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[Mr.Smile12]

You need to look that up yourself by school, and meaningful is going to be very subjective. Early clinical exposure is found in most schools but you should ask students on "meaningful." What are you looking for specifically?

 

[chilly_md]

Seems you are already a medical student. For premed students applying, this kind of information is usually more useful after they have received acceptances.

 

[voxveritatisetlucis]

Way too subjective

Experience varies intraschool to such an extent that it is impossible to categorize

You could look at schools that do 3 years of clerkships

 

[candbgirl]

I just posted to the premed forum because I thought that's where people are most likely to be interested in these things. We have an optional program for clinical exposure for M1s at my school, which I took part in, and we're working with faculty to improve the program, so I was wondering if there are any medical schools with exceptional programs in this area we could emulate.

Why didn’t you just start with this explanation?

 

[Mr.Smile12]

Why didn’t you just start with this explanation?

Agrees.

It also helps knowing what type of program this is and where you are. Who knows if we were to name a school that we could mention yours.

If anything, you can leverage your AMSA connections. Faculty have their networks within AAMC. That said, you may be disappointed if you find out you are the only one piloting this, but you probably aren't. Medical schools like to reproduce elements of others curriculum into their own all the time.

 

[Mad Jack]

Of course students can connect with faculty members on their own to arrange shadowing and things like that, but my question is about programs that are part of the school's curriculum, like Northwestern's "Education-Centered Medical Home" and UCSF's "Clinical Microsystems Clerkship." And by meaningful, I mean both quantity and quality.

I've almost universally heard from residents and fellows I've worked with that such programs were generally felt to be a waste of time that got in the way of studying

 

[Chardeemacdennis60]

I've almost universally heard from residents and fellows I've worked with that such programs were generally felt to be a waste of time that got in the way of studying

As an M2 at a program that tries to sell its "early clinical experiences" to applicants, I full-heartedly agree. Maybe I am jaded, but all of these perks/slants/unique pre-clinical offerings are just selling points to for potential students. Early clinical exposure and innovative curriculums all sound great until you are in the throes of pre-clinical studying/research/etc. and are also required to see patients in the hospital at random intervals. In my brief exposure, the experiences are often relatively brief and meaningless in the grand schemes of our extended training. You would rather just spend time on studying and improving your CV in the way you see fit then be met with even more expectations from your school's admin.

 

[Chardeemacdennis60]

Thanks for sharing! Is it more because the clinical experiences are too short for learning/development? Or that the overall workload is too much and these requirements stress people out? I ask because they sort of point in different directions (i.e. increasing the number and duration of clinical experiences would result in a greater increase in total workload)

In short - yes to both of your questions. I mean it sounds like you are a medical student so let me ask you, would having 4-8 hour mandatory weekly clinic experiences during your M1/M2 year be a burden? In my experience, the mandatory clinical experiences were in line with that requirement and they were an incredible burden placed on M1's as we began drinking through the firehose that is our preclinical years. We also have frequent mandatory in-class activities, so perhaps it would work at some schools better than others.

Sure, for some students that had absolutely no experience it was probably beneficial to get some additional exposure. That being said, we also have frequent standardized patient encounters that teach us the basics and fundamentals of assessment and note taking. To me it just seemed as if administration was becoming more delusional with their expectations of students and it was the last thing most in my class wanted to stress about during our studies. I do not really see how it would be possible to introduce a clinical curriculum during pre-clinical studies that would actually have a significant impact on our ability to perform during M3/M4. With students working 40-60 hrs/wk during clinical years, I think it is just a drop in the overall bucket that is our training.

Perhaps I am of a different mind than some, but I think pre-clinical students should have their schedules optimized to adjust and study, research/extracurriculars, or gain exposure to fields they find personally interesting. I enjoy being able to individually contact physicians I want to shadow at my own pace, rather than having an additional curriculum requirement.

