What to do with potential subpar rotations?

[SoCal_PA]

I know this should go under the student sub-forum but I thought I'd get better responses from you all who have actually gone through all of your rotations. 

 

I received my rotation schedule and was very happy to get started until students from the class above me told me that my first 2 rotations are no good. They are in 2 areas that I don't see myself working in in the future, but I still don't want to get cheated from learning and practicing. 

 

First up is a family med clinic where patients are scheduled every 10 minutes and the doctor states it's our goal to get the patient in and out asap. As this is my first rotation, I don't feel comfortable at all spending just 10 minutes with each patient. He also, apparently, doesn't care to teach much.

 

Second up is internal med.  We will be working 6x12hr shifts per week (I can deal with that) but the student who had this rotation before me said that he basically limits you to the role of an MA (answering phones, taking vitals, etc). I am NOT okay with that as I feel my time will be wasted for 6 weeks. 

 

Now, our program basically put out a disclaimer that said that we will not all get the perfect sites and to just deal with them as they come. They even said that there have been preceptors in the past that limit students to just shadow them..... 

 

I have some great rotations after those 2, but I just feel like I'm being let down. I am 99% certain that if I bring these situations up, nothing will happen.

 

 

/rant

[KMD16]

Very quickly. Careful here! I would use the info provided by fellow student to your advantage. Go in prepare. Study hard. Learn as much as you can. Go in with an open mind. Smile smile and smile. Be kind to everyone. You're there for the following reasons: to fulfill your core rotation as specified by your program, studying and passing your board and finally, auditioning for job). I precep med & PA students and was in your shoes before.

 

It is Impossible to know everything w/ a short amount of time on each rotation. Taking on a student isn't an easy task as a preceptor and still be able to see the number of patients required by the practice. Remember, your preceptor most likely doesn't get paid. If you're a bad student, he or she can fail you and you'll have to repeat the rotation. Good luck.

 

My 2 c

[PACdan]

First up is a family med clinic where patients are scheduled every 10 minutes and the doctor states it's our goal to get the patient in and out asap. As this is my first rotation, I don't feel comfortable at all spending just 10 minutes with each patient. He also, apparently, doesn't care to teach much.

 

I'm still very much a didactic student, but here's what I've heard from our 2nd and 3rd years:

 

You should not be expected to see pts. every ten minutes. You're not working as replacement for one of their providers. You should see pts. in a reasonable amount of time, present to your preceptor (they may observe you or go in and repeat pertinent parts of the examination), give your impressions, type up the notes/chart, and present your treatment plan. Your daily pt. load should be much reduced, I mean, it's your first rotation ever and you're the student.

 

 

Second up is internal med.  We will be working 6x12hr shifts per week (I can deal with that) but the student who had this rotation before me said that he basically limits you to the role of an MA (answering phones, taking vitals, etc). I am NOT okay with that as I feel my time will be wasted for 6 weeks.

 

 

My program tells students you are ABSOLUTELY NOT to be used to perform administrative, clerical, or "front desk" work. If the site tries to assign you these tasks, we're supposed to contact our site coordinator and program director immediately.

 

Taking vitals is fine, that's pt. care. But not answering phones. However; you should be seeing the pt. as you would if you worked there. Again, it's a curve, and you're not going (or shouldn't be) cut loose to do everything on day one, but they need to be teaching you an letting you see pts. as a student provider.

 

You're paying a lot of money to have this valuable learning experience. I would keep in close contact with your school if these situations arise.

 

Also, "just shadowing" for an entire rotation is totally unacceptable. Shame on your program for being okay with that. I can understand shadowing your preceptor for the first day or two, to learn the ropes. But you need to be exercising your skills and growing them.

[gbrothers98]

I have commented on rotations in the past. It is a difficult world out there with a lot of interrupting forces concerning your clinical education.

The honest answer is will this turn out to be a self fulfilling prophecy or not? A poor rotation can be turned into a better one with some effort and perspective.

I have a hard time thinking you will answer phones for all 12 hours. I also think staying on time and seeing patients quickly is a skill to be developed and possibly you will pick up some good time management tips that will benefit you.

