This "you need to be assertive" as a med student thing needs to stop

[MedicineZ0Z]

Certainly a bigger problem with DO schools but many MD ones too. Not going to rant about this but people are paying big loaned money for rotations. It's the schools job to ensure that preceptors are adequately teaching. And guess what? As an attending, it's part of the job description.
If you don't want to follow that then why take an academic job?

I'm not saying med students need to have their hand held. But like cmon... sure some attendings and rotations are pretty good but its the school's job to ensure that standards are equal for EVERY rotation. I'd be all over this as an accrediting body....

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[Rekt]

Welcome to third year

 

[W19]

@MedicineZ0Z

It is somewhat an impossible task for schools to monitor standards of every single rotation... A lot of attendings are doing the school a favor; they get paid NADA. You can argue that some of them lose money by taking students.

You learn a lot during rotation, but one of the goal of rotations in my opinion is for students to have a feel on how 'core' specialties look like so they make an informed decision when they are applying for residency... I must say some rotations are different than others. I learned a lot more in rotations that I worked with residents.

ALL rotations should last a month like it is in 4th year.

 

[Redpancreas]

Certainly a bigger problem with DO schools but many MD ones too. Not going to rant about this but people are paying big loaned money for rotations. It's the schools job to ensure that preceptors are adequately teaching. And guess what? As an attending, it's part of the job description.
If you don't want to follow that then why take an academic job?

I'm not saying med students need to have their hand held. But like cmon... sure some attendings and rotations are pretty good but its the school's job to ensure that standards are equal for EVERY rotation. I'd be all over this as an accrediting body....

Sorry but $$$= obligated teaching is the wrong attitude to have third year. You have two options. You can either be assertive, embrace each field, and learn what you can or you will have a long third year. It's not about what's fair in life, but what the market's willing to tolerate (not what it equilibrates at) . Currently, the price to sit in lectures for two years and then wear a white coat with a medical ID and see patient's for two years so you can then enter the ERAS residency selection process and then become an attending still is tolerated at 30k+/year and until something better (requires less effort but results in same benefits) come about, things won't change. If you want to make peace with it in your head, think of paying 30k for the right to see patient's, not to learn facts/theory which you can do from books or FOAM these days. To loosely quote Osler, practicing medicine without books is like sailing a sea uncharted, but not seeing patients is like not going to sea at all. Medical school tuition is just seafare. I know that sounds borderline Stockholmian but that's what works for me I guess ...

For what you're referring to, it's more of a problem at DO schools because of the limited resident exposure. As for the be-assertive mentality, welcome to 3rd year. You have two options. Hate it and make your life hell, or enjoy it and you may just learn a thing or two like mentioned above. Be assertive. You're not changing anything now so don't waste time going to the dean thinking you're feedback is going to change something. If anything, get good at whatever you're doing now so as an Intern when you have students you'll be able to spend time integrating the boards with the wards with them. The only real way you can change things is to be the change you want to see to throw in another platitude in there

 

[zero0]

Save us LCME!

 

[CherryRedDracul]

you need to be assertive

 

[Redpancreas]

Certainly a bigger problem with DO schools but many MD ones too. Not going to rant about this but people are paying big loaned money for rotations. It's the schools job to ensure that preceptors are adequately teaching. And guess what? As an attending, it's part of the job description.
If you don't want to follow that then why take an academic job?

I'm not saying med students need to have their hand held. But like cmon... sure some attendings and rotations are pretty good but its the school's job to ensure that standards are equal for EVERY rotation. I'd be all over this as an accrediting body....

Academic jobs, unless I'm mistaken, are not taken. Y the most passionate, but the ones who need something in medicine now and settle for it. Many actually go in looking forward to teach, but many do not.

 

[Staphylococcus Aureus]

Difficult for those in power to sympathize because they went through the exact same thing, only problem is they paid $5,000 for 3rd year, not $50,000.

 

[Redpancreas]

Difficult for those in power to sympathize because they went through the exact same thing, only problem is they paid $5,000 for 3rd year, not $50,000.