 

[Hzreio]

In short - yes to both of your questions. I mean it sounds like you are a medical student so let me ask you, would having 4-8 hour mandatory weekly clinic experiences during your M1/M2 year be a burden? In my experience, the mandatory clinical experiences were in line with that requirement and they were an incredible burden placed on M1's as we began drinking through the firehose that is our preclinical years. We also have frequent mandatory in-class activities, so perhaps it would work at some schools better than others.

Sure, for some students that had absolutely no experience it was probably beneficial to get some additional exposure. That being said, we also have frequent standardized patient encounters that teach us the basics and fundamentals of assessment and note taking. To me it just seemed as if administration was becoming more delusional with their expectations of students and it was the last thing most in my class wanted to stress about during our studies. I do not really see how it would be possible to introduce a clinical curriculum during pre-clinical studies that would actually have a significant impact on our ability to perform during M3/M4. With students working 40-60 hrs/wk during clinical years, I think it is just a drop in the overall bucket that is our training.

Perhaps I am of a different mind than some, but I think pre-clinical students should have their schedules optimized to adjust and study, research/extracurriculars, or gain exposure to fields they find personally interesting. I enjoy being able to individually contact physicians I want to shadow at my own pace, rather than having an additional curriculum requirement.

Words cannot describe how much I agree with this. Some clinical duties in the 1st/2nd year is good. 4-8 hrs a week a ludicrous

 

[fathergoat]

The one that accepts you....

 

[PhD_to_DO]

Of course students can connect with faculty members on their own to arrange shadowing and things like that, but my question is about programs that are part of the school's curriculum, like Northwestern's "Education-Centered Medical Home" and UCSF's "Clinical Microsystems Clerkship." And by meaningful, I mean both quantity and quality.

My school has an early clinical program that just gets in the way of studying. Students participate in a required EMT course during Unit 1 & 2 that requires a 12 hour EMS clinical shift with a local agency and passing the NREMT exam. The course can be waived if you are certified as an EMT or higher (this does not include being licensed as an RN, NP, or PA though; everyone has to go through the EMT course). After you’re certified, there are mandatory and volunteer shifts with the mobile medical van (street medicine program), health fairs around town, COVID clinics, and high school sports physicals. In the OMS-2 year, there is one required shift (8 hours) at an outpatient FM or IM clinic and later in the year, required shifts at these student run clinics that the school has set up in several low income housing complexes. Students can still volunteer with the street medicine teams and other volunteer activities. You can be engaged as you want or you can hide in the back if you wish.

The EMT course just gets in the way of studying and its not an insignificant amount of time that you have to devote to the course. Its considered part of the Unit 1 grade so you can’t blow it off. For me personally it sucked because I’d been an Army medic for years and at one time, was a civilian paramedic. Since my cert had lapsed, I had to go through the EMT course; the final hands on NREMT skills test was the weekend before Unit 1 final exams and my 12 hour clinical ride along was on Christmas night. I love EMS however and threw myself into the shift. Two of my classmates responded to the Uvalde shooting and there was a student who responded to the church shooting that happened here in TX a few years ago. Still, most of these activities just increase our workload and get in the way of studying.

 

[drbatsandwich]

My school has a ton of clinical exposure in years 1-2. We have biweekly oral presentations in small group; bimonthly/monthly standardized patient encounters with feedback; week-long shadowing with specialty of choice every 9th week. 8 weeks of (optional) clinical experience in specialty of choice during summer after M1.

 

[BeachQuidditch]

M3 at Hofstra. Our school has a half day a week during the first 2 years rotating 1:1 with an attending. We work in turn with OB, Surg, IM, Peds, and Psych. We also have 3 weeks a year during which we can select any specialty or attending and the school connects us to them. The mandatory specialties tie in with the material in the systems-based block during which they are scheduled. It's not just shadowing, we have a long list of expectations, such as taking and documenting histories and doing physical exams (there are like 20-odd specific ones per spefialty). I also did blood draws, shots and finger sticks, as well as sutures, incisions, and even laparoscopic cuts.

For me it was THE highlight of my preclinical years. It helped me decide which specialties I was interested in or not. Motivated me in a way that textbooks did not. Connected me to attendings in my future specialty. Anchored the course material. Prepared me for the hospital and M3. And just made me happy interacting with patients. Not everyone at my school liked it. I absolutely loved it.

