Will there ever be too many medical schools in the US?

[jakeislove]

It is our problem. I don't see how it is yours or why other people here are going crazy attacking DO schools. In the end, we already have regulations to limit schools by requiring a certain number of matches to stay accredited. All these "crap" schools are still better than the unknown FMG or the average IMG and none have damaged the overall percentage of residency matches for us. Again, these are our problems. I don't see why so many MD here feel the need to bash and criticize over something that they already believe doesn't affect them. I certainly don't care if the Caribbean opens 20 new schools.

Among patients who prefer an MD, Caribbean probably has more value. They're still completing an ACGME accredited residency.

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[AnonymousD.O.]

100% agree. Everything you just elaborated on is pure BS. The studies backing cranial and CSF flow and all that would not make it in any major medical journal. Zero argument. Complete garbage

However, that stuff isn't even a component in many DO schools - it's maybe 2hrs out of 4 years in medical school absolute max. We've all spent more time on sdn in the last 48 hours than DOs spend "learning" cranial. I've heard deans of DO schools completely renounce those practices. Those are good doctors. It's something that need to be distanced from.

You can't equate quack DOs with the entire profession just like people don't equate MDs with taking acacia berries and saw palmetto as a tx for prostate cancer because some fringe doctors say so.

It's awesome medical students and physicians, MD and DO, are calling out things that don't past muster for an educated 6th grader (that's being generous). Keep doing it. I agree it's better for medicine as a whole. I just urge you to reconsider the amount of time DOs spend learning treatments that isn't basic PT or PM&R. It's incredibly small and met with skepticism and honestly laughter. If the techniques didn't sound like a psychotic wizard named them, that would probably go along way. It should be marketed this way. Your physician partners, the overwhelmingly vast majority, are not ignorant. Just like your classmates are not. This is why every DO student organization supported the residency merger.

Agreed. I'm 3 weeks into 2nd year and cranial hasn't even been mentioned to us. Well actually one doc mentioned it on a slide about Sinus infection and then followed up by saying that she didn't ever use cranial. Cranial isn't really taught anymore, but people love to cherry pick it as a reason why they think Osteopathic Medicine is a joke.

Although I can certainly understand why somebody is upset / disagrees with treatments such as Cranial being billed for, when they are pretty ridiculous. The issue I guess lies in where the line is drawn between what works and what doesn't, when scientifically it hasn't been shown.

 

[DermViser]

Agreed. I'm 3 weeks into 2nd year and cranial hasn't even been mentioned to us. Well actually one doc mentioned it on a slide about Sinus infection and then followed up by saying that she didn't ever use cranial. Cranial isn't really taught anymore, but people love to cherry pick it as a reason why they think Osteopathic Medicine is a joke.

No, just the OMT part and the quality of MS-3 clerkship rotations, on average.

 

[touchpause13]

Among patients who prefer an MD, Caribbean probably has more value. They're still completing an ACGME accredited residency.

Most DOs complete an ACGME residency. And by 2020 all DOs will

 

[GoSpursGo]

I still think you're cherry-picking the handful of things that make the degrees different, despite numerous people backing up that the majority of DOs don't use OMT in their practice. I don't really know what you're basing your claim that the MS-3 clerkships are subpar on, but as the poster above me said the majority of DO grads do an ACGME residency, which is where we learn what is actually important for our ultimate careers.

There are bad DOs, and there are bad MDs too. As I've said before, I've met a number of excellent DOs as well. The quality of the schools may in fact differ, but that's far from the only the only thing that goes into how good a doctor turns out to be.

 

[Mad Jack]

I've experienced the same think with RFUMS. Every other Chicago school student I've met just says "I go to Northwestern" or "I go to Loyola".

The carib studs definitely do this with NY

That's interesting. I've never met a layman who even knows medical schools that aren't Yale, Harvard, Columbia, or Hopkins, plus whatever schools are in their state. To the upper-middle class, there might very well be splitting of hairs between the different medical schools, but less than a third of Americans even have a Bachelors degree, let alone know the names of the various medical schools and their relative quality.

If you're trying to hook wealthy clients and are in private practice, name may matter, but for the average hospital employed physician (where most of us are headed post-graduation in this current environment, let's be cereal) name won't matter much.

 

[Mad Jack]

Craniosacral therapy, chelation therapy, OMT, take your pick. There's tons. Like anyone that says that CSF has an independent rhythm that a physician can change by touching the patient in certain ways, I'm going to think they're nuts. There's literally nothing in the science world that validates that theory. I don't understand how these procedures even get created. Like there is no basis in biology for them, so does someone just get high and say " hey I feel like CSF probably has it's own innate rhythm that I can control." I seriously don't get it. How is it possible to just pull treatments out of your *ss with no scientific basis? beats me.

You're really going out of your way to bash on practices that 49 out of 50 DOs don't even use. Even the DOs that use OMT generally don't use cranial, and chelation therapy isn't something that is taught in DO school at all.

