What are the differences between war-based and preceptor based rotations?

[779663]

What are the good and bad of each kind of clinical rotation?

Is one more preferable than the other?

EDIT: Ward-based, not war-based lol

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[AnatomyGrey12]

Well war is more intense.... sorry I couldn't help it.

Ward is generally at a teaching hospital hospital and you work in a team with the residents and the attending. Preceptor is you are assigned to a specific doc.

I view wards based as better because the point of medical school is to turn you into a good intern, being with a resident team really teaches you those skills, with preceptor based you might not learn how to function in that way and if you are just figuring out how to do those things on an audition rotation then you will be behind the other applicants. Wards is generally much more consistent and preceptors can be highly variable, some are fantastic and others not so much.

Edit: a current student or resident is completely free to correct me though if my train of thinking is faulty

 

[dorster]

.

 

[yanks26dmb]

From my (M2) understanding, that's mostly correct. The downsides of ward based are you'll often get less contact with your attending, get sent more scut work, and may get less hands on experience.

Preceptor based you work more one-on-one, get better feedback, and may get more experience. Downside is you'll see less variety of cases usually and will have no idea what the medical hierarchy is like in a residency.

 

[EnigmaticScale]

What are the good and bad of each kind of clinical rotation?

Is one more preferable than the other?

EDIT: Ward-based, not war-based lol

War, War never changes.

 

[gamieg]

^agree with above, also want to throw in that residencies (especially ACGME, although who knows what'll happen with the merger) tend to weigh letters of recommendation from ward-based rotations more heavily than preceptor-based, but usually a good mix is nice. kinda like a committee letter vs individual letters. both can beneficial, just depends on program preference. also some rotations like family medicine tend to be mostly outpatient based so it wouldn't really make sense for it to be ward-based anyway.

 

[dr_of_rock]

Is there a place on a schools website where you can find what type they are? Like the student handbook or school policies or something?

 

[ortnakas]

Is there a place on a schools website where you can find what type they are? Like the student handbook or school policies or something?

Not really. At most DO schools this varies between clinical sites and even within clinical sites. For example, the hospital I'm at has preceptor-based surgery but ward-based IM.

 

[dr_of_rock]

Will my schools "rotations counselor" or whoevers in charge of that know? Or will I literally not know until I get there?

 

[sdhere1234]

Will my schools "rotations counselor" or whoevers in charge of that know? Or will I literally not know until I get there?

Your best bet is current/past students. Just look up XYZ class of 2018 and under on facebook

But honestly it's not X school is ward based or Y school is preceptor.

Some schools have ward IM, but then preceptor peds, outpatient psych, etc.

 

[dr_of_rock]

edit: double post

 

[ERinspired]

edit: double post

I don't understand this question. Yes, the school administration knows how their rotation sites are formatted.


Sent from my iPhone using SDN mobile

 

[dr_of_rock]

I don't understand this question. Yes, the school administration knows how their rotation sites are formatted.


Sent from my iPhone using SDN mobile

Haha ok. Nevermind.

 

[AlteredScale]

If you happen to be at a preceptor based site say for surgery or medicine at a community hospital it usually means there is no resident team and no GME in that service which means there is no program director or academic leadership --> no solid letter --> have to go and do a Sub-I fourth year at a real academic center with wards based rotation in the specialty you are wanting to go into to get a letter.

We get a lot of feedback saying having a preceptor based rotation is great because it's hands on. But I just don't feel that an LOR that says "this medical student was doing what a resident was" carries as much weight as a letter from a Dept. Chair or PD that says "they worked well with the residents/worked well as a team/did research with me/was praised by the service team and staff" with more likelihood of that Chair or PD having a name that is familiar amongst other PD's in that same specialty.

 

[779663]

If you happen to be at a preceptor based site say for surgery or medicine at a community hospital it usually means there is no resident team and no GME in that service which means there is no program director or academic leadership --> no solid letter --> have to go and do a Sub-I fourth year at a real academic center with wards based rotation in the specialty you are wanting to go into to get a letter.