 

There should be the consideration that while that may have been prior experience, it does not have to be yours.

It is frustrating because as a student you do feel that everything should be all about you, you only have 12 months to do this, right?

Students sometimes get conveniently plugged into roles on rotation by others, sometimes they plug themselves into what is comfortable and dont realize it.

 

I recently had a student whom probably came as close to failing a rotation with us as any before. Regardless of all the encouragement and direction I gave, this student persisted in surfing the web, facebooking and such. Eventually I stopped. When the rotation grade came out (something I dont do in a vacuum, everyone that works with a student gets to give me feedback) there was surprise on the student's part that it was not what was expected.

There really was no insight into the past 5 weeks that there had been minimal involvement and effort.

 

So to segue into some advice from a preceptor.

 

Stay engaged. When you encounter frustration and disappointment, realize that the focus is not all about you, it is more how you fit into the overall puzzle of your rotation site. 

Take ownership. Do a good history, a good pe, know how you are going to present, know how you want to evaluate your patients and what your treatments and disposition are.

Realize this is a process. Lot of expectations concerning the clinical year. The truth is that the first few rotations are painful for everyone involved. I love students on their last or next to last rotations. I can have them document, they see pts in a timely manner, know what they want to do, interact with patients and staff much better.

Get something useful out the process. Even if your preceptor is a jerk, you hardly got to see pts, no one liked you, there is much you can get out of that too. Screw em and get some study time in. Realize that you dont like poor treatment and promise you will payback better in the future.

Last, no one has a perfect clinical year. You are at a place for a short period of time and move on. Personalities clash, expectations dont get met. That is life. Keep moving forward.

Good luck.

G Brothers PA-C

[ventana]

you get out of rotations what you put in to them

 

 

as a first year student don't worry about what has gone before you, don't worry about what the rumor mill has, just go into each rotation ready to learn as much as you can.

 

Believe me it will be overwhelming to start

 

If you are feeling good about yourself you can ask your preceptor to actually see a patient on your own, then present to him/her, then wrap it up - if you get 3-5 patients a day doing this that would be a huge success - but in the firs few rotations you are just trying to learn as much as possible......

[UGoLong]

Just because other students didn't like a rotation doesn't mean you won't.

 

You are there to learn and you have to be flexible to do that. We all had rotations we didn't like as much as some of the others. Learn what you can, about the specialty, about the technology, about the disease states, about the practice setting, about the personality types. As was said above, it's really not about you; they've let you into their little world and it's your job to ferret out the knowledge you need to learn. It's all around you.

 

And don't pretend that you are the inspector general, there to get the dirt on all the ways the rotation is unfair. As a clinical coordinator, I once interviewed a students on a rotation and all she could do was complain about how she couldn't wear her jewelry in the inner-city psych clinic because she was afraid that she'd be robbed. Meanwhile she was literally floating in a sea of lessons and patients to learn from. Put on some jeans and jump in!

 

Whether you like a rotation or hate it, it's over in a flash.

[Arthropathy]

^ that

[SocialMedicine]

If you have a bad rotation experience where you are not training in medicine you need to contact PA program. Do this as soon as possible. They have a responsibility to evaluate/improve rotation sites. Depending on the situation they may have a responsibility to move you elsewhere. DO NOT HESITATE to do this. I suspect the problem of LOW QUALITY PA education cites will grow and we need students to speak up. 

[PACdan]

I don't know, people seem to be skirting the issue raised here about the IM rotation. If this site is known to try and stick PA students on the phone or just grabbing pt. vitals, sorry I can do that without paying 50-70k and in fact, can get paid to do that... It's called being an MA.

 

I understand that not all rotations will be flowers and rainbows, but in the end, you're paying for the experience to learn at these places. We're not paying to do the exact same thing we did before PA school. Maybe my school is different, because the providers at 80% of our rotations work in OUR hospital. It's part of their duties, that they get paid for, to teach. Don't like it, find another job. Again, too heavy on the 'use this opportunity to learn on your own', that's not a good response to a poor preceptor or site. That can be done outside of school, at any time. Rotations are a specific, tailored exposure that we're paying for.