 

[Mad Jack]

Oh, and let's not forget that there's plenty of MD schools that are offering courses in CAM nowadays as well. It's not like it's an exclusively DO thing.

https://www.aamc.org/newsroom/reporter/feb2012/273812/therapies.html

 

[SouthernSurgeon]

That's interesting. I've never met a layman who even knows medical schools that aren't Yale, Harvard, Columbia, or Hopkins, plus whatever schools are in their state.

But they are doing this in conversations with other medical professionals, not lay people

 

[DermViser]

Oh, and let's not forget that there's plenty of MD schools that are offering courses in CAM nowadays as well. It's not like it's an exclusively DO thing.

https://www.aamc.org/newsroom/reporter/feb2012/273812/therapies.html

Bc there is money to be made from it. No wonder academic medical centers are hopping at the opportunity.

 

[Mad Jack]

But they are doing this in conversations with other medical professionals, not lay people

Oh, I was discussing it more in regard to how people tell patients or laypeople where they went to school. With other medical professionals I guess it's different, but what other people think of your school when you're making small talk just seems so inconsequential to me. My least favorite question in the world so far is "where did you go to undergrad," but I know once residency hits it'll be, "where did you go to medical school," because I find it to be a boring non-starter of conversation unless the answer happens to either be ultra prestigious or it was someplace that the person you are talking to knows intimately due to either attending the school or knowing someone that went there.

 

[SouthernSurgeon]

I don't really know what you're basing your claim that the MS-3 clerkships are subpar on, but as the poster above me said the majority of DO grads do an ACGME residency, which is where we learn what is actually important for our ultimate careers.

I've heard a number of times people (often DO students themselves) on this board raise concerns about the quality of clinicals, especially at some of the newer schools. I know nothing about their rotations since I've never worked directly with them so I don't usually comment on it, but it's not like the claim is out of left field.

And I think it's a bit ridiculous to say that since they do a residency they learn everything they need. If that were the case we should all just take step one then get on with our intern years. Dismissing the importance of the clinical years is absurd. IMHO M3 year is the most important year of medical school, for better or worse.

 

[Mad Jack]

I've heard a number of times people (often DO students themselves) on this board raise concerns about the quality of clinicals, especially at some of the newer schools. I know nothing about their rotations since I've never worked directly with them so I don't usually comment on it, but it's not like the claim is out of left field.

And I think it's a bit ridiculous to say that since they do a residency they learn everything they need. If that were the case we should all just take step one then get on with our intern years. Dismissing the importance of the clinical years is absurd. IMHO M3 year is the most important year of medical school, for better or worse.

If MS3 and MS4 are so critical, why are interns so useless? You learn just enough to have a baseline level of functionality for when you start your internship, and not much more. It's not that it's useless- you wouldn't be able to function at all in the hospital if you were thrown in post-MS2, but if the interns I've worked with in the past are any indication, you aren't exactly prepared to be a physician at that point by any means due to a lack of focused rotations in a specific area.

Also keep in mind that some of the newer DO schools don't have the greatest of rotations, but that doesn't mean all DO schools have subpar rotations.

I personally believe there should be more standardization on the DO side of things clinical-wise. Part of the reason I hope the LCME eventually swallows the COCA.

 

[SouthernSurgeon]

If MS3 and MS4 are so critical, why are interns so useless? You learn just enough to have a baseline level of functionality for when you start your internship, and not much more. It's not that it's useless- you wouldn't be able to function at all in the hospital if you were thrown in post-MS2, but if the interns I've worked with in the past are any indication, you aren't exactly prepared to be a physician at that point by any means due to a lack of focused rotations in a specific area.

Also keep in mind that some of the newer DO schools don't have the greatest of rotations, but that doesn't mean all DO schools have subpar rotations.

I personally believe there should be more standardization on the DO side of things clinical-wise. Part of the reason I hope the LCME eventually swallows the COCA.

This is why I said it's the most important year of medical school, for better or worse.

Third year is a transformative year. A lot of students aren't aware enough to understand that.

 

[DermViser]

If MS3 and MS4 are so critical, why are interns so useless? You learn just enough to have a baseline level of functionality for when you start your internship, and not much more. It's not that it's useless- you wouldn't be able to function at all in the hospital if you were thrown in post-MS2, but if the interns I've worked with in the past are any indication, you aren't exactly prepared to be a physician at that point by any means due to a lack of focused rotations in a specific area.

Also keep in mind that some of the newer DO schools don't have the greatest of rotations, but that doesn't mean all DO schools have subpar rotations.

I personally believe there should be more standardization on the DO side of things clinical-wise. Part of the reason I hope the LCME eventually swallows the COCA.

