Hi all,
This is my first (and probably last) post ever, but I thought I'd chuck in some opinions on this matter being that I am a DMU 4th year. Having reflected on my time in medical school as I get toward the end, I thought I'd pass on any personal information I can. The advice I have is really more for pre-meds about to head into med school. These are just my opinions and my experience, so take them for what they are. I agree that I doubt you'll hear from too many 4th years because it is a busy time, and quite frankly you lose your want to turn around and pass on information as you finish things up. Sorry if things are disjointed here, but hopefully I keep on track. Its late and I'm tired.
Just to disclaim based on some other posts I've read in this thread: My board scores for steps 1 and 2 were solid, and actually more than adequate for my chosen field (both USMLE and COMLEX). I was accepted to both MD and DO schools (multiple of each) and chose a DO school...I'm choosing an MD residency (more on this later). My MSPE and letters of rec were also much more than adequate for my field, and came from people well respected in their fields who I worked hard to have an opportunity to learn from. These were clinicians and researchers outside Iowa and far from the limited scope of what DMU had to offer. I'm stating all this because there is invariably someone out there just itching to say my comments will come from a place of animosity because I didn't live up to some self professed image of who I should be, or because someone wronged me, or whatever the individual may conjure to make my feelings about my situation null and void and theirs more crucial to the counter argument. That's fine, and yes, someone will do it. I'd like to reiterate, though, that I am evaluating my situation after creating the best possible scenario for myself in my settings, and quite frankly based on the residency interview trail, it worked. I also intentionally haven't vented on the internet for the reason that you just never know how you'll feel at the end. In addition, I am one of those people who left the state of Iowa pretty much immediately for 3rd and 4th year so if that pertains to you, I'd also offer the thoughts in this post. Lastly, I'm someone who should be doing this job for a living, so don't go reading in to my comments as though I have some grave short circuit in my life decision making ability and you have all the worldly answers and Freudian intuition I seek (I know there is at least one of you out there) because I assure you, my decision to go in to medicine could not have come from a deeper and more personal place. Now for something completely different.
First year, objectively speaking, was fine. I agree OMT is just too much of a priority throughout the first 2 years, being that 90% of what you need for boards (that you will actually know the answers to) is carried by the 1st year alone, and well over 90% of the DO's I've met in the field within 5 years out of practice are more likely to mutter "OMT what now?" There just isn't time to use it in the hospital unless OMT is what you do. DMU also insists on completing more than double the number of hours required by the DO accreditation bodies (this was the case when I saw the guidelines in 1st year), which while I am all for knowledge, is a bit unnecessary when you're already drinking from a fire hose.
The other classes were what you made of them. Either you studied hard and learned, or you didn't. Every school, from what I understand, asks nit-picking questions because they are basically training you to respect details. While I did not always agree with this particular way of teaching, I took what I needed and wanted from 1st year. The biggest complaint I have in 1st year was a mediocre 5 week pathology course full of thousands upon thousands of slides with no explanation and poor lecturing capacity at best (with exception given to 1 or 2 pathologists). It was so surprising to me to hear from many other friends at other medical schools that their pathology course would not start until 2nd year, or they tacked each system pathology on to the systems courses, or that pathology ran an entire semester. Whatever the case, I remember studying for USMLE and realizing there were pathology "buzzwords" I had never even heard of, and it was not for lack of studying the material I was given.
Second year was where things started falling apart for DMU's curriculum. Systems were routinely and almost entirely taught by multiple guest lecturers in a single unit, sometimes for an entire course and 2-3 tests worth of information. There was little consistency in goals set for a course, and even a day to day lecture, and poor follow through in terms of lecturers sticking to an agreed upon topic. Many times lectures were sliced and diced to quiz a student on what clinicians knew was overtly useless information (I can say that now having been through 2 years of clinical months). In my personal opinion, DMU would serve better to dismantle the entire curriculum for 2nd year as well as the pathology course in 1st year and completely rebuild them, as the way they are now does not afford adequate teaching to students. The end of 2nd year was, for my class, riddled with single-test classes like derm and ophtho which not only interfered with board studying in a major way for many of my classmates and myself, but also could have easily been done in the beginning of the year. Additionally, if a student fails the only test in a single-test class, one can imagine the ripple effect that is felt later on in the year and summer before taking step 1. And yes, this happened to several people in the class. And no, guy who is looking for something to comment on, I was not one of them.
