What was the motive for ACGME to merge with the AOA?

[Stagg737]

How would the AOA have more control once absorbed into the ACGME than they do now over former AOA residencies? The reason why some programs are shutting down are because of current ACGME standards that these program cannot meet. They should have had enough power to shut these residencies before, why would it increase now. It is more to say I want to understand how this indirect control will work under the ACGME?

What you are saying about new schools is definitely true. However, don't forget that older schools are also at fault for having high numbers of students as well. There will be that small percentage who get shafted at these older school simple because the quality control is extremely hard to do. Overhaul of all DO schools need to be done now rather than wait for an LCME take over.

I was saying ACGME/LCME will have more control over the opening of new DO schools. If DO match rates drop significantly after the merger it'll put COCA on the ropes and we may very well see a significant reduction in the rate of new DO schools opening. I wasn't saying the AOA would have more control, I think it's pretty obvious that the opposite is true.

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[username456789]

location is a crappy rationale for choosing a medical school? Not everyone matriculating is 22 with no strings attached and can just go wherever. Many people have families that need them to stay local.

Frankly, I don't think you've had much exposure to DO training. I don't think your point about "hidden curriculum" is valid because it can't be supported by any evidence. The huge majority of my attendings have been MDs. Two trained at Yale, one at U Michigan, one went to Cornell. The two surgeons I worked with went to regular old mid tier state school residencies in the midwest and in NY. At least 2 from U Miami. The point, of course, is that DOs are certainly not universally subjected to rotations where they shadow other DOs who went to branch XYZ of Timbuktu COM. Lots of us are taught by teachers who went to legitimate training programs.

Honestly I dont know why I responded at such length because your last sentence that MD students "being exceptional is expected" is a total clown comment.

I spent a year as an intern at a community hospital where DO students rotated through for some of their core rotations, including IM and GS. They all told me that our hospital was coveted as the best place to work since they heard they "learned the most even if they had to work hard."

It was a complete joke.

They had almost zero clinica responsibilities, and their experience had zero resemblance to what I experienced as a medical student.

All the attendings were of course MDs. Many from prestigious Ivy League and similar institutions. But that has no bearing here. There were no other major residency programs there and the students shadowed the attendings and "helped" the interns but were essentially less than useless unfortunately. They universally suffered from a lack of basic knowledge and clinical acumen.

Further, and this can't be overstated despite your refusal to believe it, but doing many/most of your rotations at a hospital with no strong residency presence is an extreme handicap. No matter how many times you get to first assist the surgeon or whatever, you are missing an enormous fund is knowledge and experience - learning how to think like a physician. At a level that is commensurate with your experience.

It would be like an airline pilot bringing his 10 year old son into the cockpit and showing him all the shiny knows and gauges and maybe even allowing him to press a few. It makes the kid feel special and tingly, but he doesn't leave there knowing how to fly the plane. He is missing the entire foundation leading up to this.

Most of the reason M3/M4 and residency suck at times is because things take longer than you think they should, either because you yourself are not yet as efficient and effective at processing the information in useful ways, or because the day to day processes are deliberately drawn out in a way that does not occur at major teaching hospitals.

Rounding with an IM physician or team at a community hospital is often quick and the students cannot simply pick up the nuances of medical management by observing/participating in the attending's practices. He or she has spent years/decades honing his or her skills to the point where so very much of the complicated thought process (and leg work) from the time a patient enters the hospital until the time they leave is performed without your knowledge of its existence. Just because the attending might toss out a nugget of wisdom from room to room doesn't mean the student isn't missing out big time.

I shudder to think what the "average" or "lesser" rotations were like.

It's not that a difference of MCAT score means someone will be a better or worse resident or clinician. It's that the score often determines the branch point between MD and DO, and whether you like it or not, the difference in clinical education is often a sticking point for, say, Program Directors considering MD or DO students. Of course I'm not suggesting that all allopathic medical school rotations are perfect, but the trend is very real.

 

[Brorthopedic]

I often wonder if people, outside of medicine, would laugh at the **** we squirm about if they read it. It's almost hilarious how we're so obsessed with the idea of constantly differentiating ourselves from our colleagues that we forget we're all on the same side.

 

[username456789]

I often wonder if people, outside of medicine, would laugh at the **** we squirm about if they read it. It's almost hilarious how we're so obsessed with the idea of constantly differentiating ourselves from our colleagues that we forget we're all on the same side.

That sounds like NP talk.

 

[Mad Jack]

ACGME has vested interest because it opens up competitive specialty DO spots for MDs with out giving up anything (DOs can already apply to MD spots). It's win-win.

AOA has no choice but to agree, because ACGME threatened to close off their residency spots which will screw DO graduates. Lose less - lose more.

They threatened to close off fellowships, not residencies- there was already a federal lawsuit years back that prevented them from closing residencies off to IMGs and DOs.

 

[235009]

I spent a year as an intern at a community hospital where DO students rotated through for some of their core rotations, including IM and GS. They all told me that our hospital was coveted as the best place to work since they heard they "learned the most even if they had to work hard."

It was a complete joke.

They had almost zero clinica responsibilities, and their experience had zero resemblance to what I experienced as a medical student.

All the attendings were of course MDs. Many from prestigious Ivy League and similar institutions. But that has no bearing here. There were no other major residency programs there and the students shadowed the attendings and "helped" the interns but were essentially less than useless unfortunately. They universally suffered from a lack of basic knowledge and clinical acumen.

Further, and this can't be overstated despite your refusal to believe it, but doing many/most of your rotations at a hospital with no strong residency presence is an extreme handicap. No matter how many times you get to first assist the surgeon or whatever, you are missing an enormous fund is knowledge and experience - learning how to think like a physician. At a level that is commensurate with your experience.