 

[Ho0v-man]

My school did a little of this and it was worthless. Also, don’t the vast majority of med students only get into one medical school anyway? So they wouldn’t care what happens. For the few with multiple acceptances, they’re ranking based on location, prestige, etc. So these “opportunities” don’t matter at that stage. I would also be very surprised if even at the places referenced in the OP if you could find any evidence that these experiences improved anything in regards to med student performance by any metric.

 

[Captain_Falcon]

I agree thst preclinical year clinical exposure and activities really doesn't help too much. The learning curve will be there at the beginning of M3. So long as a school had a clinical skills class to go over the head to toe exam, some interviewing workshops, a couple workshops practicing presentations and writing notes that is more than sufficient for groundwork before m3 year.

More important would be opportunities to shadow different fields that aren't part of core rotations (Rads, surgical specialties, Anesthesia, PMR, HPM, etc)

 

[throwaway123342]

I think a better question is finding out which MD schools are offering BS clinical exposure in general. At my school I literally had entire clerkships where I never interviewed a patient. As in I was literally just shadowing or even less.

Would be interesting if we could organize anonymous "reviews" of every school in the country so we know what places offer actual training, not just blind anki-ing your way to application season.

 

[Putkernerinthehall]

My school did a little of this and it was worthless. Also, don’t the vast majority of med students only get into one medical school anyway? So they wouldn’t care what happens. For the few with multiple acceptances, they’re ranking based on location, prestige, etc. So these “opportunities” don’t matter at that stage. I would also be very surprised if even at the places referenced in the OP if you could find any evidence that these experiences improved anything in regards to med student performance by any metric.

Some schools have a lot of clinical exposure in M1, M2. Physical exam training, patient interviewing skills, weekly PBL with patient interaction, ultrasound training, standardized patient interaction, formal and informal physician shadowing, time at student run clinic, etc. I think some do it well and some don't. Only way to know how much value it provides is to talk to graduates from the different schools you've been accepted to and get an assessment of how much they feel they gained from the experiences.

 

[Ho0v-man]

Some schools have a lot of clinical exposure in M1, M2. Physical exam training, patient interviewing skills, weekly PBL with patient interaction, ultrasound training, standardized patient interaction, formal and informal physician shadowing, time at student run clinic, etc. I think some do it well and some don't. Only way to know how much value it provides is to talk to graduates from the different schools you've been accepted to and get an assessment of how much they feel they gained from the experiences.

So these are all pretty standard things everywhere does and I wouldn’t call any of them clinical exposure except the student clinic. I’m talking about experiences when you’re forced to go to the hospital and try to participate in actual patient care.

 

[Kardio]

My school has an early clinical program that just gets in the way of studying. Students participate in a required EMT course during Unit 1 & 2 that requires a 12 hour EMS clinical shift with a local agency and passing the NREMT exam. The course can be waived if you are certified as an EMT or higher (this does not include being licensed as an RN, NP, or PA though; everyone has to go through the EMT course). After you’re certified, there are mandatory and volunteer shifts with the mobile medical van (street medicine program), health fairs around town, COVID clinics, and high school sports physicals. In the OMS-2 year, there is one required shift (8 hours) at an outpatient FM or IM clinic and later in the year, required shifts at these student run clinics that the school has set up in several low income housing complexes. Students can still volunteer with the street medicine teams and other volunteer activities. You can be engaged as you want or you can hide in the back if you wish.

The EMT course just gets in the way of studying and its not an insignificant amount of time that you have to devote to the course. Its considered part of the Unit 1 grade so you can’t blow it off. For me personally it sucked because I’d been an Army medic for years and at one time, was a civilian paramedic. Since my cert had lapsed, I had to go through the EMT course; the final hands on NREMT skills test was the weekend before Unit 1 final exams and my 12 hour clinical ride along was on Christmas night. I love EMS however and threw myself into the shift. Two of my classmates responded to the Uvalde shooting and there was a student who responded to the church shooting that happened here in TX a few years ago. Still, most of these activities just increase our workload and get in the way of studying.

