Why is it important to do your rotations at a facility that has affiliated residencies?

[yvi101]

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Hello!

i was wondering if anyone could shed light on why it is important to do your clinical rotations at a facility that has residencies affiliated with them.

I was recently accepted into ACOM but what I have seen is that their core rotation sites are not located at facilities that have residencies.
Should this be a concern?

 

[Drrrrrr. Celty]

Generally it implies that the hospital will train you better and you'll be working with residents and as such learn how to do residency.

 

[meliora27]

Training alongside residents will train you to function as a resident.

One of the biggest concerns PD's have about taking DO interns is their questionable clinical training. Exclusively preceptor based rotations will NOT prepare you to hit the ground running as an intern, and programs are acutely aware of this.

 

[FrkyBgStok]

There are goods and bads. I can say that the rotations where I worked directly with the attending, they often let me do more in regards to procedures, notes, etc. The attendings were basically all, "i have done a thousand intubations, you can do them all." Which is awesome for me getting intubations. In addition, they often got to know me well and trust me, so i would operate like a 3rd year resident, and what i mean by that is "oh i think this is what they have so do these tests" and they would respond with "i agree, lets do it." However when i did my sub-I at an MD place with a more structured residency program, I had done the laid back presentation so often, i was rusty on the structured SOAP presentation. So the 3rd years looked more impressive than I did, at least in the beginning. I was reminded how to do it, but there was a gap on assessment, diff dx, plan presentation, stuff like that. sure i had a leg up on many things, but that was something i was deficient on. But as a student, they basically had things that were "sorry, we don't allow students to do that."

So as I said, there are goods and bads about working in a place like that. As a 3rd year, I am really glad I got to see both environments.

 

[kenjixshadow]

There are goods and bads. I can say that the rotations where I worked directly with the attending, they often let me do more in regards to procedures, notes, etc. The attendings were basically all, "i have done a thousand intubations, you can do them all." Which is awesome for me getting intubations. In addition, they often got to know me well and trust me, so i would operate like a 3rd year resident, and what i mean by that is "oh i think this is what they have so do these tests" and they would respond with "i agree, lets do it." However when i did my sub-I at an MD place with a more structured residency program, I had done the laid back presentation so often, i was rusty on the structured SOAP presentation. So the 3rd years looked more impressive than I did, at least in the beginning. I was reminded how to do it, but there was a gap on assessment, diff dx, plan presentation, stuff like that. sure i had a leg up on many things, but that was something i was deficient on. But as a student, they basically had things that were "sorry, we don't allow students to do that."

So as I said, there are goods and bads about working in a place like that. As a 3rd year, I am really glad I got to see both environments.

Were you able to honor that sub-I in the end? This is what Meliora was speaking of. As medical students, we should be learning how to function as residents (as interns to be precise), not as attendings/3rd year residents, and performing procedures can be well-learned in residency.

Hello!

i was wondering if anyone could shed light on why it is important to do your clinical rotations at a facility that has residencies affiliated with them.

I was recently accepted into ACOM but what I have seen is that their core rotation sites are not located at facilities that have residencies.
Should this be a concern?

Yes, forget about the first two years b/c every other school will teach you the same thing. Clinical clerkship are arguably more important. If you can, go to a school where you get to rotate with residents.

 

[meliora27]

Forgive my frankness.

At some point in your first or second year at any given DO school, odds are, you will receive a talk from one of the Deans or Associate Deans (likely background = TRI or Family Practice) who is a COM faculty member with a leadership post. They will most likely be very removed from actual clinical practice, and almost guaranteed to be removed from any sort of hospital based academic medicine.

They will tell you about how the experience you will get by working (shadowing?) in some adjunct's outpatient clinic or rounding with them at a small, non-tertiary, non teaching hospital, will make you the most sought out intern in the country, because unlike your colleagues at some big fancy university hospital where all they do is round all day, you can actually place a central line, do an I&D, deliver a baby.

What they won't tell you is you likely will struggle to write a note or present a patient, actual skills that are vital for an intern.

Do not buy into this sales pitch. Do yourself a favor, and and make sure to schedule some rotations at a large academic medical center, where you will learn the necessary skills to be an intern (which are not placing an ultrasound guided right ij...)

 

[yvi101]

Thank you everyone for your replies.

I am still trying to completely understand how rotations work.

Now I understand why it is important to do rotations with a facility that has a residency affiliated with it.

However, I am still a little confused. Is it only important for away (audition) rotations ? Or should I try to do my core rotations at a facility with residencies affiliated with it as well? It seems that ACOM's core rotation sites are not affiliated with residencies. Should this be a concern? Or no because I just need to make sure to schedule away rotations (4th year) at sites with residencies?

 

[IslandStyle808]

Thank you everyone for your replies.

I am still trying to completely understand how rotations work.

Now I understand why it is important to do rotations with a facility that has a residency affiliated with it.

However, I am still a little confused. Is it only important for away (audition) rotations ? Or should I try to do my core rotations at a facility with residencies affiliated with it as well? It seems that ACOM's core rotation sites are not affiliated with residencies. Should this be a concern? Or no because I just need to make sure to schedule away rotations (4th year) at sites with residencies?

You want these rotations BEFORE you hit auditions rotations. Two of the several top things that are important in a good match is 1) having good core rotations 2) have a strong letter of rec. (some of which you get from your audition rotations). Audition rotations are a time where you are impressing programs, not a time of learning the basics. So you want your core rotations to be under residency programs. This way you get the basics of functioning as an intern down. Once at your audition rotation, you are trying to function like an intern to the best your abilities. Hopefully you honor the audition rotation and get a letter of recommendation from the program. This is going to help you match well. It is the largest reason why you want ward based training early and through most rotations.

