Bruh, auditions are tough.

[Spectreman]

I just needed to vent a bit cause I didn’t like being told my family is going to hate me for becoming a doctor.

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[Ho0v-man]

I just needed to vent a bit cause I didn’t like being told my family is going to hate me for becoming a doctor.

The residents said that? Dude from your description their families probably hate them because they’re tools who just happen to also be doctors.

 

[ERK123]

This is one of those skills that is widely utilized in all specialties.

I think these skills you keep emphasizing are a pit specialty specific. I don’t think a single resident or attending has picked up an US during the last year in my program.

 

[DO2015CA]

I think these skills you keep emphasizing are a pit specialty specific. I don’t think a single resident or attending has picked up an US during the last year in my program.

Not saying that poster specifically but sometimes people need a little less Procedural skills and a little more medical management skills. So using an US would not meet the residency selection criteria for my specialty

 

[gyngyn]

Remember to treat each other with respect, especially if you disagree.

 

[FutureDoctor5000]

Where does it say that DO students are inferior? My post was in reference to exposure. Just to let you know, my DO colleague a few years ago was able to do all of that at the end of third year medical school. Just like there are MD students who will be able to do this, but more due to exposure during their superior clinical training. But there are also a ton of MD students walking around without much capability while having these exposures. I personally was never exposed to this intensity as a medical student, and was able to pick it up on the fly and excel at an intense program. So, it is not a requirement. But you can bet that I would have developed these skills by 4th yr if I was exposed to them earlier. I don’t see what your point is in arguing these points with me. As a DO, you are already behind the eight ball on paper in comparison to your MD colleagues. When all things are equal, it will always be MD > DO across all specialties. That’s just the fact of life. Being a normal person who gets along well with the team and average clinically isn’t going to cut it for auditions at university ACGME programs.

But make no mistake that the bar set to be a superstar performer even at your level is very high especially for mid to high tier programs. You will likely do well and are probably above average if you can pick up 2-3 pts independently from the ED and see them yourself at your level.

My MD attending said he never learned those things in 3rd year and still can’t do half the things you mentioned. Most third years at md schools are shadowing residents and learning to take notes. This is largely the case for DO’s as well.

 

[Dr. Brandon Green]

Don’t be in a race to apathy and throw in the towel. I guarantee you that if the program director is seasoned and has good faculty with experience they can see through the students who are playing off each other. The longer you’re in student and resident education the easier it is to see who’s a team player and who’s out for themselves and will put down others to look better. Don’t be discouraged as they likely know more about the other students than you realize.

 

[SLC]

... In a simple thing like a CXR with opacity, how do you know whether it’s lobar pneumonia or pulmonary edema from something else? Use US to rule out pulmonary edema and start abx instead of waiting for the read in a couple of hrs.

I always judge based on clinical picture, physical exam, and lab findings. No US needed. POCUS in this setting is just overkill IMO, a handy tool but in no way necessary. A fever, infiltrate, leukocytosis, elevated CRP, etc adds up to pneumonia. Plus, pulm edema is generally much more diffuse. So I f I think the patient has pneumonia, no amount of ultrasounds are going to get me to delay antibiotics.

Pt has diffuse ST elevation consistently with pericarditis. Need to use the US to r/o tamponade and txt them ASAP to make them stable before you proceed to other stuff.

Once again, good history, thorough exam (friction rub? Improvement with leaning forward etc) and a good handle on labs and how to interpret them. US not critical for correct dx or appropriate treatment.

If there is such a thing as a ultrasound elective, I highly recommend you to get some exposure.

There is, there’s also CME for it. It’s the new trendy thing for EM, Pulm-Crit types and the like. I have thought about doing a CME course; but I don’t feel compelled that it’s going to radically change my practice in any meaningful way, so I haven’t yet gotten around to it in my 3yrs of attending hood.

That’s how you end up separating yourself as a real doc instead of a MLP with the MD/DO behind your name.

I like your fire, but I think you’re overplaying your hand a bit here bro.

