2018-2019 School Attrition

[NukHopkins]

Yeah, you're right. It's better when more people get kicked out of medical school, saddled with six-figure debt, an enormous gap in their resume, and feelings of intense dread, because that means less competition for the survivors. That's definitely not a scummy, tactless thing to say.

Not sure if you checked out the very next sentence of my post, but I agreed with Goro and suggested that students who cannot hack it in the first year school should get the boot. This does not include people who seek help and have a reason for medical/personal LOA. Everyone in the group is better off if those that struggle are not allowed back. Less debt, more time to find a new career and grow in that role and save money for the person leaving; lessens the already narrowing bottleneck of residency applications for number of available residency spots for those able to get through a school's curriculum.

Whoever is six figures in debt after the first year of medical school is, honestly, doing it wrong (unless they go to Midwestern).

The "enormous gap" in the resume can be explained away (felt pressured by family to pursue medicine, but primal scream therapy is my passion and here's why I want to work in the industry...)...POOF!

The intense feeling of dread is on the individual to seek help and get through. I can't imagine having to go through it, but I imagine the emotions can be managed and worked-through as time moves forward and the individual finds a new career path.

It may sound scummy and tactless, but it is the reality of the situation if someone cannot handle the first year of medical school. It doesn't get any easier.

PS - Aren't you an M1? Correct me if I'm wrong...

---

Members don't see this ad.

 

[MedicineZ0Z]

The actors have a rubric that you, as the testee have to follow. Sounds simple to me.

At my school, in our clinical medicine labs, we film our student encounters with standardized patients.

The ones who who have the most trouble with these exams are the ones most likely to fail CE.

We conclude that these kids have difficult to treat humanistic domain defects, despite interventions!

Also , your slam on the actors brings to mind a concern that you do not like being judged.

IF I'm correct, keep.in mind that you will be judged for the rest of your professional career.

No I just don't trust that they can accurately grade a physical exam. Or even a history.. especially as a teenager.

there's no physician (watching the camera) doing part of the grading?

They grade the OMT & SOAP notes only.

 

[ricksimmonsrafowens]

there's no physician (watching the camera) doing part of the grading?

I don't think so, I think the physician grades only the note portion.

 

[AlbinoHawk DO]

I agree with Roxas, the ultimate reason students are kicked is because the schools are afraid they won't match. If you could match with 5 failed classes and repeated boards, I imagine there would be many DO schools willing to keep taking your tuition money. Its when you look like your in danger of not being able to complete in 6 years (i.e. no more fed money) or will not match thus discouraging future students from coming that this becomes a real issue.

DO schools know the only thing between them and the Carribbeans is that 98% placement rate. If that drops to a simular number as the carribbean, why would people put up with the extra OMM nonsense. The Carribs are often cheaper as well.

Schools won't dismiss you because they think you won't match. They will dismiss you because of board failures or unethical behavior. The school looks much worse with higher attrition rates and low graduation percentages than they do by having someone go unmatched.

 

[AlbinoHawk DO]

Knowing my school admin, it probably went along the lines of:


Admin 1: Hey, our level 1 pass rate is 92%. How do we increase it?
Admin 2: Let's make class attendance mandatory.

[Following year]
Admin 1: Our pass rate dropped to 85%. what are we doing wrong?
Admin 2: I think we give them too much dedicated time off. Let's cut it from 5 weeks to 3 and put in a mandatory ACLS/BLS
course during dedicated.

[Following year]
Admin 1: Whoops, it's 80% now.
Admin 2: Clearly, the students are getting lazier. They're not fit to be doctors. They should be dismissed.

[Following year]
Admin 1: Now that the level 1 problem is taken care of and they're all dismissed. What are we gonna do to increase our 94% level 2 pass rate?
...

You joke around, but I kid you not that my advisor once told me that they were worried of these same issues and there were a few professors that in all seriousness suggested that students should come in at night for classes in addition to our already 8 to 5pm curriculum

 

[rg2o3]

Correct. 3 of the 4 domains on the PE are 100% graded by an actor of which no physician ever checks, corrects, or reverses one iota

Fantastic. So the fate of my career will some day be held in the hands of an actor.. That makes sense.

 

[2021Doctor]

Here is the sad voice of experience, not authority. There are simply too many students who do NOT seek out help when they are flailing and floundering, because they view this as a loss of face, a sign of weakness or they're afraid that somehow PDs will find out about thier mental health issues and deny them and won't invite or rank them.

We can't make them go for help. All we can do is encourage.

Now layer onto this the denial that tons of people indulge in, and then you have failing students who think "if I get a 98 on the final exam, I'll pass the course!"

And just to verify something, attrition does NOT solely mean dismissal or withdrawal. It means, as define in the attached PDF in the OP "who take a leave of absence or withdraw from their medical school" Withdrawal or dismissal is the LESS common of the two attrition criteria.

So take a step back and what we're seeing is more accurately [for the majority] "delay in graduation". We see this in MD schools as well. and people delay for the following:
pregnancy
illness (physical and mental)
injury
research fellowship (more common for MD students)
teaching fellowships
Step failures
Course failures
family issues (I had a student who suffered not one but two deaths in the family in a short period of time). Clobbered them for two years. Managed to graduate and is now in private practice.