This varies by school.
Your average med student coming from WashU who did his clerkships at Barnes-Jewish and St. Louis Children's is a little different than a student from a D.O. school rotating in community (non-teaching) hospitals. The LCME would never take over COCA. I guarantee you many of those schools wouldn't have been opened in the first place.

 

[Mad Jack]

This varies by school.
Your average med student coming from WashU who did his clerkships at Barnes-Jewish and St. Louis Children's is a little different than a student from a D.O. school rotating in community (non-teaching) hospitals. The LCME would never take over COCA. I guarantee you many of those schools wouldn't have been opened in the first place.

You know my background DV, I worked with interns that were often fed from top 10s and the vast majority of them were functionally ******ed when it came to actually prcticing medicine during intern year. Rare was the intern that wasnt outright dangerously incompetent. Residency makes you competent, not medical school.

As to the LCME, they could take over COCA and close a lot of the schools that could not secure proper rotation sites, or force them to develop proper teaching hospitals. So far as the reason to do so- money, control, and power. More member schools drive more income for the LCME, a lack of a competing accreditation body prptects their ability to control the medical eduction market, and they would be the only orgnization with which politicians could deal with in regrd to medical education- with a third of students graduting from DO schools in 20 years, the COCA will have significnt power to undermine LCME political objectives via competition.

 

[Mad Jack]

This is why I said it's the most important year of medical school, for better or worse.

Third year is a transformative year. A lot of students aren't aware enough to understand that.

It is more powerful as an exposure nd indoctrination tool than it is as a way to actually learn how to function as a physician. It is unlikely that the difference in third year rotations will have any lasting impact when comparing two students that attended the same residency at the same institution 10 years out.

 

[DermViser]

You know my background DV, I worked with interns that were often fed from top 10s and the vast majority of them were functionally ******ed when it came to actually prcticing medicine during intern year. Rare was the intern that wasnt outright dangerously incompetent. Residency makes you competent, not medical school.

As to the LCME, they could take over COCA and close a lot of the schools that could not secure proper rotation sites, or force them to develop proper teaching hospitals. So far as the reason to do so- money, control, and power. More member schools drive more income for the LCME, a lack of a competing accreditation body prptects their ability to control the medical eduction market, and they would be the only orgnization with which politicians could deal with in regrd to medical education- with a third of students graduting from DO schools in 20 years, the COCA will have significnt power to undermine LCME political objectives via competition.

Are you a med student or resident? I'm confused.

One of my classmates was called "unprofessional" for something in class the other day, made me think of you lol.

I really feel like physicians should rebel against all of this nonsense, but the powers that be at the AMA and the AOA are all on board to sell us out.

 

[Mad Jack]

Are you a med student or resident? I'm confused.

Currently a medical student. 10,000 hours of experience in the ICUs/wards and 1,400 hours of experience in the ED of a top 10's teaching hospital where I'd have to get attendings to intervene on my behalf and stop interns from doing dumb things on a very, very regular basis. Many of them are less than useless, bringing the potentil for harm into a sitution in which there should be none, and this was the "best of the best" supposedly, kids from Hopkins and Yale and Columbia. They learned how to be doctors via that internship year, not from their MS3 meanderings.

 

[DermViser]

Currently a medical student. 10,000 hours of experience in the ICUs/wards and 1,400 hours of experience in the ED of a top 10's teaching hospital where I'd have to get attendings to intervene on my behalf and stop interns from doing dumb things on a very, very regular basis. Many of them are less than useless, bringing the potentil for harm into a sitution in which there should be none, and this was the "best of the best" supposedly, kids from Hopkins and Yale and Columbia. They learned how to be doctors via that internship year, not from their MS3 meanderings.

So then how you are you able to evaluate objectively from your vantage point that you "worked with interns that were often fed from top 10s and the vast majority of them were functionally ******ed when it came to actually prcticing medicine during intern year. Rare was the intern that wasnt outright dangerously incompetent."?

 

[AlbinoHawk DO]

With all due respect, it isn't. Not when you're under the Medical Board (I realize some states have an "osteopathic" medical board but let's look at most states here). Also I think it's interesting that in this scenario you guys want to separate yourselves, but not in other scenarios. You can't pick and choose when you want to be just like allopaths and when you're in your own special group. I think what ticks people off is that you pick one side or the other depending on whether it personally benefits you.

I'm not trying to pick sides. I hate inconsistency, so I apologize if I have been. I think we have 2 professions that are essentially parallel and work collaboratively. The MD world has open its doors for decades to us, but as before the merger the MD world wanted to close the door on us on fellowships, the power balance has always been shifted on your side, which is okay with me because it wasn't our residencies. When something "bad" happens in the DO world, it reflects on DOs. We have a different degree. Now, if you want us all to have a common profession, which we are working on with the merger, you guys have to give us equal treatment and access in all areas; that means no degree discrimination. Until that happens, we still have 2 different professions.