 

[FutureDoctor5000]

I always judge based on clinical picture, physical exam, and lab findings. No US needed. POCUS in this setting is just overkill IMO, a handy tool but in no way necessary. A fever, infiltrate, leukocytosis, elevated CRP, etc adds up to pneumonia. Plus, pulm edema is generally much more diffuse. So I f I think the patient has pneumonia, no amount of ultrasounds are going to get me to delay antibiotics.



Once again, good history, thorough exam (friction rub? Improvement with leaning forward etc) and a good handle on labs and how to interpret them. US not critical for correct dx or appropriate treatment.



There is, there’s also CME for it. It’s the new trendy thing for EM, Pulm-Crit types and the like. I have thought about doing a CME course; but I don’t feel compelled that it’s going to radically change my practice in any meaningful way, so I haven’t yet gotten around to it in my 3yrs of attending hood.






I like your fire, but I think you’re overplaying your hand a bit here bro.

Way to school him....

 

[Candidate2017]

I just needed to vent a bit cause I didn’t like being told my family is going to hate me for becoming a doctor.

Are you auditioning for neurosurgery at Johns Hopkins? Or an abusive IMG factory? Do your best, be play well with others, and don't let the haters get you down.

And the U/S sales rep above needs to loosen up a bit and find out where they misplaced the U/S probe.

 

[Spectreman]

WTF, who told you that? Are you auditioning for neurosurgery at Johns Hopkins? Or an abusive IMG factory? Do your best, be play well with others, and don't let the haters get you down.

And the U/S sales rep above needs to loosen up a bit and find out where they misplaced the U/S probe.

The program has turned into an abusive IMG factory. Will probably get shut down.

 

[Dr.Bruh]

Poor clinical rotations, lack of structure, and lack of teachings from specialists.

How many 4th yr DO students can interpret the #s written on a LHC or RHC report besides reading the impression?

How many 4th yr DO students can independently interpret an EKG report in term of rate/rhythm/origin of P wave/axis deviation/hypertrophy/ischemia and tie it to the clinical picture?

How many 4th yr DO students can do a beside U/S to r/o pulmonary edema?

How many 4th yr DO students can do a parasternal short/long/apical view to r/o cardiac tamponade?

How many 4th yr DO students can use the U/S probe to look at the IVC to r/o fluid dry or overload status?

How many 4th yr DO students even deal with liver dx pts, from beginning to end?

How many 4th yr DO students can read a CXR in the ABC method?

These are some stuff off my head, in which rotating students at my institutions are taught. I'm sure that there are more. Due to the clinical teachings here, any students who stay awake can pump out 240+ on their Step 2 easily.

Patient presentation is the minimal standard that has been mastered by 3rd yr MD students by Xmas. Sorry, not hating on DO students and am a DO myself. Just feel bad for you guys in general now that I'm on the other side of things.

Lol I’m a DO M4 going EM and me and basically all of my classmate going EM (the ones I’ve seen clinically the most) can do all of these things. I’m on an ED sub-I with multiple MD M4 students now and I had to explain what Morrison’s pouch was to them.

 

[Dr.Bruh]

Maybe it’s an EM thing but I’ve been having a blast on audition. Covid has def made things more stressful but I’m super bummed I can’t do more. A typical audition is 12-14 8 hr shifts plus conference every week so you really have half the month off. Those shift are tough and you gotta be on your game for sure tho. But all the residents, faculty, nurses, scribes etc have all been so chill. Nobody takes themself too serious, lots of joking around and telling cool ED stories. Residents are all super hyped to help out the Med students and to get us procedures and stuff. 10/10

 

[BorntobeDO?]

