sunsweet said:
How do you guys feel about the clinical experience @ Cornell? I've heard from many people that since its in a "rich" area, you don't really get that much clinical experiences. Then again, at Cornell they told us that there are both private and medicaid patients at NY Presbyterian so you do get experience with both...
interesting question. seems to come up quite often. *wink*
the question translates perhaps to:
do cornellians get strong "clinical experiences"
meaning = are cornell med students trained to be excellent clinicians by their medical school?
more specifically:
1) do they see different types of pathology? in different types of locales?
2) do they learn how to adequately take H&P's (history and physicals)?
3) can they adequately formulate an A&P (assessment and plan)?
4) are they given enough responsibility?
5) are they given enough independence?
6) do they get to do their share of procedures?
7) do they continue to perform well after graduating as they are assessed by residency directors (do they give cornell a good name, enabling future grads to get top positions based on their "forebearers" performance?)
as a current med student here whilst finishing up my 3rd year(& being very relieved to be done with peds / ob-gyn / medicine / surgery / doing elective right now)
i guess, here's my take on things
1) do people see different types of pathology?
= New York Presbyterian is just like any top-rated tertiary care hospital = you will have a chance to see in the flesh all the common major diseases and complications thereof (MI's, end-stage renal failure, heart failure, sepsis, all stages of diabetes, PE's, infectious dz, all types of cancers: heme / GI / neuro / pulmonary neoplasms) as well as your share of zebras (can you believe seeing Neurofibromatosis I AND... II ??, or a pt with a NEMO mutation or a pt with post-cardiotomy syndrome??).
in different types of locales?
interestingly, the ONLY required parts of rotations you MUST do at New York Hospital= 2 months of internal medicine (the 3rd month is done at an away site), and 1 month of surgical subspecialties (other 2 months either at NYH or away)
the other hospitals one has to chose from are:
a) Lincoln hosptial = inner city hospital in south bronx; busiest Emergency Medicine service in New York City ~180,000 visits / year. predominantly poor - working class / varied Latino and African American population. very good ER and psych rotations as well as trauma / bread and butter surgery experience there as well. sadly OB part is disorganized.
b) NYH Queens = community hospital in Flushing, Queens = predominantly
Chinese / Russian / Working class Italian / Irish / Mix. Long hours for surgery but fair amount of trauma and bread and butter cases. Also has neurosurg and cardiac cases in a community setting. strong surgical ICU experience if that is your cuppa tea.
c) St. Barnabas: Urban community hospital. Very strong peds rotation here: lots of bread an butter community health issues.
d) Methodist Hospital: In Park Slope Brooklyn: serves Red Hook as well. Middle class / working class / poor pts. Community hospital.
e) Westchester NYH: Dedicated Psych hospital in Westchester County ~ suburban small city USA population. Great teaching.
f) Memorial Sloan Kettering: top-notch cancer center across the street from Cornell (for Neurology / Intensive Care / all sorts of Electives). the best of the best, and excellent teaching to boot.
because of the teaching at the main hospital, New York Hospital (the NY in NYPH when NYH-cornell merged with Columbia-Presbyterian: med schools totally separate / hospital administration and financials of hospitals linked)
... i chose to do peds, medicine, psych at NYH, surgery and ob-gyn at a combo of NYH, queens, and lincoln. for neuro i'll be at memorial sloan kettering.
2) do they learn how to adequately take H&P's (history and physicals)?
-- as in any med school, you will do so many that won't want any more~!
3) can they formulate a well thought-out totally complete A&P (assessment and plan)?
-- this comes with practice, and i must admit i'm still really working hard to master this!! (any one who tells you they've mastered it at the end of any med school is foolin'!) ! actually this is one of the toughest things in med school to do especially in 3rd year as you are constantly being bombarded with different disciplines / diseases / medical and surgical services. however, that being said, i do feel confident that after 9 months of different rotations i have a strong foundation / framework on which to work up patients and am ready to face my forth year sub-I... (see next)
4) are they given enough responsibility?
& 5) are they given enough independence?
-- med school is like the college i went to, in a way. you have to take INITIATIVE or you won't learn squat. if you take the initiative and show your patients and your team that you are there for them, they will give you more responsibility, trust in what you say (scary at first!), and value you for your real contribution.
-- that being said, another one of the major strong points at cornell is the Medicine Sub-internship at New York Hospital during 4th year. basically for a month you function as an intern with another partner paired with you (hence sub-intern): You are your patient's doctor: and means you do pretty much everything for your patients (with senior residents / fellows there for back-up if you need it). that means: you are on-call q4 / there's very little filtering of cases when they get to you / you attend to any issues they have / you present to the attending directly and anything that does or doesn't get done is your responsibility. at other hospitals, often times folks get 2 or 3 pts. it is the rare hospital (as with most of the people i know who've done it in past years) that has each sub-intern handle 5 , 6 on a regular basis. but that is exactly what you get at New York Hospital (NYPH) -- an Intense but truly a worthy experience.
6) do they get to do procedures?
-- doing "x" amount of blood draws becomes only educational to a point.
That being said, my personal experience has been to achieve a certain level of competancy in doing blood draws / draw cultures/ put in IV's / properly sampling from PICC lines / doing ABGs / put in foleys / put in NG tubes / put in OG tubes/ "close" on surgical pts / take out chest tubes.
currently doing an anesthesia rotation, on a daily basis I am intubating (successfully!) / putting in A-lines / putting in central lines / floating the swan-ganz catherter up the pulmonary artery.
it's really up to you how much you want to do and how aggressive you are at finding opportunities. at any med school, if you want to float by, you can. you can dictate your education anyway you chose.
but always remember the difference between you and a good technician (basically any procedure is just repetition) is really the CLINICAL JUDGEMENT and KNOWLEDGE base that you learn while on the wards.
you can draw the ABG, but can you analyze it and work it up for anion-gap acidosis or perhaps a concomittant non-anion gap acidosis? can you figure out if respiratory compensation is adequate?
will you take the time to follow-up and actually view the blood-smear or get that CT-scan read, stat? what about finding out why it's prefereable to measure and calculate for the fraction excretion of urea instead of FeNa when your patient is on Lasix?
it's up to you.
7) do cornellians continue to perform well in residency.... i.e. after graduating are residency directors satisfied by the performance of cornell grads?
-- Yes.
anyway,
the point is,
if you are present and willing, you should get a quality and diverse clinical experience at most any med school one can attend, cornell being one of many.
The medicine sub-I at the main hospital is exceptional.
hope this helps...