We get a lot of feedback saying having a preceptor based rotation is great because it's hands on. But I just don't feel that an LOR that says "this medical student was doing what a resident was" carries as much weight as a letter from a Dept. Chair or PD that says "they worked well with the residents/worked well as a team/did research with me/was praised by the service team and staff" with more likelihood of that Chair or PD having a name that is familiar amongst other PD's in that same specialty.

So do you find this to be an issue at your school? I've seen you mention that KCU is by and large preceptor based?

 

[LutGholein]

So do you find this to be an issue at your school? I've seen you mention that KCU is by and large preceptor based?

KCU-Joplin has a good mix of ward-based rotations and preceptors from what I hear

 

[779663]

KCU-Joplin has a good mix of ward-based rotations and preceptors from what I hear

Do both KCU schools share rotation sites?

 

[AnatomyGrey12]

Do both KCU schools share rotation sites?

Right now yeah but I was told at my interview that once Joplin's students get to third year the sites in Joplin will be reserved for the Joplin students and the KC students won't rotate there anymore. They can still rotate through the residency programs in 4th year however.

 

[AlteredScale]

Right now yeah but I was told at my interview that once Joplin's students get to third year the sites in Joplin will be reserved for the Joplin students and the KC students won't rotate there anymore. They can still rotate through the residency programs in 4th year however.

Yep this is exactly correct, so starting August 2017 and two years on. KCU - KC Campus students will still be able to rotate in Joplin. I myself am very much considering going down there for third year.

KCU-Joplin has a good mix of ward-based rotations and preceptors from what I hear

There are two sties in Joplin: Mercy Hospital and Freeman. Mercy is preceptor based while Freeman is wards however I have heard that you can switch over from hospital system to hospital system if you wish to do one or the other.

 

[ShowtimeKaner88]

If you happen to be at a preceptor based site say for surgery or medicine at a community hospital it usually means there is no resident team and no GME in that service which means there is no program director or academic leadership --> no solid letter --> have to go and do a Sub-I fourth year at a real academic center with wards based rotation in the specialty you are wanting to go into to get a letter.

We get a lot of feedback saying having a preceptor based rotation is great because it's hands on. But I just don't feel that an LOR that says "this medical student was doing what a resident was" carries as much weight as a letter from a Dept. Chair or PD that says "they worked well with the residents/worked well as a team/did research with me/was praised by the service team and staff" with more likelihood of that Chair or PD having a name that is familiar amongst other PD's in that same specialty.

Just going to play some devils advocate here. I somewhat understand the whole LOR predicament, but in reality all DO students should be doing sub-I's during fourth year and trying to get letters from people in their field of interest during 4th year so whether you have it 3rd year shouldn't make a huge difference. As a third year student, you have pretty limited ability to think clinically and that's the whole point of 3rd year rotations is to help you start building that skill. Also consider this scenario, you have a ward based rotation for your IM or whatever it may be, but what if it's your very first rotation? You don't know jack about clinical medicine and even though you mean well, chances are every time you have input about something it will be common knowledge or some useless fact that you memorized about the disease for Step I. I just personally don't think whether third year rotations are ward vs preceptor based matters significantly for a variety of reasons.

- You are the third year med student and subsequently represent the bottom of the hierarchy. The PD or assistant PD isn't going to be paying much attention to you in the first place and you aren't going to make a significant impact on their input about you unless you kiss some serious *** (which some would find really annoying). The only way to stand out as a third year student is to do the basics by working hard, helping the team, knowing your basics when you can, and generally not making the rest of the teams' lives difficult.

- Being the bottom of the totem pole means you spectate on basically everything, whatever procedures there are go to residents first and then maybe if they're lucky the fourth year student can be supervised doing it. Chances are slim that you'll be doing anything fun other than rectal exams, which I did plenty on my EM rotation and that was preceptor based. You don't realize how boring it is or how much it sucks to just sit around and not get to do anything. Personally, I learn by doing the best so whatever the procedure is, I'm happy to do it. Cerumen impaction removal, rectal exams, whatever you can think of, it is just better to be doing things in my opinion as opposed to just standing there and sometimes getting in the way.

- Good preceptors are everywhere, there are a few bad apples, but in general most docs who agree to precept do it because they actually like teaching and are pretty good at it. The best part about having preceptors is that most of them will let you do a lot of things on your own and whenever there are procedures you're the only one there instead of a team of residents. This was especially true in my EM rotation because my preceptors loved teaching and for the most part anytime there was a procedure they offered to just let me do it and supervise me.