I'm not saying people did not do well on step 1, but it certainly was not without undo stress. OMT also becomes a joke toward the end, as the entire second semester is not a part of board material. This was actually told to me by a faculty member and later proved to me on both step 1 and 2 of COMLEX. They theoretically give you enough time to study for boards assuming you are okay with not having too much of a break. This said, though, when you are seeing stuff sometimes for the first time when studying for boards, you start to realize the holes in the floor of second year might be catching up with you.
I left as soon as I could for 3rd year. Sorry, but I'm not going to get specific about where I went based on my personal preference of anonymity. I will say, I took it upon myself to work incredibly hard to make sure I met people who could help me with residency letters, solid base knowledge, etc. (again, none were supplied by DMU). While DMU had spots reserved where I went, the physician staffing was not done by DMU, nor did they ever do a site visit or know personally any but 1 of the clinicians I worked with.
The process for rotations is dismal at DMU. A class of over 200 people are, for lack of a better description, thrown to the wolves. In our 2nd year we were actually told at one point, "We don't know where our sites are because they keep changing...we won't know where you can go until we get to January [the time of the lottery]." Add to this that 12 people actually did not get any of the rotation spots they had ranked out of 6 rankings each, and I hope that begins to impress upon you all how disorganized and flimsy an organization has to be to not only not know where all of its future doctors are going to learn their craft, but also how they will get there, where they will live, who will teach them, what curriculum will be taught, etc, etc, etc. If you don't know where a student will be, how can you control or monitor what they will be learning?
And to those talking about not being able to find specifics on out of state sites on DMU's website, its because they don't exist for the above reasons.
I was speechless because in my interviews for medical school I specifically asked if rotation exposure would be an issue in terms of out of state availability and curriculum structure. I was reassured I would be taken care of and well prepared compared to my peers, and that I would have the opportunity to leave the state with no hang ups at all. This wasn't the case, of course. I was lucky to get out, not ushered out.
I have worked now with other students from over a dozen medical schools both MD and DO and can tell you, DMU doesn't help you look better than the guy or gal standing next to you. I studied harder than most in school, but you can't learn what you don't know is out there. Fact is, with no standard rotation curriculum (not even a procedure requirement), there is no way to know if you are learning the right things if none of the preceptors are held to a standard. I was lucky because I was held to a standard far above many of the other sites due to being a part of an actual hospital system. I also had didactic sessions on a regular basis. I say this and everyone at other schools laugh. But as a student I can actually graduate from DMU without ever setting foot in an actual hospital, without ever doing any inpatient or ER rotations, and without ever attending a single didactic teaching lecture in my 3rd or 4th year...I don't care who you are or what you want to do with your life, that is concerning.
As an example of the breakdown in communication between administration and the student body, the "bring em back to Iowa" campaign really does exist, and was never mentioned to medical students until at least 2 years after its inception. The amount of out of state quality spots which disappeared virtually overnight from one year to the next was astounding to say the least. Additionally, being called "irrelevant" as a school at the biggest national DO education administration meeting in the country because your reputation has been reduced to ash by politics (yes, the former president is the past and present governor of Iowa...bring em back indeed) and poor leadership is a mar on the school's thin skin which won't be healing anytime soon. Add to that the fact that most of the advisers who are actual practicing physicians have never spent any significant time outside the state of Iowa for practice (and most went to DMU), and you can start to get an idea of how the administration was formed and chooses to practice. Additionally, from friends of mine I have heard that rotations in 3rd AND 4th year in central Iowa are glorified shadowing sessions in which your time, effort, and money is grossly mistreated.
As far as 4th year, all of my statements have been further bolstered due to my exposure to some of the best hospitals in the country for my field. I have spent months of my 4th year with people whose names come before protocols we use on patients on a day to day basis. And likewise, I have spent months at the schools where they teach and practice. I can say that while every school has its flaws, students at many of the MD schools/hospitals I have been spending time in are proving far more pleased with their schooling situations.