It would be like an airline pilot bringing his 10 year old son into the cockpit and showing him all the shiny knows and gauges and maybe even allowing him to press a few. It makes the kid feel special and tingly, but he doesn't leave there knowing how to fly the plane. He is missing the entire foundation leading up to this.

Most of the reason M3/M4 and residency suck at times is because things take longer than you think they should, either because you yourself are not yet as efficient and effective at processing the information in useful ways, or because the day to day processes are deliberately drawn out in a way that does not occur at major teaching hospitals.

Rounding with an IM physician or team at a community hospital is often quick and the students cannot simply pick up the nuances of medical management by observing/participating in the attending's practices. He or she has spent years/decades honing his or her skills to the point where so very much of the complicated thought process (and leg work) from the time a patient enters the hospital until the time they leave is performed without your knowledge of its existence. Just because the attending might toss out a nugget of wisdom from room to room doesn't mean the student isn't missing out big time.

I shudder to think what the "average" or "lesser" rotations were like.

It's not that a difference of MCAT score means someone will be a better or worse resident or clinician. It's that the score often determines the branch point between MD and DO, and whether you like it or not, the difference in clinical education is often a sticking point for, say, Program Directors considering MD or DO students. Of course I'm not suggesting that all allopathic medical school rotations are perfect, but the trend is very real.

This is a fantastic post.

To add to it: at my med school the IM residency had lots of DOs. I initially didn't realize I wanted to do IM so decided to do my rotation at the VA because it was easier. My senior resident, a DO who graduated from the school down the road, would marvel at all the assignments we had to do and that we had daily lecture and weekly meetings with the course director to go over our h&ps. He said none of that existed where he did his rotation and that they just sat around all day. Keep in mind this was one of the "easier" rotations at my school. I had other friends at the same DO school who would tell me that their IM rotations involved lots of sitting around and too many students per patient.


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[Brorthopedic]

That sounds like NP talk.

you're a clown

 

[Psai]

location is a crappy rationale for choosing a medical school? Not everyone matriculating is 22 with no strings attached and can just go wherever. Many people have families that need them to stay local.

Frankly, I don't think you've had much exposure to DO training. I don't think your point about "hidden curriculum" is valid because it can't be supported by any evidence. The huge majority of my attendings have been MDs. Two trained at Yale, one at U Michigan, one went to Cornell. The two surgeons I worked with went to regular old mid tier state school residencies in the midwest and in NY. At least 2 from U Miami. The point, of course, is that DOs are certainly not universally subjected to rotations where they shadow other DOs who went to branch XYZ of Timbuktu COM. Lots of us are taught by teachers who went to legitimate training programs.

Honestly I dont know why I responded at such length because your last sentence that MD students "being exceptional is expected" is a total clown comment.

Can't be supported by any evidence? Do you know how much of what we do is not supported by any evidence? You can't run double blinded plabeco randomized control trials for everything. And a blind subservience to academic publications is doing a disservice to yourself and your patients. But I've rotated with many DO students and residents. There is a noticeable difference in knowledge base.

Your attendings likely got top notch training. That doesn't mean that people at institutions less ivory than those are getting lesser training. But it also doesn't mean that your training is any better. Taking a class taught by a guy who graduated from Harvard doesn't mean that you're getting a Harvard education. Your fellow medical students and residents matter much more than the attendings do as they are the ones you are spending the most time with. I hope you do an away or match at a name brand place, you will then understand what I'm talking about.

Btw I have no idea where most of my attendings come from and it's bizarre that you know the academic history of yours in such detail.

 

[hallowmann]

For those of us graduating in 2018 and potentially starting an AOA residency that turns into ACGME in 2020, will we still be considered AOA program graduates or will that turn into an ACGME certification?

This varies based on the individual type of residency and the length of time during which your training is ACGME accredited (i.e. it depends on when your program actually attains initial ACGME accreditation). For more info on the specific requirements for fields, look at this table:

https://www.osteopathic.org/inside-...ystem/Documents/board-certification-chart.pdf

They threatened to close off fellowships, not residencies- there was already a federal lawsuit years back that prevented them from closing residencies off to IMGs and DOs.

The 2016 common requirements would have closed off all advanced training to DOs that had previous AOA training (e.g. TRIs, residency, etc.). This includes residencies that require, but don't include an intern year, as well as fellowships.

 

[QualityProcess]

My senior resident, a DO who graduated from the school down the road, would marvel at all the assignments we had to do and that we had daily lecture and weekly meetings with the course director to go over our h&ps. He said none of that existed where he did his rotation and that they just sat around all day.

This is such a ridiculous conversation. We had all of that too, except it wasn't the course director, it was another experienced physician. Why would anyone think that sitting around all day was a productive rotation? In fact, thank you for pointing out some of the characteristics of your quality IM rotation because it supports my claim that I also had a good IM rotation. Maybe when the local MD school finishes buying up all our clinical rotation spots from the DO school, it will suddenly be a legitimate experience.

Again, I am not defending DO clinical education at large. I'm defending my experience against what is clearly an inappropriate generalization. Repeating yourselves over and over about your experiences with DOs, and the misguided perception of other DOs about the quality of their training is not an indictment of mine. Y'all dont know anything about my clinical experince other than what im telling you, which is "I did all the stuff you listed."

Btw I have no idea where most of my attendings come from and it's bizarre that you know the academic history of yours in such detail.