I can’t believe they made you get an EMT certification (as a medical student) to participate in those clinical experiences.

 

[Shazam243]

M3 at Hofstra. Our school has a half day a week during the first 2 years rotating 1:1 with an attending. We work in turn with OB, Surg, IM, Peds, and Psych. We also have 3 weeks a year during which we can select any specialty or attending and the school connects us to them. The mandatory specialties tie in with the material in the systems-based block during which they are scheduled. It's not just shadowing, we have a long list of expectations, such as taking and documenting histories and doing physical exams (there are like 20-odd specific ones per spefialty). I also did blood draws, shots and finger sticks, as well as sutures, incisions, and even laparoscopic cuts.

For me it was THE highlight of my preclinical years. It helped me decide which specialties I was interested in or not. Motivated me in a way that textbooks did not. Connected me to attendings in my future specialty. Anchored the course material. Prepared me for the hospital and M3. And just made me happy interacting with patients. Not everyone at my school liked it. I absolutely loved it.

This is most likely the exception by far, rather than the rule. It's more of a nuisance than not. One week of M3 rotation will give you far more experience than 2 years of these preclinical exposure courses. If you really want patient interaction, you can just shadow attendings/residents in the hospital, most will be more than happy for you to tag along. It can be pretty low yield but you can increase your learning significantly if you pretend that you're the resident/attending and think what you would ask/do and ask the resident/attending what they think of your thought process. Most likely, yours will be a very ignorant plan, but most people appreciate you asking questions more than anything else.

I will say that the one exception to the above is the sessions that they teach you basic physical exam maneuvers. I did find them valuable. You will be expected to know how to auscultate the heart and lungs, palpate the abdomen, etc. before you start your clerkships. But even if you don't, if you simply acknowledge it, and ask for help the resident/attending on service will teach you in a few minutes. The method that my school taught me for physical exam maneuvers is often more than what the attending do, in the sense that it is very "proper" and thorough. It is, however, textbook and the right way to do it.

 

[PhD_to_DO]

I can’t believe they made you get an EMT certification (as a medical student) to participate in those clinical experiences.

I think there are a couple of other schools, UNLV being one of them, that have their students do this. Wouldn’t be so annoying if it was done in June or July before classes start but its just sort of thrown haphazardly in with our first two units and there is zero integration (i.e., when we’re studying EMS pharmacology, why not use that as a tome to introduce the basics of medical pharmacology or integrate some of H&P into the EMS course?) In any case, its an easy course but it does take time away from studying our ‘meat and potatoes’ material.

 

[Putkernerinthehall]

M3 at Hofstra. Our school has a half day a week during the first 2 years rotating 1:1 with an attending. We work in turn with OB, Surg, IM, Peds, and Psych. We also have 3 weeks a year during which we can select any specialty or attending and the school connects us to them. The mandatory specialties tie in with the material in the systems-based block during which they are scheduled. It's not just shadowing, we have a long list of expectations, such as taking and documenting histories and doing physical exams (there are like 20-odd specific ones per spefialty). I also did blood draws, shots and finger sticks, as well as sutures, incisions, and even laparoscopic cuts.

For me it was THE highlight of my preclinical years. It helped me decide which specialties I was interested in or not. Motivated me in a way that textbooks did not. Connected me to attendings in my future specialty. Anchored the course material. Prepared me for the hospital and M3. And just made me happy interacting with patients. Not everyone at my school liked it. I absolutely loved it.

Great input. Sounds like Hofstra is doing a good job trying to give y'all some solid training and exposure before rotations.

 

[PandaBaer]

I went into school seeking out clinical experiences as well, but have found that aside from getting familiar with basic skills, the mandatory, structured materials/sessions are a huge timesink for very little reward.
Hofstra's program sounds very nice, but it is basically taking our weekly patient/clinic skills lab and integrating it into the hospital setting, which is a huge improvement and I would love to have it at our school, but still probably not enough to be "meaningful".
My theory on clinical skills is that they are very different from didactic knowledge and you can only truly learn them through condensed repetition, i.e. rotation/residency. Any skills learned during didactics should be purely informative and short. If you want "meaningful" experience you'll end up sacrificing didactic competence.