 

[DermViser]

I'm not trying to pick sides. I hate inconsistency, so I apologize if I have been. I think we have 2 professions that are essentially parallel and work collaboratively. The MD world has open its doors for decades to us, but as before the merger the MD world wanted to close the door on us on fellowships, the power balance has always been shifted on your side, which is okay with me because it wasn't our residencies. When something "bad" happens in the DO world, it reflects on DOs. We have a different degree. Now, if you want us all to have a common profession, which we are working on with the merger, you guys have to give us equal treatment and access in all areas; that means no degree discrimination. Until that happens, we still have 2 different professions.

Wrong. DOs in residencies have gotten fellowships. If anything your side closed your residencies to MDs. And no - just like MD graduates from different schools are perceived differently (Vanderbilt vs. Meharry), so will your schools as well. This isn't Brown vs. Board of Education. You don't get "equal" access.

 

[Mad Jack]

So then how you are you able to evaluate objectively from your vantage point that you "worked with interns that were often fed from top 10s and the vast majority of them were functionally ******ed when it came to actually prcticing medicine during intern year. Rare was the intern that wasnt outright dangerously incompetent."?

I'm able to objectively say that supposed top medical students would damn near kill my patients at least once a week doing things so dumb that they would leave attendings, residents, and experienced nurses/RTs/PAs gawking at their stupidity. if their MS3 rotations are so good, and train them so well, why are they almost all struggling with hemodynamics, basic vent management, and simple antibiotic coverge questions? If they cant handle such basic things, and functionally exist as observers that write notes and call the resident 90% of the time to figure out wtf to do, how much could they have possibly actually learned in their rotations?

And when I say ******ed, I mean ******ed. Ignoring tracheal deviation and unilaterl chest rise and ordering albuterol on a patient with a sat of 86%. Not being able to differentiate pulmonary edema from COPD on exam. Ordering a morphine drip and initiating comfort measures on patients before exhausting all other options discussed during morning rounds. Ordering patients that arent spontaneously breathing to be placed on spontaneous modes of ventilation.

None of this is because they will be bad physicians or because they are actually stupid. They just have incredibly poor clinical skills and judgement when starting internship. By the end of residency, theyre generally awesome. Residency makes a doctor, competent, not classroom time or passing through the wards taking notes, watching, and performing minor procedures during medical school.

 

[DermViser]

I'm able to objectively say that supposed top medical students would damn near kill my patients at least once a week doing things so dumb that they would leave attendings, residents, and experienced nurses/RTs/PAs gawking at their stupidity. if their MS3 rotations are so good, and train them so well, why are they almost all struggling with hemodynamics, basic vent management, and simple antibiotic coverge questions? If they cant handle such basic things, and functionally exist as observers that write notes and call the resident 90% of the time to figure out wtf to do, how much could they have possibly actually learned in their rotations?

And when I say ******ed, I mean ******ed. Ignoring tracheal deviation and unilaterl chest rise and ordering albuterol on a patient with a sat of 86%. Not being able to differentiate pulmonary edema from COPD on exam. Ordering a morphine drip and initiating comfort measures on patients before exhausting all other options discussed during morning rounds. Ordering patients that arent spontaneously breathing to be placed on spontaneous modes of ventilation.

None of this is because they will be bad physicians or because they are actually stupid. They just have incredibly poor clinical skills and judgement when starting internship. By the end of residency, theyre generally awesome. Residency makes a doctor, competent, not classroom time or passing through the wards taking notes, watching, and performing minor procedures during medical school.

You realize your MS-3 Internal Medicine clerkship generally doesn't include an ICU month, right? Again you're a med student - they aren't YOUR patients.

 

[AlbinoHawk DO]

Wrong. DOs in residencies have gotten fellowships. If anything your side closed your residencies to MDs. And no - just like MD graduates from different schools are perceived differently (Vanderbilt vs. Meharry), so will your schools as well. This isn't Brown vs. Board of Education. You don't get "equal" access.

DOs had gotten fellowships but there was a threat to stop that. With the merger, which I support entirely because I do believe MDs should access our residencies, there is no more closed side.

People are getting discriminated based on degree only. This is a fact. It has nothing to do with perceptions. MSU and Rowan both have MD and DO schools. By virtue of letters alone a graduate from the MD college will have easier placement than the DO one when the only difference is the letters after graduation. This is real degree discrimination. To pretend that all MD are by default better than all DO is simply ignorant. You get a guy from a DO school like mine who gets a 250 on the USMLE and does rotations with UCR/UCLA/LLU students (which we do) vs a graduate from UCR/UCLA/LLU with a 225 that did the exact same rotations and the guy from my school gets discriminated. It is entirely based on degree and nothing to do with the quality of potential physicians, which is what should matter. I understand you don't like equal access, but until the MD world doesn't capitulate this point, don't expect us to capitulate on things you don't like.