Last thought, I personally think that being able to use the US in conjunction with your clinical judgment will make you a good doc. Skills won’t come overnight but residency is only a few years. Might as well learn to use well. This is one of those skills that is widely utilized in all specialties. For example, how do you r/o vasospasm after SAH? Use the Transcranial Doppler. In GS, there are a ton of stuff you can do with US like bleeding, hernia, etc... In a simple thing like a CXR with opacity, how do you know whether it’s lobar pneumonia or pulmonary edema from something else? Use US to rule out pulmonary edema and start abx instead of waiting for the read in a couple of hrs. Pt has diffuse ST elevation consistently with pericarditis. Need to use the US to r/o tamponade and txt them ASAP to make them stable before you proceed to other stuff. If there is such a thing as a ultrasound elective, I highly recommend you to get some exposure.

That’s how you end up separating yourself as a real doc instead of a MLP with the MD/DO behind your name.

Yeah bedside ultrasound has an inter operator reliability just slightly better than percussion. It’s the hot trend, but I will take the formals over it any time I need to make an actual important decision.

 

[ciestar]

Just as an aside, I have friends in finance, engineering, biotech, etc. and so far all of them are enjoying COVID to the max. WFH, no commutes, saving money, etc. If anything, attitudes towards work-life balance are switching much more towards enjoyment, whereas medicine is continuously hell bent on making training as terrible as possible. Such is life in a traditionally hyper conservative field, with admittedly a lot at stake (people's health).

My husband agrees with all of this (he’s in finance). He also essentially got a raise because he’s paying less in taxes since he’s not paying Philly’s wage tax anymore.

 

[ciestar]

My point is that having those skills is not that important since by your own admission you’re doing well in residency despite starting without them. I’m not arguing that DO clinical education is equivalent to MD because it’s not. I’m arguing that your list of skills in an earlier post don’t sound like too much of a big deal if you just picked them up on your first rotation in residency.

Again, I also balk at the idea of crushing auditions. Especially when you spend your first week learning the new emr and can’t even find your way around.

Lol the sub-i’s where i just did my last rotation dont even have access to the EMR.

 

[Ho0v-man]

Lol the sub-i’s where i just did my last rotation dont even have access to the EMR.

I’ve had rotations like that. Talk about pointless

 

[ciestar]

I’ve had rotations like that. Talk about pointless

The sub-i had to ask me to show her the vitals of the patients she was seeing. Hard to audition when you dont have access to even basic information.

 

[Neopolymath]

Lol the sub-i’s where i just did my last rotation dont even have access to the EMR.

Uh WHAT?

This is worse than an M3 rotation for most people lol.

 

[ciestar]

Uh WHAT?

This is worse than an M3 rotation for most people lol.

Yeah it made zero sense lol
My peds sub-i i literally was the one writing all the notes on my patients... H&P, progress, discharges, i was responsible for it all. The chief and attending would write their own addendum and cosign.

My second sub-i my notes counted for nothing and i could only do progress notes. The third, i was only allowed to do outpatient notes

 

[Neopolymath]

Yeah it made zero sense lol
My peds sub-i i literally was the one writing all the notes on my patients... H&P, progress, discharges, i was responsible for it all. The chief and attending would write their own addendum and cosign.

My second sub-i my notes counted for nothing and i could only do progress notes. The third, i was only allowed to do outpatient notes

I imagine these are the same places talking smack about new interns not being prepared and blah blah blah.

I likely won't write any more discharge summaries before graduation aside from a few at a long term rehab joint I did 3rd year but no HP and no progress notes during a sub-i? Wow.

 

[AnatomyGrey12]

I've had a few rotations where I didn't have EMR access. Both were electives though, and not sub-i's. Not having EMR on a sub-I is extremely. stoooopid lol.

 

[ciestar]

I imagine these are the same places talking smack about new interns not being prepared and blah blah blah.

I likely won't write any more discharge summaries before graduation aside from a few at a long term rehab joint I did 3rd year but no HP and no progress notes during a sub-i? Wow.

The EMR was Sunrise which was insanely primitive and didnt give students even the option to write one. That said, i was instructed to write one in my progress note setup and the resident or attending would look at what i wrote there. Either way, some places are reallly weird about student notes.

 

[Deecee2DO]

What's absolutely bonkers to me is that as medical student these expectations were pretty much never there. I essentially dicked around for all of 3rd year and parts of 4th year and now, surprise surprise, I find myself massively struggling as an intern in an admittedly very competitive environment. DO schools simply cannot compare with what top 20 MD schools are doing with their students.