It is weird, but you know what, so am I. I have always been interested in the ways medical education differs based on where you are from. People in general like it when you ask them about the "good ol days." Obviously I'm selective about who I ask... if I asked my gen surg attending about his training he would probably ask me if we were on a date, then rant about work hour restrictions and remind me for the 3423th time that work hour restrictions are for residents and not students, then close up and tell me he was getting coffee so go troll the ER for rectal exams and meet at the OR schedule board in 10.

I also regularly ask my attendings (if we're not in a hurry) if their partners/colleagues do it differently. Its also the most PC way to ask an attending why they are deviating from guidelines without saying "UHHH THIS ISNT IN THE GUIDELINES WHY DONT YOU DO THE GUIDELINES" like a neandertal.

 

[Stagg737]

This is a fantastic post.

To add to it: at my med school the IM residency had lots of DOs. I initially didn't realize I wanted to do IM so decided to do my rotation at the VA because it was easier. My senior resident, a DO who graduated from the school down the road, would marvel at all the assignments we had to do and that we had daily lecture and weekly meetings with the course director to go over our h&ps. He said none of that existed where he did his rotation and that they just sat around all day. Keep in mind this was one of the "easier" rotations at my school. I had other friends at the same DO school who would tell me that their IM rotations involved lots of sitting around and too many students per patient.

Sounds like your senior resident went to a school with sh** rotations. Not all of my school's rotation sites have daily didactics, but I've yet to hear a student say they 'sat around all day' or that they weren't taking h&ps and going over them with their attendings. The problem with DO rotations isn't that all of them, or even the majority of them suck (I don't know what percent of each meets X, Y, and Z criteria), the problem is the lack of standardization and extremely low standards set by some schools and those more concerned with money and maintaining the "brand name" of DO than their students' clinical education.

 

[Ho0v-man]

I've mainly just been lurking and making sarcastic comments in this thread. I'd just like to say as someone who worked at a hospital that takes MD and DO students for rotations, I can confidently say that there is no difference in clinical acumen. Both types kinda sucked. The main difference being that the MD students seemed completely oblivious to this fact. The DO students were on average just humble about it. I know my opinion as a premed doesn't hold much water, but this is just me paraphrasing their supervising physicians.


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[Back 5]

This varies based on the individual type of residency and the length of time during which your training is ACGME accredited (i.e. it depends on when your program actually attains initial ACGME accreditation). For more info on the specific requirements for fields, look at this table:

https://www.osteopathic.org/inside-...ystem/Documents/board-certification-chart.pdf

Thanks, appreciate the info.

 

[Psai]

I've mainly just been lurking and making sarcastic comments in this thread. I'd just like to say as someone who worked at a hospital that takes MD and DO students for rotations, I can confidently say that there is no difference in clinical acumen. Both types kinda sucked. The main difference being that the MD students seemed completely oblivious to this fact. The DO students were on average just humble about it. I know my opinion as a premed doesn't hold much water, but this is just me paraphrasing their supervising physicians.


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If there's any opinion of clinical acumen that matters in this thread, it's yours.

 

[deleted407021]

Someone says that MD and DO students are noticeably different, no one bats an eye.

Say they're ... uhmm, wait... noticeably different and everybody looses their minds.

 

[hallowmann]

This is a fantastic post.

To add to it: at my med school the IM residency had lots of DOs. I initially didn't realize I wanted to do IM so decided to do my rotation at the VA because it was easier. My senior resident, a DO who graduated from the school down the road, would marvel at all the assignments we had to do and that we had daily lecture and weekly meetings with the course director to go over our h&ps. He said none of that existed where he did his rotation and that they just sat around all day. Keep in mind this was one of the "easier" rotations at my school. I had other friends at the same DO school who would tell me that their IM rotations involved lots of sitting around and too many students per patient.


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I gotta be honest, I heard this same stuff from US MD residents or recently graduated attendings about their schools. I honestly think that either experiences vary across the board or that docs (and probably people) have a selective memory especially when it comes to their education. A lot of times my own classmates say something like "I can't believe the lower classmen have to do X", and then I remind them, "you know we had to do that, right?" A year out from pre-clinicals, and half my class forgot about specific requirements, whole classes, policies, etc.

Once you're in the swing of a completely different educational experience (like med school vs. undergrad, clinical rotations vs. preclinicals, intern year vs. med school, etc.) things tend to get fuzzy or just fade away. You end with knowledge, but don't really remember how you came about it, save a few anecdotes, patient experiences, and mnemonics that stuck with you.

I want to also echo the words of those above me that at my clinical campus we have 6+ hours of didactics every week, and we're just as busy as I was at a another of our clinical sites that also serves 2 MD schools (a mid-tier and a low-tier) for cores. I recognize this isn't the case at some of my school's other sites, but most of our rotations are pretty solid.

Don't get me wrong though, I bumped into multiple DO students from a school in a neighboring state that basically shadowed for half of their rotations. It's just poor practice to assume all DOs had that experience, when the reality is its likely less than half of them. It's one thing for PDs to not want to take a risk for their residency, but its another for you as an attending or fellow to assume all DOs had poor clinical experiences just because you met a couple from one nearby school.

 

[Ho0v-man]

If there's any opinion of clinical acumen that matters in this thread, it's yours.

Again, it's the opinion of the docs that were in charge at the time. I didn't think too much of it until I saw an MD student who was "not to be disturbed" while doing his physical exam have to be forcibly removed by two nurses (which is unbelievable in and of itself) because he was too dumb to realize he needed to get out of the way and let them intubate the patient lol. Then I started realizing crap like that happened all the time from them.

The docs and unit nurses I was friends with would all collectively agree that both types of students performed about the same, but when DO students messed up or were incorrect they would just apologize and ask how they could improve. The MD students just made excuses and somehow became more condescending (which was an impressive feat, mind you).