 

[DermViser]

DOs had gotten fellowships but there was a threat to stop that. With the merger, which I support entirely because I do believe MDs should access our residencies, there is no more closed side.

People are getting discriminated based on degree only. This is a fact. It has nothing to do with perceptions. MSU and Rowan both have MD and DO schools. By virtue of letters alone a graduate from the MD college will have easier placement than the DO one when the only difference is the letters after graduation. This is real degree discrimination. To pretend that all MD are by default better than all DO is simply ignorant. You get a guy from a DO school like mine who gets a 250 on the USMLE and does rotations with UCR/UCLA/LLU students (which we do) vs a graduate from UCR/UCLA/LLU with a 225 that did the exact same rotations and the guy from my school gets discriminated. It is entirely based on degree and nothing to do with the quality of potential physicians, which is what should matter. I understand you don't like equal access, but until the MD world doesn't capitulate this point, don't expect us to capitulate on things you don't like.

Again, this was BEFORE the merger. The ACGME allowed DO students to apply for ACGME residencies (which the AOA was irresponsible enough to have so many DO students they couldn't even accomodate them in their own residencies) and the AOA would not allow MD students to apply for their AOA residencies. No, the "threat" was that you had to complete an ACGME residency to go into an ACGME fellowship. The AOA could have created their own fellowships.

The fact that you think that a USMLE Step 1 3-digit score is an all-encompassing metric of medical education speaks volumes about how much you know about the process - which is none. However, this isn't surprising as you just entered OMS-1. Saying "D.O. discrimination" makes you look foolish.

 

[Mad Jack]

You realize your MS-3 Internal Medicine clerkship generally doesn't include an ICU month, right? Again you're a med student - they aren't YOUR patients.

When I was working in the ICU, they WERE my patients. We're talking about my prior career here, NOT my time as a medical student. They were directly under my care, my license was on the line if I were to follow a bad order and they were to die, and I rounded on them with the team and was expected to provide input as it pertained to my side of care and to come up with adequate treatment plans to get them out of the unit. But this goes back to just how useless I think MS3 and MS4 are. You don't actually have any responsibility. You don't get to provide a great level of clinical input or use your critical thinking skills on a level that is required in internship and residency. You're a glorified shadower and note-taker (or at least that's the impression I generally got from the medical students floating about). Sure, you get to see a lot of things, but you're not actively involved enough to learn any real skills aside from how to fill out paperwork, hold retractors, or do chest compressions. It's a lot of shallow exposure, and not a lot of meaty hands-on experience from what I've seen.

 

[DermViser]

When I was working in the ICU, they WERE my patients. We're talking about my prior career here, NOT my time as a medical student. They were directly under my care, my license was on the line if I were to follow a bad order and they were to die, and I rounded on them with the team and was expected to provide input as it pertained to my side of care and to come up with adequate treatment plans to get them out of the unit. But this goes back to just how useless I think MS3 and MS4 are. You don't actually have any responsibility. You don't get to provide a great level of clinical input or use your critical thinking skills on a level that is required in internship and residency. You're a glorified shadower and note-taker (or at least that's the impression I generally got from the medical students floating about). Sure, you get to see a lot of things, but you're not actively involved enough to learn any real skills aside from how to fill out paperwork, hold retractors, or do chest compressions. It's a lot of shallow exposure, and not a lot of meaty hands-on experience from what I've seen.

WRONG. MS-3 clerkships are self-directed learning. If you choose to "shadow", you're doing it wrong and you won't get Honors. I realize you think you realize what medical training is like from the perspective of a non-trad, but you don't.

 

[SouthernSurgeon]

I'm able to objectively say that supposed top medical students would damn near kill my patients at least once a week doing things so dumb that they would leave attendings, residents, and experienced nurses/RTs/PAs gawking at their stupidity. if their MS3 rotations are so good, and train them so well, why are they almost all struggling with hemodynamics, basic vent management, and simple antibiotic coverge questions? If they cant handle such basic things, and functionally exist as observers that write notes and call the resident 90% of the time to figure out wtf to do, how much could they have possibly actually learned in their rotations?

And when I say ******ed, I mean ******ed. Ignoring tracheal deviation and unilaterl chest rise and ordering albuterol on a patient with a sat of 86%. Not being able to differentiate pulmonary edema from COPD on exam. Ordering a morphine drip and initiating comfort measures on patients before exhausting all other options discussed during morning rounds. Ordering patients that arent spontaneously breathing to be placed on spontaneous modes of ventilation.

None of this is because they will be bad physicians or because they are actually stupid. They just have incredibly poor clinical skills and judgement when starting internship. By the end of residency, theyre generally awesome. Residency makes a doctor, competent, not classroom time or passing through the wards taking notes, watching, and performing minor procedures during medical school.

Were you an RT, or an RN in an ICU?

I can tell you, from my own experience and all my co-residents, that ICU management in general, and vent/pulm management are woefully inadequate in most medical schools.