 

[Chardeemacdennis60]

I went into school seeking out clinical experiences as well, but have found that aside from getting familiar with basic skills, the mandatory, structured materials/sessions are a huge timesink for very little reward.
Hofstra's program sounds very nice, but it is basically taking our weekly patient/clinic skills lab and integrating it into the hospital setting, which is a huge improvement and I would love to have it at our school, but still probably not enough to be "meaningful".
My theory on clinical skills is that they are very different from didactic knowledge and you can only truly learn them through condensed repetition, i.e. rotation/residency. Any skills learned during didactics should be purely informative and short. If you want "meaningful" experience you'll end up sacrificing didactic competence.

Feel like all premeds deciding between multiple schools should read this thread.

 

[Redpancreas]

I think a better question is finding out which MD schools are offering BS clinical exposure in general. At my school I literally had entire clerkships where I never interviewed a patient. As in I was literally just shadowing or even less.

Would be interesting if we could organize anonymous "reviews" of every school in the country so we know what places offer actual training, not just blind anki-ing your way to application season.

Did all your classmates feel this was the case too?

 

[Hzreio]

Great input. Sounds like Hofstra is doing a good job trying to give y'all some solid training and exposure before rotations.

Idk half day per week sounds annoying to me

 

[Putkernerinthehall]

Idk half day per week sounds annoying to me

Depends on the program and how it is done. If it's meaningful with real patient interactions in clinic or hospital and you're actively involved and not just passively watching, it can be valuable. Sitting in your room studying for two years and then being thrown into clinical rotations with no training sounds more annoying.

 

[voxveritatisetlucis]

honestly, these things become a huge time drag and don’t produce much dividends in the long run. Two weeks out from a block exam, you want to be studying not on the wards or in an outpatient care unit

 

[FluffyCat1212]

I think my school does pretty well with this. My first standardized patient encounter was during our second week? In the preclinical 1.5 years, we shadow preceptors in the hospital and practice physical exam skills on consenting patients. We also have routine standardized patient encounters that are relevant to the block we're currently in.

Outside of that, we help staff a Salvation Army clinic, outpatient community IM clinic, and our consultation IM service (which focuses on more complex non-local cases)- all with VERY heavy preceptor supervision. It's nice because these are graded P/F, and the threshold for pass is along the lines of "did the student show up and actually try." This makes these extremely low-stress. Some blocks mandate that we shadow a preceptor in clinic for an afternoon and we have "selectives" every couple of weeks where we can shadow in an area we're interested in. We also are mandated to shadow a pathologist/path resident for an autopsy and write a pathology patient write-up for feedback. We've also had several block-specific sessions on ultrasound and have an optional longitudinal selective on point-of-care ultrasonagraphy.

Echoing what vox mentioned, it is kind of annoying and stressful having 4 hours in clinic in the leadup to a big exam. While it's annoying, it usually doesn't hurt our performance too much because you either only have to come in for one patient or you have a lot of downtime while you're there. As you get into the organ blocks, they also try to tailor the clinical experiences to the block we're currently in (outside of the clinic stuff because you can't really tailor that...), so the clinical experiences will sometimes be helpful in preparing for the exam.

During my first year, we were taught how to do a comprehensive physical exam, a neuro exam, a thorough history, health coach, write a full clinical note, and present a patient to a preceptor.

I honestly have no idea how this compares to other schools because I have only attended one med school lol, but I assume that most schools will have some type of early clinical exposure?

 

[voxveritatisetlucis]

I believe that it also depends upon the grading structure of your school. We are pass/fail but internally (and externally I guess since it is released to residencies) ranked and have AOA. This means that one can’t approach exams with the goal of just passing. So these events do get somewhat tense leading up to an exam with many students complaining and or not paying attention (doing Anki etc.)

If I just had to pass these exams, these events would be much less frustrating