Your original post about MDs being exceptional as a rule is probably just confirmation bias.

Edit: To clarify, this is my own anecdotal experience working for two years at one clinical site that takes MDs from one school and at the time took DOs from several, though that has changed since I worked there. I will concede that there were pleasant MD students and douchey DO students, both of which were rare occurrences. But performance in clinicals...they were all the same.

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[Psai]

Again, it's the opinion of the docs that were in charge at the time. I didn't think too much of it until I saw an MD student who was "not to be disturbed" while doing his physical exam have to be forcibly removed by two nurses (which is unbelievable in and of itself) because he was too dumb to realize he needed to get out of the way and let them intubate the patient lol. Then I started realizing crap like that happened all the time from them.

The docs and unit nurses I was friends with would all collectively agree that both types of students performed about the same, but when DO students messed up or were incorrect they would just apologize and ask how they could improve. The MD students just made excuses and somehow became more condescending (which was an impressive feat, mind you).

Your original post about MDs being exceptional as a rule is probably just confirmation bias.

Edit: To clarify, this is my own anecdotal experience working for two years at one clinical site that takes MDs from one school and at the time took DOs from several, though that has changed since I worked there. I will concede that there were pleasant MD students and douchey DO students, both of which were rare occurrences. But performance in clinicals...they were all the same.

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You're a premed. You have no idea about clinical performance. I respect everyone else in this thread for their opinions even when I disagree but you have no say.

 

[PL198]

There is a preference over MD vs do for a reason. You want to act like there is no difference. If there wasn't, there would be no reason for a preference to exist.

Who knew rotation at major academic medical centers vs Joe schmo community hospital of 100 beds would vary? Guys this isn't a difficult concept

 

[235009]

There is a preference over MD vs do for a reason. You want to act like there is no difference. If there wasn't, there would be no reason for a preference to exist.

Because if you convince yourself (and others on SDN) that there is no difference then you could call the preference for US MDs by program directors "DO discrimination" and "unfair" instead of a calculated choice to not risk your residency program's reputation and the wellbeing of your patients on someone whose med school education is an unknown commodity that is more likely to be inadequate.

 

[VisionaryTics]

I spent a year as an intern at a community hospital where DO students rotated through for some of their core rotations, including IM and GS. They all told me that our hospital was coveted as the best place to work since they heard they "learned the most even if they had to work hard."

It was a complete joke.

They had almost zero clinica responsibilities, and their experience had zero resemblance to what I experienced as a medical student.

All the attendings were of course MDs. Many from prestigious Ivy League and similar institutions. But that has no bearing here. There were no other major residency programs there and the students shadowed the attendings and "helped" the interns but were essentially less than useless unfortunately. They universally suffered from a lack of basic knowledge and clinical acumen.

Further, and this can't be overstated despite your refusal to believe it, but doing many/most of your rotations at a hospital with no strong residency presence is an extreme handicap. No matter how many times you get to first assist the surgeon or whatever, you are missing an enormous fund is knowledge and experience - learning how to think like a physician. At a level that is commensurate with your experience.

It would be like an airline pilot bringing his 10 year old son into the cockpit and showing him all the shiny knows and gauges and maybe even allowing him to press a few. It makes the kid feel special and tingly, but he doesn't leave there knowing how to fly the plane. He is missing the entire foundation leading up to this.

Most of the reason M3/M4 and residency suck at times is because things take longer than you think they should, either because you yourself are not yet as efficient and effective at processing the information in useful ways, or because the day to day processes are deliberately drawn out in a way that does not occur at major teaching hospitals.

Rounding with an IM physician or team at a community hospital is often quick and the students cannot simply pick up the nuances of medical management by observing/participating in the attending's practices. He or she has spent years/decades honing his or her skills to the point where so very much of the complicated thought process (and leg work) from the time a patient enters the hospital until the time they leave is performed without your knowledge of its existence. Just because the attending might toss out a nugget of wisdom from room to room doesn't mean the student isn't missing out big time.

I shudder to think what the "average" or "lesser" rotations were like.

It's not that a difference of MCAT score means someone will be a better or worse resident or clinician. It's that the score often determines the branch point between MD and DO, and whether you like it or not, the difference in clinical education is often a sticking point for, say, Program Directors considering MD or DO students. Of course I'm not suggesting that all allopathic medical school rotations are perfect, but the trend is very real.

Outstanding post.

However, this phenomenom is not unique to DO schools. There are some MD schools without affiliated academic hospitals and residencies.

We occasionally get a student from these programs doing an away rotation. They have been uniformly the least prepared medical students we've dealt with; just no conception of how an academic program functions. They're not stupid students or lazy, but they really have culture shock when they're thrown into a busy surgical residency program. Some adapt well and get nice letters and grades. Many don't.

 

[Ho0v-man]

You're a premed. You have no idea about clinical performance. I respect everyone else in this thread for their opinions even when I disagree but you have no say.

I apologize. I was simply conveying the opinions of others farther along in training. But when you're right, you're right. All the best.


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[hallowmann]

There is a preference over MD vs do for a reason. You want to act like there is no difference. If there wasn't, there would be no reason for a preference to exist...

That is really flawed logic. Forget MD or DO. You're basically saying that because people in the past believed X is better than Y, then X is better than Y OR because people believe X is better than Y, it's because X really is better than Y. It's basically an appeal to tradition or appeal to popularity/majority fallacy. You might as well being saying, for generations people thought the Earth was flat for a reason, therefore the Earth must be flat. Or, millions of people believe the Earth is flat for a reason, therefore the Earth must be flat. Just because a preference for something exists doesn't actually mean that thing is better, it just means people feel its better.