 

This should be your program's responsibility to make this situation right, IF IT OCCURS. Go in open and see what happens.

[swooshie1]

I hear where you are coming from. 7 months of my 10-month clinical year was mostly shadowing with preceptors who were not interested in teaching; makes you wonder why they take a student.  My clinical advisor "admitted" to me that they didn't have enough ER, inpatient, or surgery rotations for the number of students (yet the program grows every year), so, they were just thrilled to get students placed. period.   Relentlessly hearing program/clinical staff tell us about how hard it is to organize and place students in rotations and that we just needed to suck it up, yeah, that gets old.  You know what else gets old? Writing a $9,000 tuition check every 3 months, THAT gets old.  My program did not care to hear about it, when I expressed my concern about not being allowed to see patients,  the first response was: "have you done something to make them not trust you?"

 

Here is what I tried to do when it became obvious that I was in for another shadow-fest :  Find another provider within the group,  heck find 3 if you can, and ask to work with them.  Ask each one if they have a patient you could see and present each day.  Review the patient schedule the day ahead of time and the night before study up on the more interesting patients' CC.  Your preceptor will probably be happy to let you go.  And, I agree: otherwise,  "screw 'em and get some study time in."   I still learned something from my worst preceptor, and that was, how I WON'T practice.  :-)

 

As someone said, just smile smile smile.  You might be screaming on the inside, but you need to pass your rotations.  I think I cried every other night during my family med rotation because my preceptor's goal for my entire 4 month rotation was for me to "perfect" my BASIC SCREENING EXAM.  I took scrupulous notes during my "observation" with all other patients, and tried to learn on my own.  I survived, I graduated, got licensed, and have a kick-ass job in an awesome clinic with MDs who are there for me when I need them.

 

Good luck.

[PACdan]

If you have a bad rotation experience where you are not training in medicine you need to contact PA program. Do this as soon as possible. They have a responsibility to evaluate/improve rotation sites. Depending on the situation they may have a responsibility to move you elsewhere. DO NOT HESITATE to do this. I suspect the problem of LOW QUALITY PA education cites will grow and we need students to speak up. 

 

1,000 x yes.

[winterallsummer]

I have gone through rotations where I took vitals, answered phones, rounded on PTs who are lucky if they are afforded ten minutes of the teams time including the time it took to scribble a hand written progress note, I've worked with docs who only let you shadow, etc ad naseum.

 

A rule of thumb is two great rotations, two awful ones and the rest mediocre.

 

I've also had rotations I was warned about. Turns out the prior students just didn't like the rotation but if you get over yourself there were tons of learning opportunities.

 

I don't mean to be rude because when I was in your shoes I complained too. But my sincere advice is go into the rotation as if you know nothing about it and make the most of it. It is your responsibility to learn and few preceptors are going to be great mentors tbh (though you will meet at least one). And guess what as a PA I do sometimes get my own vitals, I am often taking nonsense phone calls, and sometimes I have to see PTs and formulate a plan in ten minutes or less. So just be glad you are about to begin rotations and for your own sake, adopt a better attitude!

[KMD16]

This should be your program's responsibility to make this situation right.

Not necessarily true. It's business as usual. Too many PA programs and the ever increasing competition for clinical site.

[KMD16]

 

I don't mean to be rude because when I was in your shoes I complained too. But my sincere advice is go into the rotation as if you know nothing about it and make the most of it. It is your responsibility to learn and few preceptors are going to be great mentors tbh (though you will meet at least one). And guess what as a PA I do sometimes get my own vitals, I am often taking nonsense phone calls, and sometimes I have to see PTs and formulate a plan in ten minutes or less. So just be glad you are about to begin rotations and for your own sake, adopt a better attitude!

Very true. You'll be surprised if you humble yourself enough, you could learn some valuable trick that you could use at future job. This could be from either an MA or a nurse. Yes. Roll your sleeves and jump in. If the room is empty, pickup the chart, room the patient and take their VS and do your thing. It's all about team work. Input from all staff does carries lots of weight at final evaluation/grading.