I hear you but just like complaining about how detail minutiae are tested in 1st/2nd year doesn't help, neither does expecting more teaching help in 3rd year. I think everyone universally agrees that was it happening is wrong but the system is how it is and no one is going to change it because residents are essentially cheap labor hospital workhorses, academic attendings are usually people who chose the job for convenience not passion, so medical students at the bottom have to adapt because the most valuable commodity to the hospitals that save lives are residents/attendings, not us. We have to do our best and just get good at what we're doing so when we have medical students, we can spare some time to make time for them.

In an ideal world, work would start at 7 with receiving an auto populated sheet of all the relevant information, a gourmet breakfast, rounds/ presentations of each patient on a podium in front of the team with an assistant writing your presentation on the whiteboard with a socratic discussion about the differential where discussions from S1Q3T3 to Renal Tubular Acidosis are discussed with a review of pathophysiology and management. After rounds, we have focused didactics and get home at a reasonable time where we can work out, have dinner with a friend, and complete a block of UWorld. The problems that mess this up are that most hospital visits are due to social issues so half the patients are not an academic in nature (sickle cell PCA pump shenanigans or the chest pain consult with a history of GERD, Anxiety, and Fibromyalgia with reproducible chest pain). This makes medicine more routine at times which residents need to manage things efficiently so when new 3rd year students see the patients and think they see a zebra they need to be ignored for a bit for the better of everyone.

As a future resident, one of my biggest fears will be screwing over a student or making them feel unwanted or worried about evals. I will try to give them the most interesting patients that will take them through the high yield shelf differentials and do the busy work on the rest of the patient's but at times I could see residents doing this and then having it blow up in their face with the interesting patient leaving AMA right when I started to get hammer paged and then having to explain to my attending why she was paged about a Benedryll order at 4 pm, getting distracted with something else, and then getting busy while not noticing the student is sitting around with nothing to do for three hours when he could have been at home studying working out or sleeping.

 

[Light at end of tunnel]

I was once told to be more assertive AND less assertive during the same inpatient shift. That's when I started drinking.

 

[MedicineZ0Z]

Sorry but $$$= obligated teaching is the wrong attitude to have third year. You have two options. You can either be assertive, embrace each field, and learn what you can or you will have a long third year. It's not about what's fair in life, but what the market's willing to tolerate (not what it equilibrates at) . Currently, the price to sit in lectures for two years and then wear a white coat with a medical ID and see patient's for two years so you can then enter the ERAS residency selection process and then become an attending still is tolerated at 30k+/year and until something better (requires less effort but results in same benefits) come about, things won't change. If you want to make peace with it in your head, think of paying 30k for the right to see patient's, not to learn facts/theory which you can do from books or FOAM these days. To loosely quote Osler, practicing medicine without books is like sailing a sea uncharted, but not seeing patients is like not going to sea at all. Medical school tuition is just seafare. I know that sounds borderline Stockholmian but that's what works for me I guess ...

For what you're referring to, it's more of a problem at DO schools because of the limited resident exposure. As for the be-assertive mentality, welcome to 3rd year. You have two options. Hate it and make your life hell, or enjoy it and you may just learn a thing or two like mentioned above. Be assertive. You're not changing anything now so don't waste time going to the dean thinking you're feedback is going to change something. If anything, get good at whatever you're doing now so as an Intern when you have students you'll be able to spend time integrating the boards with the wards with them. The only real way you can change things is to be the change you want to see to throw in another platitude in there

The market argument is the only valid and good point that will be made in this thread.

 

[gyngyn]

Faculty are not paid for teaching, they are penalized.
As money gets tighter, they are being required to be more productive at the expense of teaching.
The market economy is driving faculty disengagement...

 

[MedicineZ0Z]

Difficult for those in power to sympathize because they went through the exact same thing, only problem is they paid $5,000 for 3rd year, not $50,000.

This is my point. And when no one says anything and gets told to shut up and follow the pattern - you get 0 change. There at least needs to be more organized structure per rotation.

 

[IslandStyle808]

Difficult for those in power to sympathize because they went through the exact same thing, only problem is they paid $5,000 for 3rd year, not $50,000.