Again though, I'm not saying there isn't a difference in the quality of clinical years overall between MDs and DOs on average, I'm just pointing out the severely flawed logic you're exhibiting with this post.

 

[Psai]

That is really flawed logic. Forget MD or DO. You're basically saying that because people in the past believed X is better than Y, then X is better than Y OR because people believe X is better than Y, it's because X really is better than Y. It's basically an appeal to tradition or appeal to popularity/majority fallacy. You might as well being saying, for generations people thought the Earth was flat for a reason, therefore the Earth must be flat. Or, millions of people believe the Earth is flat for a reason, therefore the Earth must be flat. Just because a preference for something exists doesn't actually mean that thing is better, it just means people feel its better.

Again though, I'm not saying there isn't a difference in the quality of clinical years overall between MDs and DOs on average, I'm just pointing out the severely flawed logic you're exhibiting with this post.

X is better than Y. I don't know which kind of la la land you guys are coming from but DO is an inferior degree and the students are inferior in general. I know it, you know it and most importantly, PDs know it. The other guy is trying to be politically correct but there's really no reason for him to do so. I'm not saying this because it affects me in any way. I already finished medical school and matched so it doesn't matter to me at all. But facts are facts.

Sorry about your hurt feelings

 

[hallowmann]

X is better than Y. I don't know which kind of la la land you guys are coming from but DO is an inferior degree and the students are inferior in general. I know it, you know it and most importantly, PDs know it. The other guy is trying to be politically correct but there's really no reason for him to do so. I'm not saying this because it affects me in any way. I already finished medical school and matched so it doesn't matter to me at all. But facts are facts.

Sorry about your hurt feelings

No hurt feelings, I don't base my mood on the opinions of random people on the internet. Just pointing out a blatant lack of logic in the statement I quoted. You're the one trying to make it about emotions or judgement.

 

[FiveOClock]

This is hardly a discussion that even needs to be had. The DO curriculum currently includes the pseudoscientific study of osteopathy. Does it include evidence based approaches as well? Yes, we all get that. There is a reason why they have abandoned their previous art and latched onto allopathy. The academic tradition of the DO is less well-established compared to the MD, so you cannot expect for the title to be treated with equal prestige. That would be unreasonable.

 

[deleted407021]

X is better than Y. I don't know which kind of la la land you guys are coming from but DO is an inferior degree and the students are inferior in general. I know it, you know it and most importantly, PDs know it. The other guy is trying to be politically correct but there's really no reason for him to do so. I'm not saying this because it affects me in any way. I already finished medical school and matched so it doesn't matter to me at all. But facts are facts.

Sorry about your hurt feelings

And here it is. What's actually in your brain. Thanks for making it so explicit after wanking off around it for like 3 pages.

 

[acapnial]

This is a fantastic post.

To add to it: at my med school the IM residency had lots of DOs. I initially didn't realize I wanted to do IM so decided to do my rotation at the VA because it was easier. My senior resident, a DO who graduated from the school down the road, would marvel at all the assignments we had to do and that we had daily lecture and weekly meetings with the course director to go over our h&ps. He said none of that existed where he did his rotation and that they just sat around all day. Keep in mind this was one of the "easier" rotations at my school. I had other friends at the same DO school who would tell me that their IM rotations involved lots of sitting around and too many students per patient.


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Daily lectures are supposed to be a component of high quality rotations? Just because something makes the rotation harder doesn't make it better....

 

[235009]

Daily lectures are supposed to be a component of high quality rotations? Just because something makes the rotation harder doesn't make it better....

Absolutely. Not sure what's difficult about sitting in lecture for an hour or two each day. Having didactic lectures is crucial to high quality clinical education. You need someone to teach you the basics, distill things down to your level in a formal manner. Rotations should also include formal case discussion, physical exam rounds with an attending and other forms of formal structured teaching. Dropping you off in a hospital, showing you which physician you'll be following or team you'll be joining and then forgetting about you is not an appropriate way to run a clinical rotation.

 

[Psai]

Daily lectures are supposed to be a component of high quality rotations? Just because something makes the rotation harder doesn't make it better....

Yes, you're supposed to learn from your attendings through didactics as well as through bedside teaching. That's what you're paying for.

 

[acapnial]

Absolutely. Not sure what's difficult about sitting in lecture for an hour or two each day. Having didactic lectures is crucial to high quality clinical education. You need someone to teach you the basics, distill things down to your level in a formal manner. Rotations should also include formal case discussion, physical exam rounds with an attending and other forms of formal structured teaching. Dropping you off in a hospital, showing you which physician you'll be following or team you'll be joining and then forgetting about you is not an appropriate way to run a clinical rotation.

I'm all for case discussion and structured rounds, but I usually didn't get much out of plain didactics. It often WAS the basics, and it was usually stuff you could learn through studying. When we had attendings teach us about brand new drugs and clinical trials in their field it was great, because that gave information and perspectives that I couldn't easily get otherwise, but the "these bugs cause pneumonia in these situations, and these drugs cover these bugs" lectures were mostly material I could learn a lot more efficiently through study.

 

[235009]

I'm all for case discussion and structured rounds, but I usually didn't get much out of plain didactics. It often WAS the basics, and it was usually stuff you could learn through studying. When we had attendings teach us about brand new drugs and clinical trials in their field it was great, because that gave information and perspectives that I couldn't easily get otherwise, but the "these bugs cause pneumonia in these situations, and these drugs cover these bugs" lectures were mostly material I could learn a lot more efficiently through study.