[PACdan]

Not necessarily true. It's business as usual. Too many PA programs and the ever increasing competition for clinical site.

 

Maybe so, and maybe this is a good argument for attending a PA school that is part of a hospital system or a medical school. At least at those places the teaching duty is expected of the providers employed therein.

 

I do put the onus on the program though, they're taking a 30k check (avg.) from each student for that clinical year, and that money (whether or not any of it goes to the site itself) is for the school to ensure quality rotations for their students.

[gbrothers98]

Not necessarily true. It's business as usual. Too many PA programs and the ever increasing competition for clinical site.

 

 

 

This should be your program's responsibility to make this situation right, IF IT OCCURS. Go in open and see what happens.

Here are some #s to consider.

190 PA programs, avg class size 40-45.

170 ish medical schools, avg class 115ish.

Reasonable model to get more bang for your buck is to expand the PAs (NPs are fast working on their own expansion) to meet demand because medical schools take 7-8 years to produce their product out of training. So should have more PA programs rather than less.

More PAs equals a workforce with some numbers to improve work environments, salaries, education and training opportunities.

There is a tremendous amount of competition for clinical sites....because many clinical situations will not take students of any type. So there is a limited pool to choose from.

The answer.....funding. How do you get funding? A voice at the table not afraid to be heard. How do we get that voice? Money. Where does the money come from. The increasing #s of PAs. It goes on and on...

 

Anecdotal experience. Local PA program posts clinical coordinator position full time. Salary at national median. Personally interested except it is a near 60-70k pay cut. I could understand some difference between academic and clinical positions but that much? At the same time, programs struggle with clinical sites all the time. I meet the clinical coordinator for my alma mater at AAPA Boston. Climate for rotations sucks. No one wants students of any stripe period. Why? No one pays. Take a clinician busy seeing 30 pts a day and give them a student, even a very unneedy student. Productivity goes down and they get not one iota of compensation, in fact the student may negatively impact their compensation. Why are clinicians in the community NOT being compensated to take a student? When you come to my ED and spend 5 weeks with me, the clinical education I help provide has zero to do with the PA program. Monies go direct to the school from the student, none to me except a letter of thanks and a couple hundred cat 2 credits I NEVER log?

 

Very easy to state the PROGRAM needs to rectify your on the ground issue with a preceptor but in reality, the program is made of a handful of individuals like the person that took the above described job. They have little to no control over your site and your experience because they have no means to do so. This is an institutional issue and lies with the sponsoring institution not the program itself. Students have little to no insight in general what has to be managed at a program due to the university/college it belongs to. Dont lodge your issues with the program, lodge them with the school in general. It ultimately is their responsibility. I can guarantee you that your program has gone to the school about rotations. The school will do nothing till ARC brings down the probation hammer and then likely it will search for scapegoats....you guessed it, the clinical coordinator. The one true source of all that has befallen you in your poor rotation. Really?

 

Truly what needs to occur is a bottom up review of clinical education in the PA world. It is not standard. The ARC can work on this. The first order of business is an acknowledgement that NO free clinical site is worthwhile until standards are met. Pay preceptors and hold them responsible. You will see results then. PAs are reaching critical mass and have the ability to address this collectively as a group.

 

Good luck.

G Brothers PA-C

[PAnewgrad50]

As a recent graduate, rotations are truly what you make of them.  There is also some luck involved as to who you get as a preceptor, but just because a preceptor does not constantly teach (although it is nice if they do), does not mean you can't make it a great learning experience.  Go home every night and read about the things you see, especially those you are not sure about.  When you have downtime on a rotation, go on UpToDate that most hospitals/clinics have free access to.  

 

My Internal Medicine rotation was between 6 and 7 12 hour shifts a week depending on which week it was.  They seem like long daunting hours, but the experience was so valuable.  Work hard and help the residents, as you will spend the majority of your time with them.  If they see you are hard working and interested, they will teach you a lot, and perhaps you will teach them some as well.  This ended up being my best rotation, and I still keep in touch with a lot of the residents I worked with.