The pulmonary pathophysiology and physiology in M1 and M2 are taught very abstractly.

The only exposure that our M3s get to vent management is when they rotate on surgery with us. It's literally the only time all year they round on an ICU patient.

They have to do a month of ICU as M4s, but most of them procrastinate it until the spring when they are totally checked out.

But anyways, acknowledging that I think ICU experience is a weakness across the board in med school...I would say you're judging interns "competence" and pre-residency training from a particularly narrow point of view. And honestly sound like most of the bitter ICU nurses I know who have a chip on their shoulder about protecting "their" patients from the dangerous residents. Rather biased.

 

[Mad Jack]

WRONG. MS-3 clerkships are self-directed learning. If you choose to "shadow", you're doing it wrong and you won't get Honors. I realize you think you realize what medical training is like from the perspective of a non-trad, but you don't.

We'll see how different I feel about it when I'm done. You also need to keep in mind that you matched derm, so you were probably on the more motivated side when compared to most medical students and acted accordingly. Not everyone is looking to honor every rotation- a lot of people are pretty tired or aren't looking to get into something all that competitive, so they just go in and do the minimum to pass and move on. The narrow perspective cuts both ways- I've got my narrow experience of being a nontrad in one particular hospital, you've got your narrow experience of being a highly motivated medical student that put his all in and matched derm. What you got and what I get out of MS3 and MS4 will be very different, and different still because of the schools we attended and the rotation sites we ended up going through. What I can say for certain is that rotations did not seem to leave the majority of interns I worked with prepared to take care of critically ill patients at even a basic level, which is the whole reason residency exists in the first place.

 

[Mad Jack]

Were you an RT, or an RN in an ICU?

I can tell you, from my own experience and all my co-residents, that ICU management in general, and vent/pulm management are woefully inadequate in most medical schools.

The pulmonary pathophysiology and physiology in M1 and M2 are taught very abstractly.

The only exposure that our M3s get to vent management is when they rotate on surgery with us. It's literally the only time all year they round on an ICU patient.

They have to do a month of ICU as M4s, but most of them procrastinate it until the spring when they are totally checked out.

But anyways, acknowledging that I think ICU experience is a weakness across the board in med school...I would say you're judging interns "competence" and pre-residency training from a particularly narrow point of view. And honestly sound like most of the bitter ICU nurses I know who have a chip on their shoulder about protecting "their" patients from the dangerous residents. Rather biased.

I'm not bitter, but I was certainly protecting my patients (and the intern's medical career) from harmful medical errors. The only lens I really saw medicine through was that of the high-acuity, big academic hospital variety, so yeah, my perspective is definitely a bit narrow. Maybe MS3 and MS4 do a great job of preparing students for outpatient work or something, hell if I know. But they certainly aren't capable of managing ICU or step-down patients, and they're pretty dangerous to have looking after the sicker floor patients as well. So I guess my whole point is that if even the strongest programs' rotations don't make for a solid inpatient interns on day 1, I can't imagine that the schools with less robust rotations would leave them all that much worse off, and any real difference would easily disappear as they progressed through residency.

 

[DermViser]

We'll see how different I feel about it when I'm done. You also need to keep in mind that you matched derm, so you were probably on the more motivated side when compared to most medical students and acted accordingly. Not everyone is looking to honor every rotation- a lot of people are pretty tired or aren't looking to get into something all that competitive, so they just go in and do the minimum to pass and move on. The narrow perspective cuts both ways- I've got my narrow experience of being a nontrad in one particular hospital, you've got your narrow experience of being a highly motivated medical student that put his all in and matched derm. What you got and what I get out of MS3 and MS4 will be very different, and different still because of the schools we attended and the rotation sites we ended up going through. What I can say for certain is that rotations did not seem to leave the majority of interns I worked with prepared to take care of critically ill patients at even a basic level, which is the whole reason residency exists in the first place.

Um even if you're not going for something "competitive" you still want to do well on rotations, esp. bc of rampant grade inflation during MS-3, where if you do what you're supposed to do and work well with others you'll get at least a "High Pass".

 

[DermViser]

I'm not bitter, but I was certainly protecting my patients (and the intern's medical career) from harmful medical errors. The only lens I really saw medicine through was that of the high-acuity, big academic hospital variety, so yeah, my perspective is definitely a bit narrow. Maybe MS3 and MS4 do a great job of preparing students for outpatient work or something, hell if I know. But they certainly aren't capable of managing ICU or step-down patients, and they're pretty dangerous to have looking after the sicker floor patients as well. So I guess my whole point is that if even the strongest programs' rotations don't make for a solid inpatient interns on day 1, I can't imagine that the schools with less robust rotations would leave them all that much worse off, and any real difference would easily disappear as they progressed through residency.

So then you were an ICU nurse (bitter is debatable).

 

[Mad Jack]

So then you were an ICU nurse (bitter is debatable).

