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What school is infamous for tough or easy clinical rotations?

Discussion in 'Medical Students - MD' started by Thewonderer, Oct 4, 2002.

  1. Thewonderer

    Thewonderer Senior Member
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    When I did surgery, we were on q3d calls and when on-call, we stayed until 1-2am and therefore could sneak in 3 hours of sleep here and there. BUT our interns were like, "that's nothing! WHEN we were med students @ UT-Houston or Tulane (or fill in other names), we were on q3d call on surgery and we had to stay overnight with the residents!"

    So which schools are famous for being tough (or malignant) in its demand for students on clinical rotations?

    And which schools baby its students on rotations and are known to treat them insanely well? (cough, cough, UPenn, anybody? The intern from Penn sends my classmates home real early when they are on call together! Apparently, at Penn, they are only on-call q7d while on surgery and get one day off per week to sleep, GUARANTEED!).
     
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  3. Castro Viejo

    Castro Viejo Papa Clot Buster
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    For our surgery clerkship we were q4 or q5 overnight, and stayed the next day.

    If you ask me, being on-call as a third-year is somewhat pointless from an educational standpoint. I don't know how much you can learn from 4AM blood draws with an intern who's too tired to teach you anything. I firmly believe that med students doing overnight call is just a way to get an extra set of hands in there to help out the intern... aka SCUT. :)
     
  4. hotbovie

    hotbovie Member
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    Overnight call was q 5 in internal medicine, q 4 in peds, q 4 in OB ( for these, the whole team was on call, including all the students). Overnight call was q 4 on general surgery (there were 4 students, 1 stayed per night -with 1 resident per night- and we were allowed to work who stayed when amongst ourselves) and q 2 on trauma surgery (whole team on this schedule). No overnight call on psych or family.

    I thought overnight call was fairly valuable. On medicine and surgery, the student often went to the ER first and got the chance to try to evaluate the patient for about 20 min before the resident showed up. We wrote the H&P, and then followed the pts we admitted. Peds usually was a bit busier, so we often went at the same time as the resident, but they would let you try to do all the workup first if you asked. Peds had the busiest call, and that was where I learned to write H&P on the fly (instead of writing stuff down on scrap paper and recopying)... a skill that proved to be very valuable on subsequent rotations. OB call was pretty busy, the students evaluated all patients first, and then presented them to the intern. We wrote the H&P on all pts admitted to L&D. We didn't get to spend much time in the labor hall, but we did get to do deliveries galore. (avg 15 unassisted per student). By the time I got to surgery, I could do H&P pretty quickly, and so I moved on to doing both H&P and sometimes admission orders. I also took initative to help the resident in the truama evaluation area keep track of what pts had their xrays and ct scans done, and who still needed evaluation, etc.

    Students/interns here really don't draw blood or start IV's (in fact I was surprised when I did an elective away to learn that is common in some hospitals). I didn' t feel that what we did on call was just scut. I thought it was valuable. No, I didn't learn a lot of academic stuff, but I feel like I'm learning practical skills that will be very useful next year as an intern. And, at an away rotation (the one where interns do draw blood) I was treated as an intern, took intern call schedule, and even was allowed to carry the intern pager a few hours each call night. Yes, I did a lot of scut. I still thought it vaulable becuase I began to learn ways to organize the scut to get it done and get some sleep. The inern I took call with hadn't had a similar experience in school and told me he wished he had.

    Plus, helping with some of the scut can produce rich rewards...my school is a procedure mecca for students, but if you don't help with some of the call stuff, you don't get the chance. Currently I'm in an ICU rotation, and I wrote notes on 18 pts (out of 23) on my last shift. I wrote more notes than I was expected to in order to help my resident, because he was running behind as we were slammed. In return, I got to do a bronchcoscopy and a central line (got that on my first stick, too!). Plus, the resident was called to go to the OR for an urgent splenectomy as the chief and fellow were already on another case. He acutally came and found me so that I could come, too. There's another student in the same rotation, but different team, who isn't doing much and the residents say they won't let this individual do anything in the way of lines, etc because of that. I've also gotten to do some small operations, some in the third year rotation and some as a 4th year. That's not something every student gets to do, only the ones who are willing to work hard and help the residents.

    While I agree that drawing blood all night long won't help you on an exam, you will refine your skill at doing that..which could pay off nicely if you do your residency somewhere that the intern is expected to do all that. I plan on seeking out opportunites to draw blood and start IV's, though those aren't things that interns/students normally do here, so that I can practice if I wind up at a place where that is the expectation. The way I see it, the more time you can refine you skills as a student, the more efficient you can be as an intern and the more sleep you will get.

    I see one more benefit of taking overnight call as a student... you get used to staying up! I can't imagine having my first overnight call be as an intern. It will be scary enough that first call with MD behind my name, being the one actually making the decisions, I don't want to worry about the fatigue of being up. I can do 36 hours without sleep pretty easily now, and I'm very glad to have that experience under my belt.

