Clinical Exposure

[Guest me maniac]

Ian, or any of the moderators,

 

could you comment on how much clinical exposure you get in first and second year? (ie, one afternoon a week, a day a week, etc). Also, how much time do you get for independent study?

 

I am not really into spending the first two years in a lecture hall, and my understanding is that there is less clinical exposure than some other schools (oh, saaaaay... Calgary!). Please correct me if I am wrong.

 

I know Calgary and UBC have two completely different programs. I think the Calgary one is better suited for me, but I am looking for reasons to stay in province!

 

Thanks in advance.

 

me

[Guest Ian Wong]

Here's an old post of mine regarding what I liked at UBC:

 

pub125.ezboard.com/fpremed101frm14.showMessage?topicID=226.topic

 

I assume things haven't changed much since my time in the first couple years.

 

By the end of the first month of first year, you will be in the family doctor's office one afternoon a week seeing patients. Depending on the family doctor, you might spend your time doing mainly histories and physicals, or if the doctor really trusts you, you might be observing deliveries, doing home calls on patients, giving immunizations, etc. You are likely to have your responsibilities increase as you progress through the first two years. This one half-day a week will go on for the first two years of med school.

 

Simultaneously, another afternoon a week will be spent in Clinical Skills, where you will actually learn the basics of the history and physical exams. At the beginning, you'll work on interview skills on volunteer patients, and then progress to physical exams on volunteer patients. Again, this goes one half-day a week for the first two years of med school. You also have a third afternoon a week in Doctor, Patient, and Society, which is set up to discuss the whole bio-psycho-social interaction in medicine. All of the above are done in small groups primarily (DPAS does have a minor lecture component).

 

For the first two years, there are three two hour PBL sessions a week, on Monday, Wednesday, and Friday afternoons. You will also usually have an afternoon of Anatomy/Histology labs. Interspersed within the week is about 5-6 hours of lectures. You can count on an afternoon a week off for "independent study time" in both Med 1 and Med 2. There's a number of physicians in all specialties in Vancouver who have volunteered to let students shadow them, and you can use this time for those things; I saw a quintuple cardiac bypass operation, among other things, during my first year in med school.

 

Here's a sample schedule from my old website:

 

www.geocities.com/hotsprings/oasis/8998/schools/UBC/schedule.html

 

I am willing to bet that most med schools follow the same type of curriculum. Even if the classes are named differently, or done in a different order, each med school still has to teach roughly the same sorts of things. Otherwise, they wouldn't all be accredited by the LCME. Most of the differences likely occur in the other areas of the various schools: ie. access to research and clinical facilities, size and diversity of the city and its population, etc.

 

In reality, I think the strength of the UBC program is more pronounced in the clinical years. I think we have an extremely strong clerkship program scattered throughout the Vancouver hospitals. I think our rural month (spent in a rural BC community) after Med 2 is an extremely good experience for med students (by far the best learning happens here because you are the only med student on site, and can grab great teaching from any and all of the physicians in that locale.)

 

My personal bias is that three years is not enough time to see all areas of medicine to make a really informed choice prior to CaRMS. I think it's really important to have completed the majority (ideally, it would be ALL) of your mandatory clerkship rotations done before committing your valuable and limited elective time to the specialty you really want.

 

We have four full months of elective time available after finishing the twelve months of mandatory clerkships. Add on the extra month of rural in the Med 2 summer (where I had the chance to work with family doctors, anesthesiologists, radiologists, ophthalmologists, otolaryngologists, urologists, general surgeons, and internists, all on a 1-to-1 setting). If the med school expansion works out well, you may also have the opportunity to do some clerkship rotations in Victoria or Prince George, and get out of the large urban teaching hospitals into the smaller city environment. We also have those free summers off after Med 1 and Med 2 where you can get involved in research or clinical work if you desire. All of these factors give you additional versatility when exploring your career options.

 

Having that extra twelve months of time before graduation gives you the opportunity to shadow that many more clinicians, decide on what you really enjoy doing as opposed to what you THINK you might enjoy doing, publish that research paper, present said paper at a national meeting, and do additional away electives for those reference letters. These are all things that will help you to decide which specialty you will pursue after med school (arguably the most difficult and most critical decision of all of med school), and should help you strengthen your application to maximise your chances of getting that residency at your number 1 location.

 

I have no bias against Calgary; I think it's an awesome city to live and work in, and I was left with a great impression of the program when I interviewed there four years ago. Had they accepted me earlier than UBC did, I might have gone there instead; but I'd already committed to Vancouver. But, speaking as someone who just finished med school in four years, I am certain I wouldn't have benefited by doing it in three. Of course, I'm pretty young, and other people at different stages in their life might drastically prefer the three year program, but it wouldn't have been good for me.