Could you elaborate more on what you wish you had done/learned in M3/4 and what you felt your DO rotations specifically lacked that you think the T20 MD programs have?

 

[DarkHorizon]

Cocomelon has very high expectations from his students, perhaps IM programs are like that.

In ortho:
1) roll in with high scores
2) work hard and know pertinent stuff
3) Get along and don’t be a jerk
4) be Teachable

if you show you’re willing to work hard and get along as a team player and teachable, you’ll get a spot. It’s a 5 year residency, we can teach you orthopedics, but we can’t teach you how to work hard, be a team player, or be teachable. At baseline, if you roll in with high scores, you’ve already showed that you’re capable to learn orthopedics, it’s the intangibles. Therefore, most ortho programs (MD or DO) are very heavy on rotators and a lot of programs almost require you to rotate in order to match.

 

[Neopolymath]

Cocomelon has very high expectations from his students, perhaps IM programs are like that.

In ortho:
1) roll in with high scores
2) work hard and know pertinent stuff
3) Get along and don’t be a jerk
4) be Teachable

if you show you’re willing to work hard and get along as a team player and teachable, you’ll get a spot. It’s a 5 year residency, we can teach you orthopedics, but we can’t teach you how to work hard, be a team player, or be teachable. At baseline, if you roll in with high scores, you’ve already showed that you’re capable to learn orthopedics, it’s the intangibles. Therefore, most ortho programs (MD or DO) are very heavy on rotators and a lot of programs almost require you to rotate in order to match.

Counterpoint: You obviously didn't know the patient's Na+ level from 3 weeks ago so you could never make it at an IM program

 

[BorntobeDO?]

Counterpoint: You obviously didn't know the patient's Na+ level from 3 weeks ago so you could never make it at an IM program

Meanwhile back at cocomelons residency...A terrified fourth year presents a patient with a map of 66, and NSR on tele with a questionable history of HFrEF...

But did you get the Fe-urea? How can you even tell me that diuretic is working with only I&Os. My bedside ultrasound showed a non-collapsible IVC and the patient is obviously in cardiogenic or obstructive shock with their normal map and you can’t trust the urine sodium due to their diuretic. WTH are you even doing on this sub-I? You should be in pathology cause you just kill people...

 

[Ho0v-man]

Meanwhile back at cocomelons residency...A terrified fourth year presents a patient with a map of 66, and NSR on tele with a questionable history of HFrEF...

But did you get the Fe-urea? How can you even tell me that diuretic is working with only I&Os. My bedside ultrasound showed a non-collapsible IVC and the patient is obviously in cardiogenic or obstructive shock with their normal map and you can’t trust the urine sodium due to their diuretic. WTH are you even doing on this sub-I? You should be in pathology cause you just kill people...

OMG I’m not looking forward to intern year

 

[DO2015CA]

OMG I’m not looking forward to intern year

lol just dont go into IM

 

[getfat]

I'm starting to learn your audition experience depends on your team.

If your intern is struggling then you're gonna have a bad time.

If your senior resident is struggling then everyone is gonna have a bad time.

 

[ERK123]

lol just dont go into IM

This is probably the most important take away from this thread.

 

[Chibucks15]

I'm starting to learn your audition experience depends on your team.

If your intern is struggling then you're gonna have a bad time.

If your senior resident is struggling then everyone is gonna have a bad time.

I second this. I just got done with one and it was a well-oiled machine, which made life busy but relatively easy for me. I got good evals and really didn't feel overwhelmed very frequently (even with my apparently vastly inferior DO education).

It all comes down to the program itself, the residents you're with, and the attending's efficiency. If all the above have their **** together then its very likely to be an enjoyable experience.

 

[Scrubs101]

Wow i def needed the laughs from this thread tonight. Superb discussion, well above average lols, and asks thought provoking questions. Performs at level of resident, however US skills need work.

