What makes a good 3rd-4th year experience?

[pv515]

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I'm having a hard time deciding between two schools currently, in Cornell and Vanderbilt. To me, the pre-clinical education is gonna be pretty much the same outside of 1 year vs. 2 year pre-clinical curriculum. At the end of the day, though, I will learn the same stuff.

So my questions are for senior medical students or recent graduates and involve the 3rd and 4th years:

What makes a "good" 3rd year compared to a "bad" one? Obviously things will be difficult for everyone as far as time constraints, but what would make one hospital a better learning environment than another? Is having good education more of an individual thing based on luck with residents or attendings, or are there certain cultures at different institutions where medical students participate more or less? Are some schools more malignant than others to their med students?

Is diversity of patient population really important? I've experienced a pretty wide variety of cultures and diseases in my volunteer work, so I may "get it" with regards to cultural competency more than other pre-meds right now. Obviously NYC and NYPH are gonna have more diverse cases coming in and higher volume than Vanderbilt, but then there are 4 or 5 medical schools in NYC, so I don't know whether Columbia and Cornell or other rotating students will be fighting to see interesting cases (or is this even a concept? Excuse my ignorance, as I have no idea).

Then with 4th year, what is most important here? Is there a difference between schools, particularly if a school has a certain elective class or rotation you want to do? How hard is it to do away rotations, really? If it's easy, why would 4th year at one school be any different from another if much time is spent doing away rotations?

Any help from some more experienced folks would be awesome! I feel like I could call some current students at each school, but the ones who actually gave me contact info are 1st/2nd year students. Would it be worth talking to them or not about this?

 

[Geebeejay]

I'm having a hard time deciding between two schools currently, in Cornell and Vanderbilt. To me, the pre-clinical education is gonna be pretty much the same outside of 1 year vs. 2 year pre-clinical curriculum. At the end of the day, though, I will learn the same stuff.

So my questions are for senior medical students or recent graduates and involve the 3rd and 4th years:

What makes a "good" 3rd year compared to a "bad" one? Obviously things will be difficult for everyone as far as time constraints, but what would make one hospital a better learning environment than another? Is having good education more of an individual thing based on luck with residents or attendings, or are there certain cultures at different institutions where medical students participate more or less? Are some schools more malignant than others to their med students?

Is diversity of patient population really important? I've experienced a pretty wide variety of cultures and diseases in my volunteer work, so I may "get it" with regards to cultural competency more than other pre-meds right now. Obviously NYC and NYPH are gonna have more diverse cases coming in and higher volume than Vanderbilt, but then there are 4 or 5 medical schools in NYC, so I don't know whether Columbia and Cornell or other rotating students will be fighting to see interesting cases (or is this even a concept? Excuse my ignorance, as I have no idea).

Then with 4th year, what is most important here? Is there a difference between schools, particularly if a school has a certain elective class or rotation you want to do? How hard is it to do away rotations, really? If it's easy, why would 4th year at one school be any different from another if much time is spent doing away rotations?

Any help from some more experienced folks would be awesome! I feel like I could call some current students at each school, but the ones who actually gave me contact info are 1st/2nd year students. Would it be worth talking to them or not about this?

I don't think diversity of patient populations has anything to do with "experiencing a pretty wide variety of cultures and diseases". Do you think it is important to be adept at taking histories through an interpreter? Would you like to be comfortable dealing with non-academic america who really doesn't care that you are college educated, and doesn't care about "evidence-based" living, etc.? Do you want to learn about treating patients that refuse certain treatments, refuse physical exams, refuse being treated by the opposite sex due to cultural and religious preferences?

This is what they mean when schools say "diverse patient population". It has nothing to do with "experiencing" different types of people, but learning how to conduct yourself to appropriately care for and treat these different types of people without looking like a complete idiot. If you think this important, than you might want to choose the hospital with more "diverse patient populations", but obviously is only one of many considerations.

 

[LovelyBRass]

Well what I think is important is not gonna be an issue for you - having a university hospital and having excellent residents at the hospital. You want to be some place with a lot of diversity in the way the previous poster said and some place where teaching is most important; for instance, teaching attendings dedicated to teaching residents and students alike (this would be as opposed to private attendings, who, in a nutshell, round in the hospital on the patients, and sort of just tell the residents what to do - not the best for learning) - they'll also be more likely to give the residents plenty of autonomy (which helps to give you autonomy as well 🙂).