I never said what I did in the ICU. Coulda been a midlevel, a nurse, an RT, it doesn't really matter. Certainly not bitter though, lol, aside from at the federal government and what they've done to medicine in conjunction with the the Joint Commission, the AMA, and state governments.

 

[AlbinoHawk DO]

Again, this was BEFORE the merger. The ACGME allowed DO students to apply for ACGME residencies (which the AOA was irresponsible enough to have so many DO students they couldn't even accomodate them in their own residencies) and the AOA would not allow MD students to apply for their AOA residencies. No, the "threat" was that you had to complete an ACGME residency to go into an ACGME fellowship. The AOA could have created their own fellowships.

The fact that you think that a USMLE Step 1 3-digit score is an all-encompassing metric of medical education speaks volumes about how much you know about the process - which is none. However, this isn't surprising as you just entered OMS-1. Saying "D.O. discrimination" makes you look foolish.

It would look foolish if I said it was all down to USMLE, but you are purposely ignoring my many examples where rotations are exactly the same as those in MD programs. Being a resident in derm, I expect more from you. I guess what you said about score on USMLE is a projection of the reality of who you are.

The MDs had no reason to threaten fellowship. Did the AOA magically change in between? Nope. They just wanted to force the DO hand.

 

[DermViser]

It would look foolish if I said it was all down to USMLE, but you are purposely ignoring my many examples where rotations are exactly the same as those in MD programs. Being a resident in derm, I expect more from you. I guess what you said about score on USMLE is a projection of the reality of who you are.

The MDs had no reason to threaten fellowship. Did the AOA magically change in between? Nope. They just wanted to force the DO hand.

You said they take the same rotations, only difference being board score. Funny how you skip past the part where I said even before the merger, MDs were not allowed to apply to DO residency programs, while DOs were allowed to apply to MD residency programs. The rule was you did an ACGME residency to get an ACGME fellowship. Don't like it? Create an AOA fellowship.

 

[AlbinoHawk DO]

You said they take the same rotations, only difference being board score. Funny how you skip past the part where I said even before the merger, MDs were not allowed to apply to DO residency programs, while DOs were allowed to apply to MD residency programs. The rule was you did an ACGME residency to get an ACGME fellowship. Don't like it? Create an AOA fellowship.

I didn't skip it. I addressed it. Maybe go see someone in Ophthalmology? Again, I'm not arguing about "liking" the rule but rather that the rule was just made arbitrarily to discriminate when before it wasn't a problem, and yes, I did say the same rotations. What's your argument? That pre-clinical is better at other schools? You're grasping at straws and you know it. Are you scared of DOs being able to compete with you if we don't get discriminated?

 

[DermViser]

I didn't skip it. I addressed it. Maybe go see someone in Ophthalmology? Again, I'm not arguing about "liking" the rule but rather that the rule was just made arbitrarily to discriminate when before it wasn't a problem, and yes, I did say the same rotations. What's your argument? That pre-clinical is better at other schools? You're grasping at straws and you know it. Are you scared of DOs being able to compete with you if we don't get discriminated?

You can scream "D.O. discrimination" all you want, but it makes you sound foolish to any rational individual. Your scenario was based off of equal rotations, different board scores, as if institution doesn't make a difference. Northwestern will be treated differently than Meharry, and that's just in the MD world. Same for D.O. schools. Institutions matter. Period.

 

[AnonymousD.O.]

I still think you're cherry-picking the handful of things that make the degrees different, despite numerous people backing up that the majority of DOs don't use OMT in their practice. I don't really know what you're basing your claim that the MS-3 clerkships are subpar on, but as the poster above me said the majority of DO grads do an ACGME residency, which is where we learn what is actually important for our ultimate careers.

There are bad DOs, and there are bad MDs too. As I've said before, I've met a number of excellent DOs as well. The quality of the schools may in fact differ, but that's far from the only the only thing that goes into how good a doctor turns out to be.

Well said. "The quality of the schools may in fact differ, but that's far from the only the only thing that goes into how good a doctor turns out to be."

I admit that many D.O. Schools, may not provide students with as many opportunities as MD schools. BUT, the opportunities are sufficient enough to support those D.O. Students that wish to enter into primary care, and many of the schools provide for those that wish to peruse other specialties. VCOM for instance has hospitals that have rotated MD students from UVA, VCU etc. before Va Tech Carilion opened. So to just assume that a D.O. had crappy 3rd year training isn't exactly fair.

And besides, although I am only a second year, I can't image that 3rd year defines a physician. Although it is a major stepping stone, the hospitals that one rotates in third year is just one part of a long process.

And anyone that thinks the first 2 years differ that much is kidding themselves in my opinion.