 

[IslandStyle808]

Forgive my frankness.

At some point in your first or second year at any given DO, odds are, you will receive a talk from one of the Deans or Associate Deans (likely background = TRI or Family Practice) who is a COM faculty member with a leadership post. They will most likely be very removed from actual clinical practice, and almost guaranteed to be removed from any sort of hospital based academic medicine.

They will tell you about how the experience you will get by working (shadowing?) in some adjunct's outpatient clinic or rounding with them at a small, non-tertiary, non teaching hospital, will make you the most sought out intern in the country because unlike your colleagues at some big fancy university hospital where all they do is round all day, you can actually place a central line, do an I&D, deliver a baby.

What they won't tel you is you likely will struggle to write a note or present a patient, actual skills that are vital for an intern.

Do not buy into this sales pitch. Do yourself a favor, and and make sure to schedule some rotations at a large academic medical center, where you will learn the necessary skills to be an intern (which are not placing an ultrasound guided right ij...)

This is spot on. During my past cycle interviews, a few schools would do this. They had very few residencies associated with it, hence the reason for the smoke and mirrors talk.

 

[FrkyBgStok]

Were you able to honor that sub-I in the end? This is what Meliora was speaking of. As medical students, we should be learning how to function as residents (as interns to be precise), not as attendings/3rd year residents, and performing procedures can be well-learned in residency.

DMU doesn't really do honors in 4th year, more not graded at all, but I got very good comments. But it was because I was able to shift back into the "intern" presentation and I got decent instruction my 3rd year. So that is why I mentioned to have a balance of both as they both have their benefits. I was 3/4 the way through 3rd year before i wrote a note. luckily i caught on quickly and near the end was able to write good notes, but i didn't get that rotating directly with attendings. it was the rotation with a residency.

 

[kenjixshadow]

Is it only important for away (audition) rotations ? Or should I try to do my core rotations at a facility with residencies affiliated with it as well? It seems that ACOM's core rotation sites are not affiliated with residencies. Should this be a concern? Or no because I just need to make sure to schedule away rotations (4th year) at sites with residencies?

What @IslandStyle808 wrote is spot on. If ACOM is your only acceptance, roll with it. Nevertheless, you will need to play some catch up. If you have any available elective in 3rd year, use it to rotate at a residency program - not at any of your top choice because you will be doing some learning and will be at a disadvantage to impress PD. After that, when you're ready, go rotate at your top choices.

 

[yvi101]

Thank you everyone for your responses! I really appreciate it.

I have been accepted into ACOM and have a interview scheduled for CUSOM next week. I have been contemplating whether to attend my interview to CUSOM. ACOM would work better for my family because of location and my husband's employment but CUSOM has core rotation sites that are affiliated with residencies. Therefore, I have been trying to figure out what is best to do. Aghhhhhhhh

 

[simbad8]

DMU doesn't really do honors in 4th year, more not graded at all, but I got very good comments. But it was because I was able to shift back into the "intern" presentation and I got decent instruction my 3rd year. So that is why I mentioned to have a balance of both as they both have their benefits. I was 3/4 the way through 3rd year before i wrote a note. luckily i caught on quickly and near the end was able to write good notes, but i didn't get that rotating directly with attendings. it was the rotation with a residency.

Did you guys not learn/practice how to write notes in your didactic years?
Also, I know some third years at my school who wrote the notes for the patients they saw for their preceptors ... So I guess it depends on the rotation spot?

 

[hallowmann]

Thank you everyone for your replies.

I am still trying to completely understand how rotations work.

Now I understand why it is important to do rotations with a facility that has a residency affiliated with it.

However, I am still a little confused. Is it only important for away (audition) rotations ? Or should I try to do my core rotations at a facility with residencies affiliated with it as well? It seems that ACOM's core rotation sites are not affiliated with residencies. Should this be a concern? Or no because I just need to make sure to schedule away rotations (4th year) at sites with residencies?

Regardless of what everyone is saying, there are benefits to doing rotations in both types of settings. The truth is that the majority of physicians do NOT work in an academic medical center, and as such unfortunately the way medical education is set up not only doesn't provide students or residents with an idea of the average physicians day-to-day they also tend to get less opportunities for procedures because of the line ahead of them.

That said, most learning of how to be a physician must happen in an academic setting. There are also inherent skills associated with working on an academic service team that can really only be learned in that setting. It gives you the idea of your role in the team, and at the same time, you have a range of people at different levels each of whom can teach you important skills.

If I were to suggest rotations that should ideally be done in an academic setting, IM is by far the most important, followed by surgery, and maybe Peds. Psych and FM can be done in an outpatient or preceptor based setting (but aim for preceptors that really like to teach), and OB is probably ideally done with a preceptor within a hospital, simply because in other settings you either won't get to do as much or you won't get to see as much volume/pathology.

In my opinion, ideally, you'll be exposed to both. You need an academic setting in many cases because it will make you appealing to and comfortable in residencies. It also helps you grow in a linear way. At the same time, the opportunity to do a lot and see how physicians think and work is valuable for both your confidence and your understanding of what to expect after residency.

Did you guys not learn/practice how to write notes in your didactic years?
Also, I know some third years at my school who wrote the notes for the patients they saw for their preceptors ... So I guess it depends on the rotation spot?

Of course we did, but after a year (or even a couple months) of having 12 hr days on rotations, it's understandable to lose that skill. Its something you'll experience. When you're actually out on clinicals, you'll realize how quickly you get rusty on skills you don't use. You learned them, so you can get them back quickly, but it still takes time.

Writing clinic or preceptor notes is not the same as writing full intern-level notes or full H&Ps. Anyway, you'll see how it is. That's my advice.