Actually it should be reason why reason why they should sympathize, and motivation to change the system. However, that is probably not on the top of their priority list. Not much we can do as medical schools really.

 

[cellsaver]

Certainly a bigger problem with DO schools but many MD ones too. Not going to rant about this but people are paying big loaned money for rotations. It's the schools job to ensure that preceptors are adequately teaching. And guess what? As an attending, it's part of the job description.
If you don't want to follow that then why take an academic job?

I'm not saying med students need to have their hand held. But like cmon... sure some attendings and rotations are pretty good but its the school's job to ensure that standards are equal for EVERY rotation. I'd be all over this as an accrediting body....

you are misinformed as to the funding sources for your faculty

your tuition doesnt cover what you think it does

"Allopathic medical schools generally derive a very small percentage (10% or less) of their total revenue from tuition." AMSA

Medical School Revenues and Budgeting Principles

You need to be more assertive with yourself about your mood swings. Self regulation is key

 

[Redpancreas]

you are misinformed as to the funding sources for your faculty

your tuition doesnt cover what you think it does

"Allopathic medical schools generally derive a very small percentage (10% or less) of their total revenue from tuition." AMSA

Medical School Revenues and Budgeting Principles

You need to be more assertive with yourself about your mood swings. Self regulation is keyView attachment 222429

What is going on here, Cell ? Besides that, informative post, thank you

 

[IslandStyle808]

you are misinformed as to the funding sources for your faculty

your tuition doesnt cover what you think it does

"Allopathic medical schools generally derive a very small percentage (10% or less) of their total revenue from tuition." AMSA

Medical School Revenues and Budgeting Principles

You need to be more assertive with yourself about your mood swings. Self regulation is keyView attachment 222429

If he is attending a private DO school, then you are wrong.

 

[hello1234!]

Med school is too expensive. I agree with you there.

You are learning to be an independent leader. The goal is try and take charge of your education and learn as much as you can from patients.

 

[MedicineZ0Z]

If he is attending a private DO school, then you are wrong.

View attachment 222432

Bingo

 

[Crayola227]

doesn't take pie charts to put together that the driven madness of Oslerian era training doesn't work for today's for-profit private healthcare market

 

[NYCdude]

Literally sat at a desk for 4 hours today (in total out of a 8 hour shift) but couldn't study because it was so freakin' loud and couldn't go somewhere quieter to study in case the residents went somewhere and I needed to follow along.

Was beyond freakin' miserable. You can only ask "Hey, is there anything I can do for you?" so many times before they wanna smack you in the face and you wanna jump off a roof.

 

[MedicineZ0Z]

Literally sat at a desk for 4 hours today (in total out of a 8 hour shift) but couldn't study because it was so freakin' loud and couldn't go somewhere quieter to study in case the residents went somewhere and I needed to follow along.

Was beyond freakin' miserable. You can only ask "Hey, is there anything I can do for you?" so many times before they wanna smack you in the face and you wanna jump off a roof.

But..but... you have to be assertive!

 

[Redpancreas]

But..but... you have to be assertive!

Man everything we're saying is to help you, not trying to prop up the ass of a system we're currently going through. Always listen even when the residents are talking among themselves. It's hard now on your first rotation, but you'll get an idea of each patient and will be aware of how you can help. That attention to detail will come with more rotation time too.

As for down time, do UWorld on your phone. Reading is pointless because as you said it's too loud and you may get through a page. At least with Uworld 10qs now makes it 10qs you dont have to do when you get home and can read more then. Try talking through the explanation with your classmates and you'll retain the info better. As for residents, if you're worried about their attitude if you're on your phone talking thru UWorld questions helps them see otherwise as does using a tablet instead of a phone. Also, when they pimp you on UWorld/board stuff, try to get it right and give a solid answer. I did this the first few times on a few rotations and now when they see me on my phone they'll assume I'm doing UWorld or something.