3/5 read more, will not be ranking.

Call/text if you have any questions
- Scrubs101

(BTW op I would agree that auditions are your chance to evaluate programs as much as they are the programs chance to evaluate you. If you’re a stud, absolutely miserable program = DNR, if risk adverse, just toss it to the bottom of the list)

 

[manwelio]

As a 4th year medical student you should know tirads cold. You should probably drop out because your performance as an intern will likely cause shame to all of medicine.

I'm just responding because I like your profile pic. Points for Namekian medicine!

 

[AlteredScale]

Lol I’m a DO M4 going EM and me and basically all of my classmate going EM (the ones I’ve seen clinically the most) can do all of these things. I’m on an ED sub-I with multiple MD M4 students now and I had to explain what Morrison’s pouch was to them.

What? Im sorry but most senior IM residents (unless going into cardiology) can interpret ALL the findings of a LHC and RHC.

 

[SurgDoc95]

I am a D.O at an academic institution on an audition rotation. I feel you on this post. I am so incredibly miserable. I just hate my life.

Should’ve gone community

 

[Spectreman]

I am a D.O at an academic institution on an audition rotation. I feel you on this post. I am so incredibly miserable. I just hate my life.

It gets better my friend. Just finished another one and it was AWESOME. Love this place.

 

[AlteredScale]

I am a D.O at an academic institution on an audition rotation. I feel you on this post. I am so incredibly miserable. I just hate my life.

Why? What are they making you do?

 

[bigindian4891]

SDN told me "dont rotate at the programs you want." I beg to differ, I have a huge leg up vs other applicants just because I rotated. These audition rotations have been very insightful for both the program and the applicant. I wish I rotated more with programs I was interested in.

 

[Giovanotto]

SDN told me "dont rotate at the programs you want." I beg to differ, I have a huge leg up vs other applicants just because I rotated. These audition rotations have been very insightful for both the program and the applicant. I wish I rotated more with programs I was interested in.

Yeah, I've always maintained that's bad advice. Program I've matched at wouldn't even have laughed at my application had I not done a sub-I there. I think the only time SDN would really disagree with me is for IM, but even I don't know why exactly that is. I guess it's a numbers thing?

 

[Chibucks15]

Yeah, I've always maintained that's bad advice. Program I've matched at wouldn't even have laughed at my application had I not done a sub-I there. I think the only time SDN would really disagree with me is for IM, but even I don't know why exactly that is. I guess it's a numbers thing?

Agree with this. Directly from the PD where I was and a couple PDs I've talked to they prefer to know what they are getting. Sure your app can look great on paper and it may make more of a difference on the coastal 'powerhouse' programs, but at the same time if you can have an okay app for the program and show that you're good to work with for 3-5 years then 95% that program would prefer you over the amazing on paper applicant who may or may not be a total tool.

 

[km93]

Agree with this. Directly from the PD where I was and a couple PDs I've talked to they prefer to know what they are getting. Sure your app can look great on paper and it may make more of a difference on the coastal 'powerhouse' programs, but at the same time if you can have an okay app for the program and show that you're good to work with for 3-5 years then 95% that program would prefer you over the amazing on paper applicant who may or may not be a total tool.

this 100%. my favorite quote was "why go looking for someone who might be an angel, when we know you aren't a devil?" PDs don't like to gamble. a one month audition gives you great insight into a candidate. how motivated they are to train/match there, their work ethic, how nicely they play in the sandbox, and so on. virtual interviews can't give you anywhere near that kind of insight. particularly for this cycle, rotators (who performed well) have a massive leg up.

 

[slowthai]

Yeah, the only specialty SDN has consistently advised against doing auditions for is IM. It makes sense to do auditions for neuro because it's considered to have the highest workload out of the non-surgical/procedural fields.

 

[diesel2202]

Yeah, I've always maintained that's bad advice. Program I've matched at wouldn't even have laughed at my application had I not done a sub-I there. I think the only time SDN would really disagree with me is for IM, but even I don't know why exactly that is. I guess it's a numbers thing?