    When I first started rotations, I didn't realize there were schools where students don't take overnight call. Now that I have learned that there are, I'm glad that we do. The experience I have had has been valuable for reasons cited above.
     
  5. Fah-Q

    Fah-Q Senior Member
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    I have heard that Baylor doesn't have overnight call. They stay until midnight and then go home!!! Sounds easy to me.

    Student 1: "How was call last night?"
    Student 2: "Oh man, we slept 6 hours!!! It was total 'Baylor-call'"
     
  6. womansurg

    womansurg it's a hard life...
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    Hey, hotbovie!

    You're right; that's great experience you're getting. You will be the strong intern of your class - no doubt. I had similar experiences as a student at Ohio State - lines, endotracheal intubations, chest tubes, working up patients independently, getting facile at diagnosis, H & Ps, and so forth.

    What school do you hail from? I want to make sure we recruit from it during our interview season. ;)
     
  7. Thewonderer

    Thewonderer Senior Member
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    Yeah, I have heard from my intern from UT-Houston who complained that his neighbors (i.e Baylor kids) don't take overnight call. I guess these differences in call and ward expectation can cause some tension/bitterness when kids from different schools (i.e. Jefferson/Temple/Penn and UT-Houston/Baylor) do rotations at the same hospital. The truth is that everyone is physically and mentally tired on the rotation, and thus everyone starts counting down to minutes as to how much some people sleep while others have to stay awake. This happens even among residents who supposedly are "professionals." Many people are now pulling out 80-hour work week golden rule to get out of clinical duty one afternoon per week, which hurts pt continuity. Also, many peds residents are b*tching about taking extra calls when there is a recent wave of fellow female residents giving births.

    I have no problem staying for call IF you get to do H&P and learn something that way instead of doing blood draws.....

    Another intern from Indiana U. said that her school's affiliated hospital had EXCELLENT ancillary service and as a result, she had very limited blood draws experience as a med student. I was shocked, I guess, in the same way as another poster above who was shocked that @ some schools, students don't get overnight calls.

    @ my schools, sub-I's do have to stay overnight and basically act as an intern in terms of blood draws, H&P and ANSWERING CALLS from nurses who wonder if they could give the pts tylenol or some form of sleeping pill (that's not too educational either).

    I don't know if having more overnight calls will make me better @ staying awake. I doubt it, since my energy level seems to be proportional to the demand @ the time (i.e. I can do ok getting 2-5 hours of sleep per day on surgery for 7 straight weeks with no day to sleep in, but once I am doing research, I need 6-8 hours of sleep a day :D )
     
  8. SomeFakeName

    SomeFakeName Membership Revoked
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    Relax guys, don't forget that'll you'll be practicing medicine for the next 30 years or so after graduation. Don't be so anxious about doing so much and spending so much time at the hospital while you're still young and a medical student. You'll be doing this kind of stuff over and over once you start practicing as a doctor that you will one day look back and wonder why you were ever so anxious to do so much out as a med student. After a while it all gets pretty routine. Do enough to learn what is required as a student and then go out and live your life...long nights at the hospital and "medicine" will always be around, especially once you're an intern.
     
  9. hotbovie

    hotbovie Member
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    I did one subI where I took calll as an intern, did the same stuff as an intern and carried the pager for a few hours, taking the nurses calls about sleeping pills and tylenol. I thought it was valuable...I started to learn how to organize the intern scut to get it done, and learned how to treat some basic stuff that every intern will deal with. This is the expeirence that I referred to in my earlier post in which the intern I was with said he wished he had a similar experience as a 4th year.

    I believe in doing everything possible while a student to learn things that will make my intern year easier. That way I'll get more sleep on call as an intern.

    And just becuase I'm trying to learn as much as possible and look for opportunites to do so while on call, doesn't mean I don't have a life. I still have days off (according to whatever schedule the team I'm on designates for the residents) and thus time to engage in whatever recreation I choose. Some rotations have less time off than others, but there still is time off.
     
  10. Ponyboy

    Ponyboy Senior Member
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    At my school, all call for Medicine, Surgery, Pediatrics, O & G, and Family Medicine were overnight. Most rotations would be q4d but some could be stretched out to q6d if there were enough students. When on call, it was expected that you would do admissions (H&P, and admission orders) and, depending on the service, ward call (tylenol orders, fevers, low U/O, etc) as well.

    When doing admissions, the student and the resident would divide the workload between themselves and do their own admissions. Afterwards, the student and the resident would present their own patients to the senior resident or to the staff and recieve input regarding what orders needed to be changed or what information needed to be clarified. The student would then become the primary physician for that patient, such that most, if not all, progress notes and orders would be written by the student, the cosignature of the resident being only a formality. When taking ward call, the student would often evaluate the patient, decide what to do and then phone the resident for a verbal order and any extra suggestions.

    Students and residents never drew blood unless the lab techs couldn't get it.

    Call was very educational. Most times, students were treated like residents and given the responsibility of residents.
     

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