 

I saw too many classmates of mine who changed their minds near the end because of their exposure to a rotation near the end (when they'd already made their mind up about a different specialty). Ob/GYN people switching to internal medicine, surgeons switching to family medicine after seeing what surgery is really like, pathologists switching to psychiatry, orthopods going into emerg, psychiatrists switching to surgery, surgical subspecialists switching to anesthesiology, etc. More time is almost always a good thing. Carolyn might be able to offer a different opinion, but she's off travelling somewhere right now.

 

In the end, med school is really what you make of it. I think that once you make your decision, either way, that you will be happy once class starts. Calgary, from what I know of it, is a dynamite place to study medicine, and so is Vancouver. It's nice to know that whichever way you end up leaning, you are going to get a quality education, and have a great time over the next several years with your new classmates. Best of luck with your decision.

 

Ian

[Guest me maniac]

Thanks, Ian, for your well thought-out answer. Early clinical exposure is important to me as I've been in a hospital setting for 10 years now. I don't just want to get my toes wet with clinical stuff, I want to jump right in!

 

On an aside, I have seen that schedule your link lead me to before. However, somewhere on this forum I thought someone said classes start at 0800. The schedule you showed me says 0830. Which is correct?

 

me

[Guest Ian Wong]

It changed to 8:00 a year or two ago; something I believe to get into concert with the bus system or some other non-school reason like that. I think this is a non-issue; if you're not a morning person, 8:30 would have hurt nearly as bad as the current 8:00 am, and besides, in third year and all of residency, you'll be showing up AT the hospital by 6:00-7:00 am... If you aren't a morning person, med school will force you to become one.

 

As far as early clinical exposure goes, I think most med schools in Canada try to get you in immediately. As far as how MUCH they let you do, that is something predicated more by each individual doctor and their practising style. Some of my classmates were suturing people up within a month or two of first year, others had to wait until their rural elective for that opportunity. While I got to observe a number of surgeries in first year, it wasn't until the very end of first year that I got to scrub in on one.

 

Looking back retrospectively, I don't think it mattered all that much exactly how early the clinical experience was; by the end of med school, everyone "equalises" out. Whichever school you end up in, there's a chance that one month into med school, you'll simply observing the family doctor interview the patient, while your classmate is bragging to the whole class that he just got to scrub in and assist on a thyroidectomy. This is the time to remind yourself that everyone evens up by the end of med school; you'll have scrubbed in as often as you wanted to, sutured and casted as much as you desired, etc. Even if someone gets a head start on you, you WILL catch up, and I think you'll hear this refrain often in Med 1. For that reason, I don't think a ton of early clinical experience is all that.

 

I do think SOME early clinical experience is great (it's absolutely what keeps you going as you slog through basic science lecture or basic science PBL because it reminds you that you're studying this stuff for your future patients), but you don't want it to dominate the pre-clinical years of med school. Without that basic science, your educational experience in the clinical stuff is diluted. I can recall lots of instances at the family doctor in the first two years that went something like this:

 

"What's atenolol? I haven't been taught that drug yet."

"Brain and Behaviour block hasn't started yet so all I really know about this patient with Parkinson's is that it's bad."

"I know that low hemogobin isn't good, but I don't know why, or what causes it."

"I haven't covered the knee joint in Anatomy yet..."

 

Those initial years of med school are there so you can learn the basic science, and understand the reasons behind what questions you ask in the history, and what you are looking for in the physical exam/x-ray/lab results. It's very easy and tempting (you'll see what I mean once school starts) to blow off the basic science in exchange for the clinical facts, but while you can do this to a small extent and get away with it, if you do it too much, you start to compromise your education.

 

At its very heart, I think that's what separates doctors from all the other ancillary health care providers, is the ability to break things down to first principles and reconstruct from there. Anyone, a doctor, nurse, heck, some guy off the street, can all follow a clinical flowchart, and say that if you have a patient who hasn't peed in 15 hours, you should stick in a Foley catheter, administer a 1 liter bolus of intravenous normal saline, and go from there. The question is why do we do this, and what are some of the rare situations when we might NOT do this. That's what those fundamentals may give you, and for that reason, you shouldn't try to shortchange yourself too early by trading in an excess amount of basic science for clinical experience.

 

I guess what I'm trying to say (I hope this doesn't come across as antagonistic, because that's certainly not my intention), is that I too used early clinical experience as a yardstick in deciding where to go to school.

 

Looking back on it however, if I were doing it again, I'd make it much less important of a factor versus other things like the city, presence of family and friends, diversity of its population, clerkship and elective schedules optimized for CaRMS, wide breadth of teaching hospitals, etc. I think that each school will give you that early experience, and if you want more of it than what is offered, you can contact the various physicians affliated with the med school for additional shadowing time.

 

Ian