I know how frustrating it can be especially on L&D where you're there for 12 hours and do nothing. I think on OB/GYN (first rotation) during my two months I never owned a single patient yet I had to be there 12 hrs. sitting at the nurses station listening to nurse and resident gossip. I was starting off cycle too so all my peers had come off surgery which I'm finishing now. Doing surgery now, I realize how much experience through rotations makes a big difference in how much you can do. Like they made us come an hour early (already early bc its surgery) and they oriented us to the EMR, fishbone lab symbols, presentations, etc. Had I come off that, I would have been more useful in OB. In OB, when the resident asked me about the patient and I didn't know, they told me it was all in the chart so I would check their physical paper chart for the first few days thinking to myself what the hell I was going to do with their allergy info and MRN#. I didn't unlock the full potential of the EMR until the next rotation where a Neuro resident sat down with me and told me how to get numbers/look up stuff/etc. I kinda knew most of it at that point but attention from a resident who seemed to care about my success was such a breath of fresh air.

 

[cellsaver]

What is going on here, Cell ? Besides that, informative post, thank you

The half life of my meds is 8 hours so when Im outside the area under the curve, I get a little edgy

The only real way you can change things is to be the change you want to see to throw in another platitude in there

This was some good sheet. Mahatma Ghandi? Dalai Lama? Bob Marley?

You are maturing Backto. Rock on!

un beso

 

[Redpancreas]

The half life of my meds is 8 hours so when Im outside the area under the curve, I get a little edgy



This was some good sheet. Mahatma Ghandi? Dalai Lama? Bob Marley?

You are maturing Backto. Rock on!

un beso

Gandhi and Osler! You didn't have to admit that, sometimes you've got some good feedback so thanks for your contributions. I wouldn't call it maturing, just learning. Gracias, lo mismo para ti!

 

[Goro]

you are misinformed as to the funding sources for your faculty

your tuition doesnt cover what you think it does

"Allopathic medical schools generally derive a very small percentage (10% or less) of their total revenue from tuition." AMSA

Medical School Revenues and Budgeting Principles

You need to be more assertive with yourself about your mood swings. Self regulation is keyView attachment 222429

If he is attending a private DO school, then you are wrong.

View attachment 222432

Very sobering and illuminating charts. For MD schools, note grants and Contracts slide of the pie compared to tuition. Any single decent research dep't can make more in the indirects from RO1 grants than they can from the tuition of an entire class of med students.

For the DO schools, I had an enlightening lunch with our University's CFO last week. Some 90% of our revenue (read: tuition) goes to salaries and supplies. Our parent university takes the vast majority of the remainder. They've told us outright "We're only paying $XXXX for each student on rotation." My school is in a lucky situation compared to a lot of other COMs in that our rotations are more ward based and less preceptor-based. And we're adding in new residency based sites soon (hopefully).

And on top of this, medical schools raid each other's rotation sites!

Even worse, bad students can literally lose rotation sites for us.

To to DO students here, I hope that you will join AOA, rise in its power structure, and throttle the current mindset of "more DOs good!" and get COCA to enact some LCME-like stringency for clinical education.

 

[cellsaver]

For the DO schools, I had an enlightening lunch with our University's CFO last week.

Goro is going towards the Dark Side.

I did not mention it earlier thinking it would not apply to some on these boards. However given that DOs are weighing down the coversation (KIDDING!) if you attend a state university, you can learn the salary of faculty, as provided by state funding, by researching their name. Local printed news organizations often run stories on where state monies are going to inform their readers. It is public information. You might be surprised just how little these poor faculty make. Believe it or not many of them are here to teach you, OP. Their motivation is not revenue based.

Either way, just get through it. Its not like youre battling aliens from outer space or levitating spaceships. Wait till you are an Attending and have to fight on the phone with a high school graduate working at a call center for a third party payer, making the case for the payer covering a rejected treatment modality that they claim is not necessary. Now those are blood curling. I have seen a few very senior Physician Specialists curse up a storm and have a complete meltdown because a dying patient needed said treatment and the call center worker wouldnt budge

ugly

 

[IsWhat]

Certainly a bigger problem with DO schools but many MD ones too. Not going to rant about this but people are paying big loaned money for rotations. It's the schools job to ensure that preceptors are adequately teaching. And guess what? As an attending, it's part of the job description.
If you don't want to follow that then why take an academic job?