Now Roxas, I vehemently disagree with you that it's less cruel to cut students loose early on than letting them go all the through when we know that they'll never match. These kids will have debt to the tune of 3-4 Tesla's and won't be able to practice Medicine. At that point, it's a worthless degree. I mean, how HMOs are going to need administrators with such a terminal degree?

When my Dean first came on board, he thought exactly like you like you...we need to do everything in our power to get them to graduation.

But in seeing the human wreckage that resulted from this, he changed his tune and we feel that it's more humane to cut them loose early.

Do some COMs take in students they shouldn't? Of course? there's a limit to how many med school capable there are in this country. And the newest schools in the southeast seem to be the biggest culprits. I'm talking at you, LMU and WCU.

Great post.

 

[ProfAnon]

The actors grade the history and physical. No one double checks it.

Where are you getting this information from?

 

[Goro]

You joke around, but I kid you not that my advisor once told me that they were worried of these same issues and there were a few professors that in all seriousness suggested that students should come in at night for classes in addition to our already 8 to 5pm curriculum

Early in our existance at mt school, someone made a similar asinine suggestion. The rest of us voted it down immediately

 

[BorntobeDO?]

Where are you getting this information from?

They tell us that in our PE prep course at my school as well.

 

[2021Doctor]

Where are you getting this information from?

Candidates’ history-taking and physical examination skills are documented by the Standardized (SP) portraying the patient immediately following the encounter, as are doctor-patient communication, interpersonal skills, and professionalism. Completed e-SOAP Notes and OMT skills (via a secured electronic recording process) are rated by NBOME trained and approved osteopathic physician examiners.
Scoring Principles — NBOME

 

[sunshinefl]

They tell us that in our PE prep course at my school as well.

That’s how our standardized patient exams are graded. The SP checks off history items, physical items, humanistic items, etc immediately after while you are outside typing your SOAP note, which is the only thing being graded by physician faculty.

 

[ricksimmonsrafowens]

That’s how our standardized patient exams are graded. The SP checks off history items, physical items, humanistic items, etc immediately after while you are outside typing your SOAP note, which is the only thing being graded by physician faculty.

this is really funny as some of the SPs have literally no background in medicine... I remember SPs at my school gave garbage advice on how to take an appropriate history or ROS because they had even less background in medicine than me as a fresh MS2... like one SP took off points for me in my HPI for asking him if he uses any insulin for his DMII because "you don't need insulin to treat DMII." One time I asked an SP like 3 times if they used "any illicits or any recreational substances such as cannabis, cocaine, heroin, ectasy, etc" or any "alternative or complementary therapies" and they denies three times and then when giving me feedback said they were going to fail me because I forgot to ask them about any marijuana use (apparently the main objective of the encounter was to figure out their marijuana use)... super annoying because irl if you ask patients in an out patient about substance use and they deny multiple times no one is going to play detective at trying to figure out if they really are using substances unless they're presenting altered or impaired or something like that. And my school's SP were a standard deviation above in quality the Step 2 CS SPs.

 

[Goro]

this is really funny as some of the SPs have literally no background in medicine... I remember SPs at my school gave garbage advice on how to take an appropriate history or ROS because they had even less background in medicine than me as a fresh MS2... like one SP took off points for me in my HPI for asking him if he uses any insulin for his DMII because "you don't need insulin to treat DMII." One time I asked an SP like 3 times if they used "any illicits or any recreational substances such as cannabis, cocaine, heroin, ectasy, etc" or any "alternative or complementary therapies" and they denies three times and then when giving me feedback said they were going to fail me because I forgot to ask them about any marijuana use (apparently the main objective of the encounter was to figure out their marijuana use)... super annoying because irl if you ask patients in an out patient about substance use and they deny multiple times no one is going to play detective at trying to figure out if they really are using substances unless they're presenting altered or impaired or something like that. And my school's SP were a standard deviation above in quality the Step 2 CS SPs.

 

[ricksimmonsrafowens]

one thing SPs do well is giving feedback in how the student is perceived by patients... like, if the student is too "cold"/not empathetic enough with patients who are in distress, or if the student appears inattentive during the physical exam and rushes the process. That is usually valuable advice and has helped me improve my own bedside manner. However, what I've noticed is that medical students tend to complain if SPs give feedback like "the student appeared not empathetic to my concerns" because it's a personality criticism and it is really distressing to the student to receive it (even if it's true). So that's why SPs at my school have stopped giving out criticism like that because it's fairly subjective and students really dislike it.

 

[fldoctorgirl]

That’s how our standardized patient exams are graded. The SP checks off history items, physical items, humanistic items, etc immediately after while you are outside typing your SOAP note, which is the only thing being graded by physician faculty.

Same out our school, but faculty will double check if you failed anything based on an SP grading you. Seems crazy that the PE wouldn't employ the same policy, considering the stakes. I guess they just don't have the time..