The lectures you should've been getting should've been about clinical reasoning not rote memorization. EKG reading, how to interpret LFTs, coming up with a solid differential for common presentations, what's the next diagnostic test for X, Y or Z scenario? what's the next step in management of that stable VT that you just learned how to identify on an EKG? etc etc

I think part of the problem here is that you haven't seen how this can be done well.

 

[acapnial]

The lectures you should've been getting should've been about clinical reasoning not rote memorization. EKG reading, how to interpret LFTs, coming up with a solid differential for common presentations, what's the next diagnostic test for X, Y or Z scenario? what's the next step in management of that stable VT that you just learned how to identify on an EKG? etc etc

I think part of the problem here is that you haven't seen how this can be done well.

We did receive those kinds of talks in case based webinar lectures/discussions that were distinct from our didactics (or so I thought- maybe those are also considered didactics and my vocabulary isn't broad enough here). I still don't think they were crucial to learning it, but I guess it's possible that what you're saying is right. Once I see didactics at a "name brand" place, I can compare them.

 

[PL198]

That is really flawed logic. Forget MD or DO. You're basically saying that because people in the past believed X is better than Y, then X is better than Y OR because people believe X is better than Y, it's because X really is better than Y. It's basically an appeal to tradition or appeal to popularity/majority fallacy. You might as well being saying, for generations people thought the Earth was flat for a reason, therefore the Earth must be flat. Or, millions of people believe the Earth is flat for a reason, therefore the Earth must be flat. Just because a preference for something exists doesn't actually mean that thing is better, it just means people feel its better.

Again though, I'm not saying there isn't a difference in the quality of clinical years overall between MDs and DOs on average, I'm just pointing out the severely flawed logic you're exhibiting with this post.

Except we aren't talking about uneducated masses here so it's not the same thing as majority at all. we're talking about PDs who are aware of how medical school works, and as such construct " biases" that they find to be effective for getting successful residents.

you can make an argument without quoting logical fallacies (which really aren't fallacies btw)

the definition of fallacy is a failed or unsuccessful argument. go watch an court proceedings. the ad hominem will keep you up at night. all those attorneys must have no idea they're doing.

sorry for the tangent but the fallacy stuff annoys me. that and people who say strawman every post. literally every argument you have to restate your opponents position and as such do it in a favorable way for you. you can argue or you can sit there and just say strawman back and forth and get nothing accomplished

 

[PL198]

I hate didactics personally. maybe if you hand out notes or something to enhance the value and commitment to memory it could work.

If you force me to sit in a room with someone for an hour (likely at lunch or 8 am) and just listen, the yield is gonna be pretty low.

I don't think this should surprise anyone when you have medical students who are basically teaching themselves using books and review materials and skipping lectures in general or watching them at astronomical speeds. I think pre-clinical years have shown that lectures are pretty useless for most, I don't think trend magically changes when your topic becomes the differential of a cough instead of the steps of glycolysis

 

[hallowmann]

Except we aren't talking about uneducated masses here so it's not the same thing as majority at all. we're talking about PDs who are aware of how medical school works, and as such construct " biases" that they find to be effective for getting successful residents.

you can make an argument without quoting logical fallacies (which really aren't fallacies btw)

the definition of fallacy is a failed or unsuccessful argument. go watch an court proceedings. the ad hominem will keep you up at night. all those attorneys must have no idea they're doing.

sorry for the tangent but the fallacy stuff annoys me. that and people who say strawman every post. literally every argument you have to restate your opponents position and as such do it in a favorable way for you. you can argue or you can sit there and just say strawman back and forth and get nothing accomplished

Just because something is effective in a courtroom doesn't mean its logical. All it means is that it convinces people. Lots of things convince people. There is a difference between a logical argument and an argument that convinces others. Your definition of fallacy is inconsistent with the definition of a logical fallacy, which is what I was obviously referring to.

PDs are human. They take what they see, they have limited exposure based on it, and in many cases, like most people they make generalizations to make their lives easier. Generalizations help them accomplish a task (i.e. sorting through thousands of applications for the dozens they'll interview). I understand this, and since DOs on average are weaker applicants than US MDs on average, something I actually never disagreed with, eliminating DOs saves them time. I don't have an issue with this reality.

The thing I have an issue with is for people to take a generalization and apply it outside of the realm of the task of dealing with a ton of residency apps. You for example implied that since this generalization is used, it must mean that DOs are weaker than US MDs. That line of thought is flawed, and quite frankly it leads to stories I hear about DO attendings being ignored or having eyes rolled at them when they try and teach US MD students, which is unfortunate for the student - the attending probably couldn't care less. The same is true when it comes to IMGs.

All I'm saying is that generalizations about DOs (or IMGs for that matter) aren't helpful nor are they beneficial outside of tasks of sorting large amounts of volume. I say this because in 4 years, all DOs will be finishing from ACGME accredited residencies, DOs will comprise >1/4 of all medical students in the US, and quite frankly they'll be your colleagues. Thinking from now that DOs are all weaker in terms of knowledge, intelligence, education, whatever, is not only inaccurate, but its not going to help you in the future.

 

[hallowmann]

I hate didactics personally. maybe if you hand out notes or something to enhance the value and commitment to memory it could work.

If you force me to sit in a room with someone for an hour (likely at lunch or 8 am) and just listen, the yield is gonna be pretty low.

I don't think this should surprise anyone when you have medical students who are basically teaching themselves using books and review materials and skipping lectures in general or watching them at astronomical speeds. I think pre-clinical years have shown that lectures are pretty useless for most, I don't think trend magically changes when your topic becomes the differential of a cough instead of the steps of glycolysis

The best didactics I've ever had were more interactive with handouts. Its hard to get interactive when you're in a huge auditorium, but resident specific sessions are pretty good (e.g. morning report), especially when you know everyone there, so people are more willing to get involved. I agree though, they are really hit or miss, especially for the students. Unless the topic directly deals with something you're seeing right now on the patient list, it kind of goes in one ear and out the other.