I'm not saying med students need to have their hand held. But like cmon... sure some attendings and rotations are pretty good but its the school's job to ensure that standards are equal for EVERY rotation. I'd be all over this as an accrediting body....

Standards are never equal - even within the same rotation. Every single program in the country has this problem. It isn't practical to monitor clinic education at a micro level. The LCME is admittedly better than COCA at monitoring the macro level though.

 

[12glaucoma34]

Certainly a bigger problem with DO schools but many MD ones too. Not going to rant about this but people are paying big loaned money for rotations. It's the schools job to ensure that preceptors are adequately teaching. And guess what? As an attending, it's part of the job description.
If you don't want to follow that then why take an academic job?

I'm not saying med students need to have their hand held. But like cmon... sure some attendings and rotations are pretty good but its the school's job to ensure that standards are equal for EVERY rotation. I'd be all over this as an accrediting body....

I couldn't agree more. This is what the vice assistant associate assistant dean of clinical affairs told me when I discussed the quality of some of my rotations with him. Tuition is over $50,000 per year for third and fourth years and his suggestions was to ensure I make sure the preceptor knows the objectives for the rotation and be assertive to ensure I get a good experience. Simple translation: we'll take your money and you are responsible for your education. Doesn't seem right to me. I agree there are aspects of medicine where being assertive is important, but just to get a basic medical school rotation experience should not require a student to be assertive. I've had rotations where if I didn't speak up I could have had a pure shadowing rotation for a core third year rotation. To make things worse, until a few years ago, many sites at my school didn't provide inpatient internal medicine rotations during third year meaning that it would be possible to graduate medical school without ever having done an inpatient internal medicine rotation. The more outrageous part, schools take these large chunks of money from us and the preceptors get paid NOTHING. Not a damn penny, I'd like an explanation of how that is ethical or why it is tolerated.

 

[12glaucoma34]

Very sobering and illuminating charts. For MD schools, note grants and Contracts slide of the pie compared to tuition. Any single decent research dep't can make more in the indirects from RO1 grants than they can from the tuition of an entire class of med students.

For the DO schools, I had an enlightening lunch with our University's CFO last week. Some 90% of our revenue (read: tuition) goes to salaries and supplies. Our parent university takes the vast majority of the remainder. They've told us outright "We're only paying $XXXX for each student on rotation." My school is in a lucky situation compared to a lot of other COMs in that our rotations are more ward based and less preceptor-based. And we're adding in new residency based sites soon (hopefully).

And on top of this, medical schools raid each other's rotation sites!

Even worse, bad students can literally lose rotation sites for us.

To to DO students here, I hope that you will join AOA, rise in its power structure, and throttle the current mindset of "more DOs good!" and get COCA to enact some LCME-like stringency for clinical education.

I refuse to believe that DOs schools aren't getting enough money to provide quality clinical rotations for their students. Many DO schools have over 150-200 students and charge over 50,000 per year plus other fees. Do the math and think about it logically. Don't tell me that isn't enough. Get rid of all the extra unnecessary faculty and employees that medical schools use. We don't need 15 deans and 15 administrators and 15 administrative assistants and 15 secretaries and 30 office assistants.

 

[Postictal Raiden]

Faculty are not paid for teaching, they are penalized.
As money gets tighter, they are being required to be more productive at the expense of teaching.
The market economy is driving faculty disengagement...

Very true statement.

I'm currently rotating in radiology, and I know that by allowing me to read and dictate in my own, and then having to go over everything I did/didn't in detail, my preceptor is losing a crapload of RVUs.

 

[12glaucoma34]

Very true statement.

I'm currently rotating in radiology, and I know that by allowing me to read and dictate in my own, and then having to go over everything I did/didn't in detail, my preceptor is losing a crapload of RVUs.

Yes, while your school pays a bunch of administrators with fancy titles who effectively do little or nothing to contribute to your education in a meaningful way.

 

[CherryRedDracul]

Literally sat at a desk for 4 hours today (in total out of a 8 hour shift) but couldn't study because it was so freakin' loud and couldn't go somewhere quieter to study in case the residents went somewhere and I needed to follow along.