- Teamwork and being able to work in a team should be a pretty simple concept. The argument a lot of people make about ward based being better because you learn how to operate within the team of residents is pretty weak when you actually experience these types of rotations. Here's basically the gist of it 1) Pull your weight (in whatever facet that may be as a 3rd year or 4th year student) as a 3rd year you will get 1 maybe 2 patients and all you have to do is follow them i.e. watch their labs and imaging, check up on them if you have some free time, and generally know everything you can about those 1 or 2 patients while having a constantly evolving assessment and plan for them. It should also be common sense that as a 4th year you will be expected to do and know more. Lastly, 2) Don't be a d*** and make everyone's lives harder which includes but is not limited to being a gunner, acting like you know everything, etc.

Apologies for typos and what not!

 

[group_theory]

I know you're just playing devil's advocate ... here's my opinion and experience

A mixture of ward experience (with a teaching service) plus outpatient experience is ideal. Family medicine is mostly outpatient, surgery is inpatient (for students) with some outpatient office experience, pediatrics should be a mix (inpatient, outpatient, newborn nursery, etc)

As a 4th year, you only have a few months toward the beginning of 4th year to get your audition rotations, AI (or SubI), before application season opens and you need your LORs (3-4). Almost every student (MD or DO) will be trying to get those spots during that limited time. In addition, your Caribbean medical students hoping to match and trying for those spots as well.

I've had students in August/Sept of 4th year starting rotation with me who never did a ward base rotation before. It was painfully obvious. They didn't know how to present (I had to work with them on how to present on rounds and organized their thought process so they know what orders should be presented). Initially they didn't know what data to collect when they pre-rounded, how to talk to specialty consults, etc. Basically they were functioning at a level of a 3rd year medical student when they should be a 4th year Acting Intern. These are skills that should have been obtained/refined during 3rd year on multiple ward rotations. Instead of teaching them the finer points of patient management (there is only so much you can learn about algorithms/pathways), I was teaching them how to present, what I'm looking for, etc. When there were issues or questions, they would come straight to me instead of their senior residents (who were tasked as AI's immediate supervisors, 3rd year students were assigned to interns) ... can't blame them since they were used to doing it with their preceptor based rotations.

When you are doing an audition rotation, your task is to function as an acting intern/subIntern and "impress" or show people you are ready to be an intern (not quite - your patient load, responsibilities, and how often your pager goes off is nowhere close but it's the closest you can get). If the senior residents and I are spending time to teach stuff that should have been taught and refined during 3rd year - you are starting the race with a significant penalty. And I don't give points for "tried real hard" and "made great efforts to correct deficiencies" - those are expected of any students. Now there are rock star students that easily overcome these deficiencies and end up impressing me and the residents - but they are rare. Most are your average (but smart) medical students

When I interview, I look at your rotations, where, and with whom, and see what the LORs actually states (in terms of experience). I don't know if my other colleagues look at it the same. My criteria is "are you ready to be a July 1st intern in the ICU if assigned, or will you create more work/stress/anxiety/headaches for the senior residents/attendings on July 1st?"

*to be fair, I'm an ICU attending so the deficiencies are more obvious, and more data plus sicker patients, which will exacerbate any skills/knowledge gap, than any ward-based rotation. I also don't expect students to be "proficient" in procedures when they start, whether it is intubation, central lines, A-lines, chest tubes, thoras, paras, LPs, etc. Those skills can be taught in residency. Besides, an overconfident student doing a procedure is more scary than a scared intern doing his/her first procedure.

**the 3rd year students are students from an MD school rotating through IM and are assigned for a few days only in the unit to experience/see what the ICU is like. The 4th year students are there as AI/subI electives and spend the full 4 weeks.

