicians are made in residency. If you fall behind years 3/4 then it isn't fatal. You will quickly catch back up in the first few weeks of residency because of the shear volume of patients you are expected to see. A good year 3-4 clinical curriculum can help alleviate the stress of those first few weeks....scratch that...it'll be stressful anyway.

 

[shadowlightfox]

I am just a third year so feel free to completely ignore everything I say. Be that as it may, I have heard several attendings state that physicians are made in residency. If you fall behind years 3/4 then it isn't fatal. You will quickly catch back up in the first few weeks of residency because of the shear volume of patients you are expected to see. A good year 3-4 clinical curriculum can help alleviate the stress of those first few weeks....scratch that...it'll be stressful anyway.

But it depends on what kind of residency you want, though. Aren't you supposed to get letters of recommendations from 3rd/4th year sites for applying for certain residencies? It would suck if the locations you ended up in your latter half of your med school career turned out terrible for those specialties.

 

[AnatomyGrey12]

But it depends on what kind of residency you want, though. Aren't you supposed to get letters of recommendations from 3rd/4th year sites for applying for certain residencies? It would suck if the locations you ended up in your latter half of your med school career turned out terrible for those specialties.

No that's what auditions and always are for. Most DO schools only have a core site for 3rd year and 4th year is mostly electives and auditions with a couple of required rotations sprinkled in

 

[Drrrrrr. Celty]

No that's what auditions and always are for. Most DO schools only have a core site for 3rd year and 4th year is mostly electives and auditions with a couple of required rotations sprinkled in

Eh. No. DO schools have rotations for all years. You can choose to use your 4th year doing away rotations and auditions and research or etc tho. But most sites have ample amounts of electives as well.

 

[shadowlightfox]

Eh. No. DO schools have rotations for all years. You can choose to use your 4th year doing away rotations and auditions and research or etc tho. But most sites have ample amounts of electives as well.

Rotations all years? You mean first and second years, too? I was under the impression that med schools, MD or DO, don't experience any rotations til third year anyway.

 

[Drrrrrr. Celty]

Rotations all years? You mean first and second years, too? I was under the impression that med schools, MD or DO, don't experience any rotations til third year anyway.

I meant 3rd&4th year.

 

[doczebra]

I am just a third year so feel free to completely ignore everything I say. Be that as it may, I have heard several attendings state that physicians are made in residency. If you fall behind years 3/4 then it isn't fatal. You will quickly catch back up in the first few weeks of residency because of the shear volume of patients you are expected to see. A good year 3-4 clinical curriculum can help alleviate the stress of those first few weeks....scratch that...it'll be stressful anyway.

The concern is that I'll be a bumbling fool on aways. It's going to hurt the impression and letters I come away with.

 

[hallowmann]

The concern is that I'll be a bumbling fool on aways. It's going to hurt the impression and letters I come away with.

Try and do one late 3rd or early 4th where you're goal is just to get an idea of what a subI does, not a LOR or a place you really want to go for residency. After 1-2 weeks of that you'll be good. Also keep in mind that it takes time to adjust to any setting (new EMR, different staff, different style, etc.), so programs understand that to a degree. If you show crazy improvement over 4 weeks and manage to really be a part of the team by the 3rd and 4th, people will notice. I wouldn't be too worried about being too unprepared. Obviously, continue to study, get feedback, etc.

I mean sure you might not look as good as someone who has basically done a subI as a 3rd year, but it shouldn't kill you.

 

[user3]

Comfort yourself with the fact that there are M.D. schools that have complete trash rotations as well.

for a long time, I bought the nebulous excuse of "questionable rotation quality" for DO bias-- I regret that now. The "bias" primarily just seems an issue of DO's on a program's roster making it look less competitive/desirable. Plenty of MD students indeed receive poor rotation experiences, just like DO students.

 

[Goro]

You're correct; they're simply DOs, who trained poorly in 3rd and 4th year clerkships!

The days of the AT Still cult are over.

It's a progressive development. But I'm saying that I think ppl on SDN might be overdoing it on trying to claim that 3rd and 4th year clerkships are what's holding back DOs from going into some ACGME fields or that they're probably majorly significant in the long run. I think it's simply the fact that they're DOs.

 

[Mad Jack]

You're correct; they're simply DOs, who trained poorly in 3rd and 4th year clerkships!

The days of the AT Still cult are over.

I believe he's referring to the stigma, which is, in many cases, a limiting factor for sure.

 

[IslandStyle808]

for a long time, I bought the nebulous excuse of "questionable rotation quality" for DO bias-- I regret that now. The "bias" primarily just seems an issue of DO's on a program's roster making it look less competitive/desirable. Plenty of MD students indeed receive poor rotation experiences, just like DO students.

I remember the good ol' days when Dermviser, MT, and others would shove that reason down the throats to those who would complain about the DO bias. However, as I have read the forums I realize it is many things. For top programs in any field, they have so many MD applicants they don't even try to get DOs. However, you will get programs, such as Hopkins anesthesia, who takes a shot and now has a sprinkle of them here and here. When you think about it if you have a top quality DO applicant matching to a high quality program, there is a high chance his/her training is good. So it would be rare to see a DO with poor clinical training even getting an interview there (tons of barrier, i.e. high USMLE, good auditions with excellent LORs). Then you also have those who buy into the who prestige thing and think DOs lower the prestige of the program. Psychatry and PM&R have the same board score averages, yet there are barely any DOs at the top of psychiatry but many at the top of PM&R. The last reason is of course the fact that there are DO schools with nebulous clinic rotations. Highly doubt clinical rotation quality to be the only reason.

 

[shadowlightfox]

What schools do DOs who get into programs at Hopkins and other top places come from, out of curiosity? Any ideas? There has to be a reason why those specific DO students were picked to participate in those top programs.

 

[abolt18]

What schools do DOs who get into programs at Hopkins and other top places come from, out of curiosity? Any ideas? There has to be a reason why those specific DO students were picked to participate in those top programs.

Obviously Kirksville.

 

[IslandStyle808]

What schools do DOs who get into programs at Hopkins and other top places come from, out of curiosity? Any ideas? There has to be a reason why those specific DO students were picked to participate in those top programs.

WVSOM



... I'm actually serious!