 

A lot of my classmates complained about this rotation... Either they did not take initiative and were limited to being a "medical assistant" or the hours were 'long and miserable"  

 

Good Luck

[SocialMedicine]

not sure I agree that PA schools are ~40-45 students G Brothers. I wonder what the mean class size is ? A few of the programs I knew in NYC were ~80. Some approach 100. And a few programs have multiple campuses. 

[gbrothers98]

not sure I agree that PA schools are ~40-45 students G Brothers. I wonder what the mean class size is ? A few of the programs I knew in NYC were ~80. Some approach 100. And a few programs have multiple campuses. 

http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/156969

page 39

[Febrifuge]

It's a tough issue, and there are at least two sides to it. I definitely caution against the attitude of "hey, I'm paying for this education, I deserve to be treated better than this." That's true in a basic but very abstract way, and real life very quickly makes it a uselessly simplistic approach to any issue that comes up. Getting rotation sites is a full-time struggle for a program, and for (as GB points out) an administrator who is very likely not being paid anywhere close to enough for what the job entails.

I went to a program that had an excellent coordinator (shout-out to Elana at RFUMS) and at the time, the school didn't have formal agreements with any of the major hospital and clinic systems. This being the greater Chicagoland area, there were fortunately a metric bum-load of different clinics and hospitals, so based on alumni networking and a good reputation, together with some serious hard work, our coordinator got us some great sites. Even then, though, there were some clunkers.

 

And yet. Any rotation one student felt was excellent would always turn out to be one that someone else felt was awful, or even worse, kind of "meh." Someone would have a great experience, and then someone else would be disappointed when it was their turn. Someone would complain about a long list of faults with a site, and then someone else would go in and have a fine time and learn a lot. There's just too much variation between preceptors, and between students. The rumors are almost always 10% helpful and 90% useless, or worse.

 

I do think students need to be as complete and honest as possible in filling out end-of-rotation feedback for their program's coordinator. Be specific about why a site is or isn't good, and try to think beyond your own single experience. I got lucky with my first rotation, but my 2nd and 3rd made me question things in ways that seem a lot like some of the comments here. Looking back, I learned a lot even if they were not experiences that were designed well to educate me (or designed at all, in some cases).

 

In the community clinic for underprivileged kids which the preceptor ran like a semi-sweatshop, giving students WAY too much autonomy and stressing speed and through-put, I did learn a ton about treating kids and administering immunizations (never do the two syringes in one hand thing, no matter how bad-ass it looks), and I learned way too much about paperwork. On my sketchy-as-hell Trauma rotation, I learned how under-funded inner-city hospitals work, how to talk to a sleep-deprived resident who hates their life and everyone in it, and how to get stuff done for your patient despite red tape.

 

Sometimes you have to be the one to do the work to even figure out what you can be learning in some of these situations. And sometimes, that's the point. It's no excuse for a poor education, and you're right that it should be easier/ better/ safer/ more complete. But be careful you're not asking for it to be more student-centered, because no such thing exists, nor should it. You're not in PA school to learn how to be a PA student; you're in PA school to learn how to be a PA. Your task is to figure out how to do the former, while you're also doing the latter.

 

You've only got, what, 50 weeks in clinicals? 60? You only get to be a student once, and you need to make the most of it. Before not too very long at all, that place could be where you work. Think about how you could practice medicine in an environment like that, and what you would need to do in order to do it well. The process is valuable, to you and your future patients.

[UpRegulated]

OK, here goes. FNP student here that just finished all program requirements yesterday. First, let me vent on this thread, but don't get mad, hear me out. My progam is at a fairly prestigious school but is...wait for it...ONLINE. My "online" program would FAIL me if I answered phones, took vitals, only observed, or did MA, LPN, or RN-level work and counted it as clinical time (and we are all RN's!). My progam, like most NP programs that I am aware of, 100% disallows any of those activities as clinical time. Instead they require at least 50%+ involvement in the assessment, diagnosis and management for every patient seen and the expecation for that increases throughout the program, but 50% is the bare minimum. If I were in the OP's program, I would be LIVID at the clinics I was being placed at.

[EMEDPA]

OK, here goes. FNP student here that just finished all program requirements yesterday.

congrats!