Now to some overall reflections concerning residency prospects, etc.
Just to dispel a quick myth because it has become a pet peeve of mine: do not fall in to the trap of believing that because you are at a DO school you treat your patient in a "whole body and respectful" manner that is some space age foreign idea to an MD. Quite frankly, its insulting and ignorant towards all physicians. People who taught my classes had all kinds of case examples of why DO's were better than MD's and that DO's really cared about their patients because one time they worked with an MD who was a jerk. Well, as we know because we are supposed to be trained as scientists too, a case study is the weakest link of proof in the grand pyramid of the scientific method and experimentation. I only mention this because I've seen too many people be insulted by this idea as I've been on the road. Okay, down from soapbox.
As for the future of training in the DO world, there is already a lack of fellowships and residencies alike being further disrupted by increasing class sizes and campuses far outpacing their MD counterparts and residency facilitation. If all the DO's went in to DO residencies, as it seems the DO administrations want us to with how they chatter, there would be enough spots for only a select few. Add to that the notorious lack of case load and unsavory locales, and you have a recipe for disaster. But that won't be the case afterall, as the AOA and ACOGME have even recently been taking 3 steps back regarding the new residency guidelines. This is evident in the newly formed pact for the ACGME to take over umbrella auditing and guideline control of all ACOGME residencies. That means the MD body will now set the guidelines for all residencies in the United States. As such, expect to see more of the DO residencies evaporate after 2015 and the already miniscule pool of residency spots for DO's to dip ever closer to the big goose egg. This has shown people like me who are in the field that a DO residency is unreliable and unpredictable, much like DMU's schooling, and not something I want to gamble with my future on. Hence my entrance to the MD world. And we can talk all day about how MD training is superior for residency if for nothing else having access to major centers, major research programs, major county and state funding, and major pathology variations.
My advice on training: don't limit yourself. You really want to do rural medicine in a single doc practice? Fantastic then that's what you should do. We need more like you anyway in this country. But don't be the guy or gal out there in the sticks who misses the 20 year old with HSP because you never saw it in someone older than 12 and so it just must be something else. You become good at what you do when you see the pathology and hone the instincts with case load and diversity in mentors. I agree with liberal doc that if you can't get in to your state MD school (which the lower tuition alone should be incentive enough), then get a masters and try again later. Apply to a broader MD base. Do some research, or better yet, work an interesting job for a bit. Trust me when I say interesting stuff in your background gets your foot in the door to prove how hard you can work on an away rotation. It is useful beyond what you ever thought possible when you get to the end of the line. Live somewhere unique or take a backpacking trip or get another degree/major. Just do something else and try again the next year. For all I've seen, going to DMU just to go to medical school isn't worth it.
I hope I have been able to shed some light on some concerns for people. These are all things I wish people had told me long ago. Every school is going to tell you not to worry, but the fact is, you really should not be doing anything but learning in your 4 years. Finding places to live and worrying about how much of your loan money is going to be needed for 80 mile commutes in 3rd year is asking too much of a med student. Of course, there are people reading this who won't take no for an answer and just want to be in medical school at 22 years old fresh out of college. But believe me, there is time...lots of time. Plenty of my colleagues are in their mid-30's coming out of medical school and doing great (other medical schools of course). Take the time to do something interesting and impress the places that can give you far more than just a piece of paper with your name on it. Unfortunately, I feel like at DMU you are going to pay 250000 big ones for that piece of paper instead of a memorable experience, and that is no way to spend 4 years of your life.
I realize someone is going to probably hiss and spit back and want to point out all the finer points of my argument and how bitter they sound, but I'm not a bitter person. I, like everyone else, only get one shot at this and mine turned out crappy. I just don't want others to make the same mistake. But believe what you want to, because there are some who just can't be convinced until they are in the hole and on the other side, so for those, good luck.
It is important to understand that DMU is at best in flux right now because of new administration. Maybe it will be great in 5 or 10 years, maybe it will be worse, but I know flux is not where I'd want to start my medical career.