 

[pv515]

I don't think diversity of patient populations has anything to do with "experiencing a pretty wide variety of cultures and diseases". Do you think it is important to be adept at taking histories through an interpreter? Would you like to be comfortable dealing with non-academic america who really doesn't care that you are college educated, and doesn't care about "evidence-based" living, etc.? Do you want to learn about treating patients that refuse certain treatments, refuse physical exams, refuse being treated by the opposite sex due to cultural and religious preferences?

This is what they mean when schools say "diverse patient population". It has nothing to do with "experiencing" different types of people, but learning how to conduct yourself to appropriately care for and treat these different types of people without looking like a complete idiot. If you think this important, than you might want to choose the hospital with more "diverse patient populations", but obviously is only one of many considerations.

Maybe I should have said cultural sensitivity, but I have volunteered extensively with people who have the attitudes you described, so I'm not sure the marginal benefit (compared to other med students) that I will get from choosing a more diverse patient population over a less diverse one. Obviously I haven't seen more than the tip of the iceberg, but I think I can handle most things that come my way regardless of whether it happens in med school or afterward.

Any other considerations you think are very important?

 

[pv515]

Well what I think is important is not gonna be an issue for you - having a university hospital and having excellent residents at the hospital. You want to be some place with a lot of diversity in the way the previous poster said and some place where teaching is most important; for instance, teaching attendings dedicated to teaching residents and students alike (this would be as opposed to private attendings, who, in a nutshell, round in the hospital on the patients, and sort of just tell the residents what to do - not the best for learning) - they'll also be more likely to give the residents plenty of autonomy (which helps to give you autonomy as well 🙂).

Any idea how to find out this information about the hospitals? Or are most university affiliated hospitals, Cornell and Vandy in particular, places where teaching is most important? Just trying to distinguish them if I can 🙂

 

[Geebeejay]

Maybe I should have said cultural sensitivity, but I have volunteered extensively with people who have the attitudes you described, so I'm not sure the marginal benefit (compared to other med students) that I will get from choosing a more diverse patient population over a less diverse one. Obviously I haven't seen more than the tip of the iceberg, but I think I can handle most things that come my way regardless of whether it happens in med school or afterward.

Any other considerations you think are very important?

I think what I was trying to say that there is a big difference between volunteering with a population of people and treating the same population of people. It doesn't have much to do with being sensitive to their culture really. It's really hard to describe in words, but many other cultures and classes of populations approach medicine in an entirely different way than post-collegiate america does. I'm not saying that being comfortable treating people from a variety of cultures is important - it's up to you to decide how important it is to you.

Other considerations: These are some of the things I've considered at least a little bit

urban vs. nonurban population

climate (i.e. a medical school in the rockies will expose you to different disease/injuries/people than a school in Florida)

primary languages of the city where the medical school is located (want to learn how to take a history using an interpreter? Might not want to go to choose U Miami over UVM then. Want to take advantage of the Italian you've spent 6 years trying to learn? Boston, Philly or St. Louis might be a better choice for you than Denver)

other specialized hospitals in the area: If there's an affiliated hospital down the street from your medical school that is a top 5 stroke center, you can bet that your university hospital will get significantly fewer stroke cases. Might not be a good choice if you want to be a neurosurgeon and you're looking forward to your neuro/nsgy rotation. Same goes for other specialties. Not sure how important this is, but worth considering.

Public vs. Private hospital

Strength of residency program (weak, frazzled, clueless residents = weak, frazzled, clueless teachers)

"Scope of Practice" of medical students - I might get some argument from this, but different medical schools afford different levels of "hands on learning". Are you going to be suturing lacs and starting ultrasound-guided lines while on the wards, or are you going to be in more of a "shadowing" role for the whole 2 years. I am under the assumption that the big academic powerhouses occasionally swing toward the latter (many reasons: more doctors, more in-house specialists, more administrative "politics", more "big-shot" doctors who do all the cool procedures themselves) while the smaller, public universities in more underserved areas may afford for some more hands-on experience.

 

[LovelyBRass]

Any idea how to find out this information about the hospitals? Or are most university affiliated hospitals, Cornell and Vandy in particular, places where teaching is most important? Just trying to distinguish them if I can 🙂

Ask the adcom or current students what the university hospital is. I suppose I don't KNOW, but I can almost guarantee you Vandy and Cornell have their own university hospitals. Google says they are Vanderbilt University Medical Center and NYP-Weill Cornell Medical Center respectively lol. Anyone with more knowledge please correct me. These places have every residency imaginable, which means a lot of trainees and teaching.

Again, you can't lose - but you can split hairs talking to current students!