***it's not the program director or assistant program director you are trying to impress. It is the faculty and residents you are trying to impress, who will go to bat for you when it comes to interview selection ("hey, this student was really great, please interview him/her") and will go to bat for you when it comes to ranking ("hey, I really like this student, would love to have him/her next year, please rank highly") or poorly ("WE don't like this student, **give examples***, place on DNR list") DNR = do not rank (or do not resuscitate, given my field)

**** if you did an inpatient rotation in a war zone, you would certainly stand out and I would be impressed. I guess inpatient rotations at Hopkins/Baltimore, Yale/New Haven, Temple/Philadelphia, Cooper/Camden, would count as well, but depends on where you stayed during those rotations)

 

[RinShanKaiHo]

I know you're just playing devil's advocate ... here's my opinion and experience

A mixture of ward experience (with a teaching service) plus outpatient experience is ideal. Family medicine is mostly outpatient, surgery is inpatient (for students) with some outpatient office experience, pediatrics should be a mix (inpatient, outpatient, newborn nursery, etc)

As a 4th year, you only have a few months toward the beginning of 4th year to get your audition rotations, AI (or SubI), before application season opens and you need your LORs (3-4). Almost every student (MD or DO) will be trying to get those spots during that limited time. In addition, your Caribbean medical students hoping to match and trying for those spots as well.

I've had students in August/Sept of 4th year starting rotation with me who never did a ward base rotation before. It was painfully obvious. They didn't know how to present (I had to work with them on how to present on rounds and organized their thought process so they know what orders should be presented). Initially they didn't know what data to collect when they pre-rounded, how to talk to specialty consults, etc. Basically they were functioning at a level of a 3rd year medical student when they should be a 4th year Acting Intern. These are skills that should have been obtained/refined during 3rd year on multiple ward rotations. Instead of teaching them the finer points of patient management (there is only so much you can learn about algorithms/pathways), I was teaching them how to present, what I'm looking for, etc. When there were issues or questions, they would come straight to me instead of their senior residents (who were tasked as AI's immediate supervisors, 3rd year students were assigned to interns) ... can't blame them since they were used to doing it with their preceptor based rotations.

When you are doing an audition rotation, your task is to function as an acting intern/subIntern and "impress" or show people you are ready to be an intern (not quite - your patient load, responsibilities, and how often your pager goes off is nowhere close but it's the closest you can get). If the senior residents and I are spending time to teach stuff that should have been taught and refined during 3rd year - you are starting the race with a significant penalty. And I don't give points for "tried real hard" and "made great efforts to correct deficiencies" - those are expected of any students. Now there are rock star students that easily overcome these deficiencies and end up impressing me and the residents - but they are rare. Most are your average (but smart) medical students

When I interview, I look at your rotations, where, and with whom, and see what the LORs actually states (in terms of experience). I don't know if my other colleagues look at it the same. My criteria is "are you ready to be a July 1st intern in the ICU if assigned, or will you create more work/stress/anxiety/headaches for the senior residents/attendings on July 1st?"

*to be fair, I'm an ICU attending so the deficiencies are more obvious, and more data plus sicker patients, which will exacerbate any skills/knowledge gap, than any ward-based rotation. I also don't expect students to be "proficient" in procedures when they start, whether it is intubation, central lines, A-lines, chest tubes, thoras, paras, LPs, etc. Those skills can be taught in residency. Besides, an overconfident student doing a procedure is more scary than a scared intern doing his/her first procedure.

**the 3rd year students are students from an MD school rotating through IM and are assigned for a few days only in the unit to experience/see what the ICU is like. The 4th year students are there as AI/subI electives and spend the full 4 weeks.

***it's not the program director or assistant program director you are trying to impress. It is the faculty and residents you are trying to impress, who will go to bat for you when it comes to interview selection ("hey, this student was really great, please interview him/her") and will go to bat for you when it comes to ranking ("hey, I really like this student, would love to have him/her next year, please rank highly") or poorly ("WE don't like this student, **give examples***, place on DNR list") DNR = do not rank (or do not resuscitate, given my field)

**** if you did an inpatient rotation in a war zone, you would certainly stand out and I would be impressed. I guess inpatient rotations at Hopkins/Baltimore, Yale/New Haven, Temple/Philadelphia, Cooper/Camden, would count as well, but depends on where you stayed during those rotations)

I'm curious about the actual war zone part. If I rotate internationally in Syria where I have some connections as one of the electives, will that actually impress some PDs? I am seriously thinking about doing that and am interested in doctors beyond border