 

[D4C]

I didn't skip it. I addressed it. Maybe go see someone in Ophthalmology? Again, I'm not arguing about "liking" the rule but rather that the rule was just made arbitrarily to discriminate when before it wasn't a problem, and yes, I did say the same rotations. What's your argument? That pre-clinical is better at other schools? You're grasping at straws and you know it. Are you scared of DOs being able to compete with you if we don't get discriminated?

These kinds of statements are rather rude and besides the point. They have no place in a reasonable retort.

 

[Silent Cool]

Bc there is money to be made from it. No wonder academic medical centers are hopping at the opportunity.

That's right--along with all the bogus "master's degrees" being 'sold' at medical schools for admission. What a scam.

 

[DermViser]

That's right--along with all the bogus "master's degrees" being 'sold' at medical schools for admission. What a scam.

You mean like the MPH, MBA, etc? Those have actual use, believe it or not. Residencies also like that type of schtick.

 

[Silent Cool]

You mean like the MPH, MBA, etc? Those have actual use, believe it or not. Residencies also like that type of schtick.

I'm talking more about entrance master's degrees, like some bogus MS in biomedical science or whatever. Although I think that MPH and MBAs are largely a waste, too.

 

[DermViser]

I'm talking more about entrance master's degrees, like some bogus MS in biomedical science or whatever. Although I think that MPH and MBAs are largely a waste, too.

The ones who do the MS are using it to bid time while applying for med school w/o having gaps. It's not a requirement to enter med school.

 

[Mad Jack]

You said they take the same rotations, only difference being board score. Funny how you skip past the part where I said even before the merger, MDs were not allowed to apply to DO residency programs, while DOs were allowed to apply to MD residency programs. The rule was you did an ACGME residency to get an ACGME fellowship. Don't like it? Create an AOA fellowship.

The thing is, before it was up to PDs to determine whether the fellow applying had sufficient credentials to attend their fellowship or not. There was no real reason for them to take that ability away, aside from trying to force the AOA/ACGME merger in order to have total control over all residency programs in the country. The rationale for DO programs not taking MDs was actually pretty sound- OMM is core component of DO residencies, and MDs wouldn't be able to meet the competency requirements for that portion of the residency, dubious though it may be. There is nothing particularly unique about MD education that a DO cannot perform, as the same basic sciences are both covered in school and tested for via the boards. Not that any MDs would really be down for attending DO programs anyway, they're generally in the middle of nowhere and don't have the quality or patient base that most MDs would desire. Ah well, that's all history as of 2020 regardless.

 

[Mad Jack]

You can scream "D.O. discrimination" all you want, but it makes you sound foolish to any rational individual. Your scenario was based off of equal rotations, different board scores, as if institution doesn't make a difference. Northwestern will be treated differently than Meharry, and that's just in the MD world. Same for D.O. schools. Institutions matter. Period.

Pretty much this. It doesn't matter what we want to happen, where you're from and who you know will always matter as much, and often even more, than how hard you work or how talented you are.

 

[DermViser]

The thing is, before it was up to PDs to determine whether the fellow applying had sufficient credentials to attend their fellowship or not. There was no real reason for them to take that ability away, aside from trying to force the AOA/ACGME merger in order to have total control over all residency programs in the country. The rationale for DO programs not taking MDs was actually pretty sound- OMM is core component of DO residencies, and MDs wouldn't be able to meet the competency requirements for that portion of the residency, dubious though it may be. There is nothing particularly unique about MD education that a DO cannot perform, as the same basic sciences are both covered in school and tested for via the boards. Not that any MDs would really be down for attending DO programs anyway, they're generally in the middle of nowhere and don't have the quality or patient base that most MDs would desire. Ah well, that's all history as of 2020 regardless.

You don't need OMM to do a D.O. derm residency, D.O. Urology, D.O. Ophtho, etc.

 

[Mad Jack]

You don't need OMM to do a D.O. derm residency, D.O. Urology, D.O. Ophtho, etc.

You still do OMM in those residencies, actually. You have to, it's a required component of all osteopathic residencies:

The program must train residents in the clinical application of osteopathic manipulative medicine. At a minimum this must include:
a. A clearly defined mechanism to measure and document competency in OMM.
b. Training in outpatient and inpatient settings.
c. Didactic instruction and hands on training.
d. Exposure to multiple treatment technique approaches.
e. Documentation of OMM in the medical record.
f. Coding and reimbursement.

 

[Silent Cool]

You don't need OMM to do a D.O. derm residency, D.O. Urology, D.O. Ophtho, etc.

You don't need OMM to do ANY residency

 

[Silent Cool]

You can scream "D.O. discrimination" all you want, but it makes you sound foolish to any rational individual. Your scenario was based off of equal rotations, different board scores, as if institution doesn't make a difference. Northwestern will be treated differently than Meharry, and that's just in the MD world. Same for D.O. schools. Institutions matter. Period.

I've actually heard that many programs prefer a foreign MD over a DO because the public etc view MD as a gold standard and that DO is a sign of inferior quality.