People typically recommend against it because it's pretty much a month long interview and there is the possibility that you could rub someone the wrong way. I think the counter to that is sure you could work with someone who is in a bad mood and may not speak highly of you, but you also have all the other people who can speak in your favor because they have gotten to know you. The PD at one place I auditioned at emailed me to meet with him because the seniors I worked with said nice things. I know of others it has happened to as well. If you bust your rear and are respectful, it gets noticed. If a DO student thinks they are interested in an academic IM program then it is definitely worth doing at least one rotation/audition at such a place, whether it's at a top choice or somewhere else.

 

[Chibucks15]

People typically recommend against it because it's pretty much a month long interview and there is the possibility that you could rub someone the wrong way. I think the counter to that is sure you could work with someone who is in a bad mood and may not speak highly of you, but you also have all the other people who can speak in your favor because they have gotten to know you. The PD at one place I auditioned at emailed me to meet with him because the seniors I worked with said nice things. I know of others it has happened to as well. If you bust your rear and are respectful, it gets noticed. If a DO student thinks they are interested in an academic IM program then it is definitely worth doing at least one rotation/audition at such a place, whether it's at a top choice or somewhere else.

It also really isn’t that hard to work hard and not be a *******. Apparently harder for some than others and man the stories I heard from residents make me wonder how people make it through med school at all not to mention life

 

[FutureInternist]

Cocomelon has very high expectations from his students, perhaps IM programs are like that.

In ortho:
1) roll in with high scores
2) work hard and know pertinent stuff
3) Get along and don’t be a jerk
4) be Teachable

if you show you’re willing to work hard and get along as a team player and teachable, you’ll get a spot. It’s a 5 year residency, we can teach you orthopedics, but we can’t teach you how to work hard, be a team player, or be teachable. At baseline, if you roll in with high scores, you’ve already showed that you’re capable to learn orthopedics, it’s the intangibles. Therefore, most ortho programs (MD or DO) are very heavy on rotators and a lot of programs almost require you to rotate in order to match.

5) Know the IM consult service pager number by heart

 

[Stagg737]

Man it's been a long time since I dropped in here, almost forgot it existed. Thoroughly needed this thread after last week, and see too much to comment on, but some things to point out (keeping in mind I'm a psych resident):

It was the end of 3rd year, so not an official Sub-I, but I was expected to carry 2-3 inpatients, I was given a pager and called for my own admits as part of the rotation on the team; and it was very much structured as a sub-I.

Da fook? What kind of monster gives a med student a pager? Although it may be good exposure therapy for 4th years going into their intern year...

I didn’t match at my auditions. I don’t regret them, cause I enjoyed them, and I was reaching for the stars a bit, and I did get interviews at all of them, but they were useless.

I have auditioning 4th years at my residency now, and honestly, I don’t know what to do with them. I try to release them early and they won’t go. I am really trying to pay it forward, especially as I am on wards and working crazy hours. Instead these students are kind of sabotaging me by making rounds longer asking extra questions and kind of distracting my seniors. Don’t do that kids.

One of the attendings already mentioned to give them a topic to look up and teach, it's a great way to make them learn independently and give yourself time to get some work done. Pimp them yourself on rounds. I straight up tell med students day 1 that I'll be pimping them frequently. I give the context that it's okay to get things wrong, but I expect them to try and look up the things they don't know for later. I also make a point of doing little didactic/learning sessions with the med students at the end of the day at least once or twice a week when we go over a topic or they can just ask questions. That way they know there's a time when they'll have my attention and they can do something else until then.

As a resident, I will be super impressed if you can independently admit 2 pts per day, come up with a nice ddx, and write a H&P with a solid plan. Follow up on everything and put in the orders with help.

If you can regularly do 3-4 admits per day with all the followings, you're a stud.

That should be the goal for all medicine Sub-I students right now.