Was beyond freakin' miserable. You can only ask "Hey, is there anything I can do for you?" so many times before they wanna smack you in the face and you wanna jump off a roof.

If I were your resident, I would have told you to give me your number and I'll text you if there's anything going on. Otherwise, I'm all for med students getting some quiet study time when nothing else is happening.

 

[W19]

I agree there are aspects of medicine where being assertive is important, but just to get a basic medical school rotation experience should not require a student to be assertive. I've had rotations where if I didn't speak up I could have had a pure shadowing rotation for a core third year rotation. To make things worse, until a few years ago, many sites at my school didn't provide inpatient internal medicine rotations during third year meaning that it would be possible to graduate medical school without ever having done an inpatient internal medicine rotation. The more outrageous part, schools take these large chunks of money from us and the preceptors get paid NOTHING. Not a damn penny, I'd like an explanation of how that is ethical or why it is tolerated.

How is that even possible? Isn't a COCA requirement to have at least 4 wks inpatient IM? You can't even get licensed in some states if you don't meat this requirement...

 

[12glaucoma34]

How is that even possible? Isn't a COCA requirement to have at least 4 wks inpatient IM? You can't even get licensed in some states if you don't meat this requirement...

Unless I was told incorrectly (which I wasn't), I know students who did not complete inpatient internal medicine or family medicine rotations during third year. They could have got away with no inpatient medicine, but did complete some away rotations during 4th year to get the experience. It probably is a COCA requirement (I hope so), but schools can fudge things. It isn't like COCA goes over the details of every student's education, as long as COCA gets their accreditation money from osteopathic schools, all is well.

 

[W19]

@12glaucoma34 I understand that some schools don't have a FM rotation... But I have never heard of any school that does not have an inpatient IM rotation... I guess schools can fudge things.

 

[12glaucoma34]

@12glaucoma34 I understand that some schools don't have a FM rotation... But I have never heard of any school that does not have an inpatient IM rotation... I guess schools can fudge things.

That is crazy not to have a FM rotation.

I think medical school is like many things in life, you can get away with a lot. If a school has 200 students and 28 of them are at sites without inpatient IM rotations, chances of anyone detecting that are low. Just like filing your federal tax return, you can fudge things a little and most likely get away with it, especially if you're low income since the rate of audit is very very low.

 

[zero0]

To to DO students here, I hope that you will join AOA, rise in its power structure, and throttle the current mindset of "more DOs good!" and get COCA to enact some LCME-like stringency for clinical education.

 

[NYCdude]

If I were your resident, I would have told you to give me your number and I'll text you if there's anything going on. Otherwise, I'm all for med students getting some quiet study time when nothing else is happening.

Some residents are freakin' clueless even though they're literally just a few years out from being in the same position as me.

When I'm a resident I'm gonna give everyone full marks and not shaft anyone for no reason, and also just let them go home if they're literally just sitting around and I don't have the time to teach them anything.

 

[jqueb29]

Literally sat at a desk for 4 hours today (in total out of a 8 hour shift) but couldn't study because it was so freakin' loud and couldn't go somewhere quieter to study in case the residents went somewhere and I needed to follow along.

Was beyond freakin' miserable. You can only ask "Hey, is there anything I can do for you?" so many times before they wanna smack you in the face and you wanna jump off a roof.

Lol welcome to 3rd year. The scenario you described happened countless times to me, as did the scenario where you ask them "hey is there anything i can do for you?" enough times to where there's no point in asking it anymore that day, so you just sit there for another 2-3 hours before they claim "oh you can go home, i totally forgot you were still here, you could have left like 3 hours ago, sorry!" Ummmmm no gtfo with the whole nonsense that you forgot I was here; I'm sitting 5 feet behind you making the ambient noises and movements of a general living human, and occasionally performing 2 small coughs every 20-30 minutes to remind you I'm here. Not only all that, but to even pretend as a resident who was obviously an MS3 once as well that you could somehow forget the daily struggle of the MS3 who clearly has no need to stay any longer that day but also obviously can't ask to leave is just ridiculous. Nobody could ever forget that.