 

[Goro]

It’s on the nbome website. Further @Goro the humanistic domain has no checklist. It’s literally how each actor “feels” you yourself acted and, as a result, made them feel. I’ve done the same transitions for years, and I’ve gotten a perfect score for transitions and also the lowest possible. It’s mind boggling anyone thinks this is a standardized exam

I'm appalled that it's this lax. I would at least film them and then have all failures reviewed by two clinicians.

 

[AnatomyGrey12]

That wonderful test you are all talking about is an honor for us to take, for a small price of $1200 of course.

 

[BorntobeDO?]

this is really funny as some of the SPs have literally no background in medicine... I remember SPs at my school gave garbage advice on how to take an appropriate history or ROS because they had even less background in medicine than me as a fresh MS2... like one SP took off points for me in my HPI for asking him if he uses any insulin for his DMII because "you don't need insulin to treat DMII." One time I asked an SP like 3 times if they used "any illicits or any recreational substances such as cannabis, cocaine, heroin, ectasy, etc" or any "alternative or complementary therapies" and they denies three times and then when giving me feedback said they were going to fail me because I forgot to ask them about any marijuana use (apparently the main objective of the encounter was to figure out their marijuana use)... super annoying because irl if you ask patients in an out patient about substance use and they deny multiple times no one is going to play detective at trying to figure out if they really are using substances unless they're presenting altered or impaired or something like that. And my school's SP were a standard deviation above in quality the Step 2 CS SPs.

This sounds frustratingly familiar to me with my schools SP's.

 

[smukke]

You joke around, but I kid you not that my advisor once told me that they were worried of these same issues and there were a few professors that in all seriousness suggested that students should come in at night for classes in addition to our already 8 to 5pm curriculum

I've heard of a school that actually implemented a version of this. Something like 30% of the M2 class "failed" their COMSAE cutoff so they made them attend a mandatory 4 week course during their dedicated study time. The mandatory course was completely home-brew, the school didn't know who was going to teach or what the schedule was even 2 weeks before it was to start and turned out they couldn't enforce attendance because classes had officially ended at that point. A bunch of people showed up to the first session then left after it was apparent it was a mess (lectures not showing up, basic science profs going over their old powerpoints without covering the high yield FA points) but a handful stuck it out to the end and they were the ones that failed. #medschooladminhubris

 

[hallowmann]

...DO schools know the only thing between them and the Carribbeans is that 98% placement rate. If that drops to a simular number as the carribbean, why would people put up with the extra OMM nonsense. The Carribs are often cheaper as well.

Any of the big 4 are on the same level cost-wise as DO schools. SGU is like $60k/yr for just tuition. The only ones that are cheaper are the non-recognized ones or ones that aren't eligible for federal loans. Even then there's a lot of extra costs like importing stuff and flights. Carib is an expensive endeavor.

As an incoming MS1, this thread scares the **** out of me.

Stay out of the bottom 10-15% and you'll be fine. Based on this data attrition is like 10-11%, and 98% place. At my school, half of the attrition were people that left for a change of heart or personal/family crises. The other half left for academic issues.

how can there be a 10%ish attrition rate in MS3? making it past MS1 & MS2 should be an almost guarantee of graduation. Name and shame guys!

That probably counts the people that took boards late and failed, started 3rd year before results came, or had multiple level 1 failures and were technically MS3s before they were officially dismissed. Don't get me wrong, it's still a huge percentage, but it probably has to do with failing Level 1.

 

[Ho0v-man]

Same out our school, but faculty will double check if you failed anything based on an SP grading you. Seems crazy that the PE wouldn't employ the same policy, considering the stakes. I guess they just don't have the time..

I had assumed they do double check failures. They film all of these encounters. They don’t look at failures!?

 

[Roxas]

I had assumed they do double check failures. They film all of these encounters. They don’t look at failures!?

Why would they when they can easily milk another $1300 out of 5-10% of examinees who are literally powerless to do anything but smile and wipe their chin. Seems like a good business model.

 

[Angus Avagadro]

A little late to the conversation, but anyone smart enough to get into med school is smart enough to stay in med school. Just saw my schools recent stats where grad rates are roughly 95 % for each class year. Where 2.5% drop out for personal reasons, and the other half flunk out for whatever reason. These are the ones who have red flags, course or board failures, the usual suspects. Schools with higher grad rates may be excellent schools or just profit driven and wont dismiss anyone

 

[deleted600623]

A little late to the conversation, but anyone smart enough to get into med school is smart enough to stay in med school. Just saw my schools recent stats where grad rates are roughly 95 % for each class year. Where 2.5% drop out for personal reasons, and the other half flunk out for whatever reason. These are the ones who have red flags, course or board failures, the usual suspects. Schools with higher grad rates may be excellent schools or just profit driven and wont dismiss anyone

This is encouraging.

 

[sunshinefl]

Circling back to the SP grading... we just got the results back from our last Clinical exam of 2nd year. One of my SPs:

In the ungraded free form comment section at the end “very warm, very understanding, great eye contact, great demeanor.”

For the *graded* affect line item: 3/5-neutral affect