I actually agree with this. When I have a sub-i who can even do 1 H&P, present it in an organized and concise manner, and come up with a reasonable plan on a consistent basis they get a gold star and an e-mail to our PD that I think they'd do well at our program (assuming no major personality or other problems). I expect 4th year sub-i's to be able to carry 3-4 patients on their own and have reasonable assessments and plans.

I have the opportunity to have both DO students from a newer branch campus school and from a top 20 MD school rotate on my service. The MD students absolutely tend to be stronger, but I have had a handful of the DO's outshine their MD counterparts. And when I get a brand new MS3 DO and MS3 MD they are very close in their skill levels. Once we get to the end of 3rd year I can see the weakness in the DO students prior clinical experiences compared to their MD counterparts (think basic things like not knowing how to present on rounds, not knowing how to write notes, etc).

Eh, I'm at a program that has both MDs (non-T20) and DOs that rotate through and I don't see much of a difference at any point overall. I can tell there are some DOs who have gotten unlucky with their preceptors because they take longer to adjust to the setting, but most of them catch up quickly enough. The one area I agree on is the writing notes. The DO school that rotates through my program has pretty inconsistent and variable experiences with EMRs and the MD students typically adjust to that aspect much more easily.

Is it just a matter of DO students being given rotations with "whoever wants to take them", whereas MD students get a very rigorous and structured curriculum at an associated hospital?

How do you know if your rotation is 'good quality' while its going on? Like in my case I felt like during IM it was good. I got to see 2-3 patients, present to a resident and got critique, then got to present to the attending. It seemed good. How would I know if its a deficient experience?

The structure is more important than how rigorous a rotation is imo. It's hard to learn when you're trying to figure out where to go/what to do for the first 2 weeks vs. being able to jump right in. You likely won't know if it's "good quality" while it's going on and honestly once you're there it doesn't matter. Just learn as much as you can. If the residents or attendings do a lot of teaching then great, if not then time to independent learning. Imo most rotations whether MD or DO in any field during M3 will be somewhat deficient because you're there so briefly (possible exceptions for the 8-week IM or surg rotations) and will likely have limited exposure. Oftentimes the truly poor rotations will be obvious, and all the rest will depend on how much you're putting into it, whether than be in the clinical setting or at home.

Again, I also balk at the idea of crushing auditions. Especially when you spend your first week learning the new emr and can’t even find your way around.

As a resident, I disagree. I've absolutely had a few sub-i's absolutely crush their auditions and one or two where I was very thankful they didn't match at our program. Imo, "crushing it" simply means you can operate at the level of an intern competently and sometimes even comfortably (ETA: if you make my job significantly easier I'd also include that). Example, when I did my 4th year sub-i at my top choice program, I carried my own team (technically under the chief who wrote the resident notes) of 3-5 patients at a given time at that location. I did my own H&Ps on new admits, came up with my own plans, presented during rounds, gathered collateral, and even gave 1-2 teaching sessions to M3s. I knew it was a successful audition because my 1 to 1 sit-down with the attending on the last day went well and he said I'd worked as a competent intern with plans and diagnoses that were reasonable. I think I crushed it because the attending, chief, and a few other residents sent e-mails to the PD on my behalf and my attending literally told me to contact him if I didn't match there so he could yell at the PD. I was a pretty weak candidate on paper, but I ended up matching there and I'm sure that rotation played a strong role in that.

That being said, I've had 2 or 3 M4s come through that same rotation who did the same thing who I think performed just as well or better than I did and thoroughly impressed me. All of them were DOs and all of them are now in my program. There is such a thing as crushing an audition, and it can sometimes be the thing that cements you an interview or even a spot in the match. That being said, this is certainly not always the case, and I think it depends just as much on the structure of the rotation and what you're allowed to do as it does on your own abilities/knowledge as a student.