 

[KnuxNole]

You do need to be assertive though....

 

[IslandStyle808]

Lol welcome to 3rd year. The scenario you described happened countless times to me, as did the scenario where you ask them "hey is there anything i can do for you?" enough times to where there's no point in asking it anymore that day, so you just sit there for another 2-3 hours before they claim "oh you can go home, i totally forgot you were still here, you could have left like 3 hours ago, sorry!" Ummmmm no gtfo with the whole nonsense that you forgot I was here; I'm sitting 5 feet behind you making the ambient noises and movements of a general living human, and occasionally performing 2 small coughs every 20-30 minutes to remind you I'm here. Not only all that, but to even pretend as a resident who was obviously an MS3 once as well that you could somehow forget the daily struggle of the MS3 who clearly has no need to stay any longer that day but also obviously can't ask to leave is just ridiculous. Nobody could ever forget that.

Its like what my mom said to me about my LOR writers for medical school "its not that they forgot you, its that your just at the low end of their priority list."

 

[gophergrl88]

What make me nervous is the frequency our school "loses" rotation sites plus the limited sites with residents, and then the mix of having PA and NP students also being thrown on that same service.


Sent from my iPad using SDN mobile

 

[MedicineZ0Z]

What make me nervous is the frequency our school "loses" rotation sites plus the limited sites with residents, and then the mix of having PA and NP students also being thrown on that same service.


Sent from my iPad using SDN mobile

Im curious, what impact do NPs/PAs have on a service? Genuinely curious as I don't know.

My issue overall is that people think its justified to pay 50k and the school provides a mediocre clinical education in return. From a business perspective it makes sense to cut ALL unnecessary staff and anything else unnecessary and instead pay preceptors a small salary to provide a guideline based education. Forget keeping med students on call for endless hours. Just have them see and do the fundamentals on that rotation. An accrediting body can easily enforce something like this across the board. So why doesn't it happen?

 

[gophergrl88]

Im curious, what impact do NPs/PAs have on a service? Genuinely curious as I don't know.

My issue overall is that people think its justified to pay 50k and the school provides a mediocre clinical education in return. From a business perspective it makes sense to cut ALL unnecessary staff and anything else unnecessary and instead pay preceptors a small salary to provide a guideline based education. Forget keeping med students on call for endless hours. Just have them see and do the fundamentals on that rotation. An accrediting body can easily enforce something like this across the board. So why doesn't it happen?

Because they share your physician preceptor and their patients/procedures



Sent from my iPad using SDN mobile

 

[12glaucoma34]

What make me nervous is the frequency our school "loses" rotation sites plus the limited sites with residents, and then the mix of having PA and NP students also being thrown on that same service.


Sent from my iPad using SDN mobile

My school lost a few sites during my preclinical years. It only takes one student to screw up and the site decides they don't want students anymore. Without being to specific, one incidence involved sexual contact between residents and medical students.

If DO schools would actually use our tuition money to invest in good rotation sites and pay the hospital for the hassle, this likely wouldn't be as big of an issue. Instead, there are more important things to do with our tuition like bonuses, pay raises, and hiring more staff to make their jobs even easier.

 

[Stagg737]

Unless I was told incorrectly (which I wasn't), I know students who did not complete inpatient internal medicine or family medicine rotations during third year. They could have got away with no inpatient medicine, but did complete some away rotations during 4th year to get the experience. It probably is a COCA requirement (I hope so), but schools can fudge things. It isn't like COCA goes over the details of every student's education, as long as COCA gets their accreditation money from osteopathic schools, all is well.

Idk if that is a COCA requirement or not. I know many people in my class who had at least one of their IM rotations in an outpatient setting (Idk if their other one was inpatient, but it wouldn't surprise me). I know one of mine was outpatient and the other was inpatient/outpatient (doc did inpatient in the morning, then outpatient clinic in the afternoon) at a pretty tiny hospital (25 beds). It didn't bother me all that much, because I despise inpatient surg/IM rounding and would be fine with never setting foot on the med/surg floor again in my life, but I understand why this would be a pretty major issue for most students.