Students actually giving the presentations and running morning report or something is really beneficial though. You learn a ton that way.

 

[brocephalic]

I don't get the people saying, "It's not a net loss for DOs because the DOs will be competitive against MDs [e.g. "Those who can hack it will be fine in ACGME, and those who can't will sink."] ".

That may be true in fields like IM or anesthesia or neurology where there has been historically less of a DO bias. But look at specialties like ENT or neurosurgery or orthopedics. It was incredibly rare for DOs students to match into ACGME residencies, so the AOA residencies were their only realistic option. Now those are in jeopardy because, 1) a good number of them are closing because they can't meet ACGME requirements, and 2) that 20-30% of MD applicants who historically didn't match into an ACGME program get a crack at those spots.

Quote from a surgical subspecialty AOA program director: "Thank God for the merger, I never have to take a ****ing DO ever again."

Haha, highly doubtful, if not an outright lie! I'm one of the residents in AOA Ortho programs and we have phenomenal candidates that apply and rotate thru. For people to assume that an MD kid with a 240 can take one of these spots is laughable. Pretty much every candidate we interview has 240+ if not 250+. One of our interns this year had a 272 and 800+ on comlex.

I have to admit that since we are not a huge academic center, we do have to do peds and Tumor at a more tertiary center, where we more than hold our own. Not just my program, but all DO Ortho programs.

Please do not comment on something you have no idea about.

 

[brocephalic]

Lol. Visionary is a resident in an ACGME oto residency and has been a very reliable poster for a long time.

IMHO the DO crew doesn't really know what the competition actually looks like. It's the definition of a big fish in a small pond. I've reviewed some national grant/scholarship awards and I hate to be an a** but I really felt a little bad for the DO applicants in that pool. I really don't think they know what they are up against. It's not just about board scores. Their applications were destroyed by the MD students.

And I'm sure all those MD students did well for themselves. But to assume that some 240+ Ortho reject MD student can now easily take one of the DO spots is just not true.

We have just as good candidates on the DO side- numbers wise- minus the research and big Whig letters. There is little focus on research in DO profession, which I admit is a weakness. Going to an MD school doesn't just magically make you better. You may or may not have more resources than DO students, depending on which school you go to. I have rotated thru big academic centers as part of my residency and saw all kind of ****ty MD students gunning for Ortho spots.

 

[Psai]

And I'm sure all those MD students did well for themselves. But to assume that some 240+ Ortho reject MD student can now easily take one of the DO spots is just not true.

We have just as good candidates on the DO side- numbers wise- minus the research and big Whig letters. There is little focus on research in DO profession, which I admit is a weakness. Going to an MD school doesn't just magically make you better. You may or may not have more resources than DO students, depending on which school you go to. I have rotated thru big academic centers as part of my residency and saw all kind of ****ty MD students gunning for Ortho spots.

Actually going to an md school does make you magically better because you didn't get stuck going to a do school. My program doesn't even interview below 240 and that's a great score. You just don't know the competition.

 

[Mjolner]

Actually going to an md school does make you magically better because you didn't get stuck going to a do school. My program doesn't even interview below 240 and that's a great score. You just don't know the competition.

So. I have to weigh here as much as I wanted to avoid the cancer that these threads are...
You forget the bottom end of DO and MD schools are VERY similar performance wise.
Step 1 pass rate for all takers in the MD pool and all takers in the DO pool are very similar 94% to 93%. ( http://www.usmle.org/performance-data/default.aspx#2015_step-1 ) You can say that's the best of the DOs vs the entirety of the MDs, but some of the best DOs stay AOA because they know they'd be destroyed by the beasts coming out of the top of the MD classes. And at the top, barring a few EXTREME outliers, the MD world destroys DO-no sane person would dispute that. Plus DO auto-filtering is real at the top programs and competitive specialties.

This being said, we're talking about the good to average MD applicants against DOs best. Don't forget that half the MD world scored below 230. And 6% of the MDs couldn't pass Step1 no matter how many times they tried last year.
At the top MD blows away DO, at the middle and the bottom the talent pool levels out some between the two because now you're looking at DO students who didn't have it together freshman year, but found the fairway as upperclassmen and Med students, vs those MD students who we're on track the whole time.

However, there are still better Match opportunities for MDs (see @MeatTornado, I mentioned it so you don't have to. I kid, I kid)


Tl;dr MD does not equal God. DO does not equal Hodor. Let's try to remember this. http://www.usmle.org/performance-data/default.aspx#2015_step-1


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[brocephalic]

Actually going to an md school does make you magically better because you didn't get stuck going to a do school. My program doesn't even interview below 240 and that's a great score. You just don't know the competition.

240 is a great score for ER.... that's about standard for ortho, if not below average. No one's stuck at a DO school, we are all aware of our shortcomings and options. Last I checked, there were no studies out there that showed that DOs were killing more patient's than MDs.

I am well aware of the competition. I have worked with/along side them in residency. However, to assume that the AOA-ACGME merger will somehow allow the MD rejects from competitive residencies to swoop in on DO spots is not true. There are very qualified DO candidates that stay in AOA match due to DO discrimination in ACGME match in surgical subspecialties. No DO program director is salivating over mediocre MD candidates, and to imply otherwise is false.

 

[brocephalic]

duplicate post

 

[brocephalic]

Implying that the MD applicants who fail to match in ortho or oto, etc, are "mediocre" is the false implication here.

There is a razor's edge separating those who match and those who don't, and a glut of highly qualified candidates from the MD side.