 

[Ho0v-man]

As a resident, I disagree. I've absolutely had a few sub-i's absolutely crush their auditions and one or two where I was very thankful they didn't match at our program. Imo, "crushing it" simply means you can operate at the level of an intern competently and sometimes even comfortably (ETA: if you make my job significantly easier I'd also include that). Example, when I did my 4th year sub-i at my top choice program, I carried my own team (technically under the chief who wrote the resident notes) of 3-5 patients at a given time at that location. I did my own H&Ps on new admits, came up with my own plans, presented during rounds, gathered collateral, and even gave 1-2 teaching sessions to M3s. I knew it was a successful audition because my 1 to 1 sit-down with the attending on the last day went well and he said I'd worked as a competent intern with plans and diagnoses that were reasonable. I think I crushed it because the attending, chief, and a few other residents sent e-mails to the PD on my behalf and my attending literally told me to contact him if I didn't match there so he could yell at the PD. I was a pretty weak candidate on paper, but I ended up matching there and I'm sure that rotation played a strong role in that.

That being said, I've had 2 or 3 M4s come through that same rotation who did the same thing who I think performed just as well or better than I did and thoroughly impressed me. All of them were DOs and all of them are now in my program. There is such a thing as crushing an audition, and it can sometimes be the thing that cements you an interview or even a spot in the match. That being said, this is certainly not always the case, and I think it depends just as much on the structure of the rotation and what you're allowed to do as it does on your own abilities/knowledge as a student.

Cool. At my only allowed away rotation (thanks Covid) I didn’t have EMR access until after the first week and had no training on it. Even after getting access, it was in some weird limited mode that the residents didn’t even understand. Kinda hard to impress in situations like that. I can do all the stuff you mention above at my home program. But no way there. The bolded is definitely true.

 

[Chibucks15]

Cool. At my only allowed away rotation (thanks Covid) I didn’t have EMR access until after the first week and had no training on it. Even after getting access, it was in some weird limited mode that the residents didn’t even understand. Kinda hard to impress in situations like that. I can do all the stuff you mention above at my home program. But no way there. The bolded is definitely true.

I was the first visiting student back at my away and didn’t have EMR for a while, luckily a home 4th year who was just doing a neuro let me piggyback or I would’ve been screwed. Everyone was very understanding when I said I literally couldn’t get into the chart. There’s only so much you can do

either everywhere I’ve rotated at is ridiculously chill, the places you guys are at are way too hardass, or there’s a little bit of exaggeration goin on

 

[hallowmann]

Da fook? What kind of monster gives a med student a pager? Although it may be good exposure therapy for 4th years going into their intern year...

Yeah, they gave use pagers on a 3rd year IM rotation (which I stupidly took as an elective). Big institution, busy service, was paged multiple times and always had to call the operator to connect me from house phones. That sucked. I forgot that it happened until literally just now.

One of the attendings already mentioned to give them a topic to look up and teach, it's a great way to make them learn independently and give yourself time to get some work done. Pimp them yourself on rounds. I straight up tell med students day 1 that I'll be pimping them frequently. I give the context that it's okay to get things wrong, but I expect them to try and look up the things they don't know for later. I also make a point of doing little didactic/learning sessions with the med students at the end of the day at least once or twice a week when we go over a topic or they can just ask questions. That way they know there's a time when they'll have my attention and they can do something else until then.

Topic to look up and present for 5-10 min is great. Great way to learn, usually not super time consuming, actually useful info, and can do it with little downtime. I don't pimp a lot, because it never really helped me learn, but getting people to present is nice.

Eh, I'm at a program that has both MDs (non-T20) and DOs that rotate through and I don't see much of a difference at any point overall. I can tell there are some DOs who have gotten unlucky with their preceptors because they take longer to adjust to the setting, but most of them catch up quickly enough. The one area I agree on is the writing notes. The DO school that rotates through my program has pretty inconsistent and variable experiences with EMRs and the MD students typically adjust to that aspect much more easily...

Similar experience, except for note writing, I've seen a lot of bad notes written by MD and DO students, but I expect them to be bad. The point of assigning them notes is to get practice and make them better.

...either everywhere I’ve rotated at is ridiculously chill, the places you guys are at are way too hardass, or there’s a little bit of exaggeration goin on

Are you in the midwest or west coast? I had a different experience out east, but people tend to be nicer here.