That is crazy not to have a FM rotation.

I think medical school is like many things in life, you can get away with a lot. If a school has 200 students and 28 of them are at sites without inpatient IM rotations, chances of anyone detecting that are low. Just like filing your federal tax return, you can fudge things a little and most likely get away with it, especially if you're low income since the rate of audit is very very low.

I think what @W19 meant was that they don't have an inpatient FM rotation, not that they don't have an FM rotation at all. My FM rotation was exclusively outpatient and I felt like I learned a lot more because of the doc I was working with (really smart with 30+ years experience who made me give him a presentation on something every day) than if I'd rotated with a bunch FM residents on inpatient (I worked with the interns on a rotation last spring and they were as clueless as I was). Maybe that's just an abnormal experience, but I was happy with most of my rotations (other than 1).

 

[12glaucoma34]

Idk if that is a COCA requirement or not. I know many people in my class who had at least one of their IM rotations in an outpatient setting (Idk if their other one was inpatient, but it wouldn't surprise me). I know one of mine was outpatient and the other was inpatient/outpatient (doc did inpatient in the morning, then outpatient clinic in the afternoon) at a pretty tiny hospital (25 beds). It didn't bother me all that much, because I despise inpatient surg/IM rounding and would be fine with never setting foot on the med/surg floor again in my life, but I understand why this would be a pretty major issue for most students.



I think what @W19 meant was that they don't have an inpatient FM rotation, not that they don't have an FM rotation at all. My FM rotation was exclusively outpatient and I felt like I learned a lot more because of the doc I was working with (really smart with 30+ years experience who made me give him a presentation on something every day) than if I'd rotated with a bunch FM residents on inpatient (I worked with the interns on a rotation last spring and they were as clueless as I was). Maybe that's just an abnormal experience, but I was happy with most of my rotations (other than 1).

I didn't care for inpatient IM either, but I'm still thankful I had the experience because I learned a lot. I wouldn't want my first inpatient rotation to be during residency. I find the pace of preceptor based rotations in IM or FM to be too fast for any teaching to occur, seeing 30+ patients doesn't allow much time.

 

[12glaucoma34]

To to DO students here, I hope that you will join AOA, rise in its power structure, and throttle the current mindset of "more DOs good!" and get COCA to enact some LCME-like stringency for clinical education.

I couldn't agree more about DO students rising to the upper levels of influencing a variety of things in regards to osteopathic medicine. I get confused every time someone does a "whoot whoot new school" thread, why exactly is this a good thing? If schools keep opening up at this pace, the market will become saturated. If these would provide a good medical education and solid rotations, then maybe. I feel the reasoning for allowing this to occur is medical schools pay COCA a sum of money each year for accreditation. More schools = more money; nothing else matters.

The same could be said for the NBOME and NBME in regards to Level 2 PE and Step 2 CS, respectively. Well over ninety percent of doctors believe this exam is nothing more than a easy money grab, but yet it prevails. I have yet to ask a physician who believes these exams are necessary for US medical student.

I believe the reason these changes are basically impossible is due to these institutions not promoting anyone to a level of authority who disagrees with the status quo. IMO, even Level 3/Step 3 should go as well. Instead we are going the other direction, now these worthless exams are two day exams. It does nothing to ensure competent physicians. If you can get through 3-5 or more years of GME, then you have earned the right to be a fully licensed physician regardless of what some completely irrelevant tests says.

The NBOME would never allow someone who doesn't agree with the necessity of Level 2 PE to become a director. What must one do to get there? My guess is mislead about your real stance until you have secured a position.

Lets not forget, NPs and PAs don't have to go through all this. NPs take an online two year course and one test. No GME. No four years of medical school after four years of undergrad.

 

[IlDestriero]

Academic jobs, unless I'm mistaken, are not taken. Y the most passionate, but the ones who need something in medicine now and settle for it. Many actually go in looking forward to teach, but many do not.

What?
People go into academia because they have an interest in at least 2 of the 3 pillars of academic medicine. Clinical work, education and research.


--
Il Destriero