Sure, just as people who fail to match such subspecialties in the AOA match.

I am a resident at a program that got ACGME approved a few months back, I can assure you that our PD/faculty will not be anymore accommodating to any MD student just because they happen to be MDs. We have had detailed discussions about this with the DME and the PD. I was involved in the ACGME-AOA merger accreditation committee at my hospital and did all the paperwork for our program and was part of all the evaluation meetings. No one ever said, " Thank god for the merger, so I don't have to ever take a ****ing DO again."

 

[Mr Roboto]

Implying that the MD applicants who fail to match in ortho or oto, etc, are "mediocre" is the false implication here.

There is a razor's edge separating those who match and those who don't, and a glut of highly qualified candidates from the MD side.

What is it that separates them? Sorry for my ignorance, I'm really curious.

 

[hallowmann]

So. I have to weigh here as much as I wanted to avoid the cancer that these threads are...
You forget the bottom end of DO and MD schools are VERY similar performance wise.
Step 1 pass rate for all takers in the MD pool and all takers in the DO pool are very similar 94% to 93%. ( http://www.usmle.org/performance-data/default.aspx#2015_step-1 ) You can say that's the best of the DOs vs the entirety of the MDs, but some of the best DOs stay AOA because they know they'd be destroyed by the beasts coming out of the top of the MD classes. And at the top, barring a few EXTREME outliers, the MD world destroys DO-no sane person would dispute that. Plus DO auto-filtering is real at the top programs and competitive specialties.

This being said, we're talking about the good to average MD applicants against DOs best. Don't forget that half the MD world scored below 230. And 6% of the MDs couldn't pass Step1 no matter how many times they tried last year.
At the top MD blows away DO, at the middle and the bottom the talent pool levels out some between the two because now you're looking at DO students who didn't have it together freshman year, but found the fairway as upperclassmen and Med students, vs those MD students who we're on track the whole time.

However, there are still better Match opportunities for MDs (see @MeatTornado, I mentioned it so you don't have to. I kid, I kid)


Tl;dr MD does not equal God. DO does not equal Hodor. Let's try to remember this. http://www.usmle.org/performance-data/default.aspx#2015_step-1


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I think what people are forgetting is that the bottom 1/3 (possibly 1/2) of current MD matriculants and the top 1/3 (possibly 1/2) of current DO matriculants are roughly the same population. We're talking about a difference between the matriculant means of basically a single standard deviation. It may make a big difference from the perspective of certain PDs, and it may make a noticeable difference come residency app time, but the difference really isn't that huge nor is it clearly delineated.

There is no real reason to assume that a top of their class DO couldn't possibly compete with an MD, because MDs in the bottom half of the matriculant class can and do rise to the top.

That said, none of us know exactly what will happen, we are all, on both sides, guessing. Let's give it a couple years. My guess is it'll be somewhere in the middle, some spots will be lost to MDs, but it won't be appreciable enough to hurt DOs to the degree its being implied on this thread.

 

[IslandStyle808]

So. I have to weigh here as much as I wanted to avoid the cancer that these threads are...
You forget the bottom end of DO and MD schools are VERY similar performance wise.
Step 1 pass rate for all takers in the MD pool and all takers in the DO pool are very similar 94% to 93%. ( http://www.usmle.org/performance-data/default.aspx#2015_step-1 ) You can say that's the best of the DOs vs the entirety of the MDs, but some of the best DOs stay AOA because they know they'd be destroyed by the beasts coming out of the top of the MD classes. And at the top, barring a few EXTREME outliers, the MD world destroys DO-no sane person would dispute that. Plus DO auto-filtering is real at the top programs and competitive specialties.

What you have stated is part of the reason, another part is that these DOs meet with filters on their applications. So there is almost no point going all in for ACGME. To add to this optho, one of the extremely competitive fields that DOs seem to match into somewhat decently on the ACGME side, is not DO friendly. The only reason it seems this way is because the SF match happens before the AOA match. When the matches combined, I am sure those stellar DOs will be matching into ACGME programs a little more (don't get me wrong I am not saying matching into competitive ACGME specialities will rise drastically, but I believe it will be a little better than before).

 

[235009]

MeatTornado being an example of a below average MD matriculant becoming an above average residency applicant

Another very curious comment about me...not sure where it comes from.
I had a 3.6/33 from an ivy league school ....not exactly "below average". Got just under 250 on step 1 but was overall just barely above average in class rank so I actually think I have been "just a bit above average" my whole career.

An MD will do far better in the match than a DO with the same stats/numbers/accomplishments. That's simply a fact. All these gymnastics of trying to compare the top DOs to the bottom MDs is all hogwash and ridiculous speculation.

 

[hallowmann]

Another very curious comment about me...not sure where it comes from.
I had a 3.6/33 from an ivy league school ....not exactly "below average". Got just under 250 on step 1 but was overall just barely above average in class rank so I actually think I have been "just a bit above average" my whole career.

An MD will do far better in the match than a DO with the same stats/numbers/accomplishments. That's simply a fact. All these gymnastics of trying to compare the top DOs to the bottom MDs is all hogwash and ridiculous speculation.

I was basing the comment on your frequent statement that you went to a "low-tier" MD school and matched at a "high-tier" residency. Maybe you were exaggerating when you said those things about your med school in the past.

 

[235009]

I was basing the comment on your frequent statement that you went to a "low-tier" MD school and matched at a "high-tier" residency. Maybe you were exaggerating when you said those things about your med school in the past.

I went to a state school ranked in the ~60s in US news. I don't think I've called my residency "high tier" but it is very competitive (due to location) and does not consider DOs.


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