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Clinical Rotations vs Medical School Residency


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Hey All, 

 

Recently accepted applicant here! What is the difference between PA school clinical rotations vs a typical medical school residency (besides the number of years)? Is there any difference between our clinical training? If there is a difference, has this affected your clinical abilities upon graduation? Any info is much appreciated!

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Yeah, there might be some confusion if you've been exposed to the interesting factoid that when planning the PA clinical phase, the good people who came before us modeled our clinicals after the various services a new Family Practice resident (Intern) rotates through. Even so, there is a little variation from program to program.

 

And at several of my sites, the staff docs expressed a preference for working with PA students over MD students, or had nice things to say about us... but that's strictly confirmation bias. These were PA school clinical rotation sites, after all.

 

In general, a PA student in clinical phase should be keeping up with MS3s and MS4s, or even doing better work. The MD students will be matching and going off to someplace where they will practice with strong guidance and supervision (one hopes), and the PA students are getting ready to go out and start practicing.

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Most pa students rotate along third and fourth year med students. A few rotations will allow med or pa students to write orders. Most allow charting.

 

A medical resident on the other hand is a doctor and are expected to practice with more autonomy and write orders etc. And some rotations you will work with residents, just like med students. In such a scenario they will likely be teaching you. Residents can be an awesome resource and may even be better teachers than your actual preceptor (attending).

 

As far as med student vs pa student, in general you will be treated as an equal and expect to be up to par with third and often fourth year med students even though they have more schooling than us. The advantage is/was that many PA students have a solid background in health care vs med students often only volunteered or shadowed or worked a summer but of course this is not always the case.

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Yeah, there might be some confusion if you've been exposed to the interesting factoid that when planning the PA clinical phase, the good people who came before us modeled our clinicals after the various services a new Family Practice resident (Intern) rotates through. Even so, there is a little variation from program to program.

 

 

 

Ummm it would be highly illegal for a PA or MD student to function like a family medicine intern.  Family medicine interns write orders without cosignatures which is forbidden for PA and MD students.  

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Hey All, 

 

Recently accepted applicant here! What is the difference between PA school clinical rotations vs a typical medical school residency (besides the number of years)? Is there any difference between our clinical training? If there is a difference, has this affected your clinical abilities upon graduation? Any info is much appreciated!

 

MD residency is completely way above and beyond anything a PA or MD student does.  It's not even remotely comparable.  

 

PA/MD students may write orders with cosignatures, write H&Ps, participate with STRONG supervision by either PA-C or MD.  Interns/residents get much, much more autonomy.  They have some supervision, but it's nothing even remotely comparable to the supervision that PA/MD students get.

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Shocker...I'm about to agree with Gordon...mostly ????

We did start on a relatively short leash as interns in July. Now in December there is much less oversight. Something mystical happens in December when we no longer have to have our preceptors see every clinic patient...of course they are always available if we ask, but it's expected that we will need them much less frequently. If we were still consulting as much by July of PGY2 as when we started that would be a real problem.

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To clarify: I suspect I have more latitude than some of my peers because faculty recognizes my experience and knowledge base. Just got my milestones eval and it's beyond PGY1-2 expectations on almost all measures--so that's validating ☺️

makes sense. a typical 10 + yr PA should have most of the outpatient stuff down already. I imagine most of your learning is happening on sick admitted patients.

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Ummm it would be highly illegal for a PA or MD student to function like a family medicine intern.  Family medicine interns write orders without cosignatures which is forbidden for PA and MD students.  

 

It would, but that's not what I said.

 

I was referencing a bit of historical trivia -- supposedly, when deciding what specialties should be included in the clinical phase for PA students, the powers that be looked to the FP internship year for inspiration. That explains why we all have core rotations in Women's Health, Peds, Internal Medicine, Surgery, Family Medicine, ER, and etc (with some variations of course).

 

I wish I could find a citation for this; I was just looking at the AAPA history site, and don't feel like watching a video. I think it was one of my instructors, back in school.

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It would, but that's not what I said.

 

I was referencing a bit of historical trivia -- supposedly, when deciding what specialties should be included in the clinical phase for PA students, the powers that be looked to the FP internship year for inspiration. That explains why we all have core rotations in Women's Health, Peds, Internal Medicine, Surgery, Family Medicine, ER, and etc (with some variations of course).

 

I wish I could find a citation for this; I was just looking at the AAPA history site, and don't feel like watching a video. I think it was one of my instructors, back in school.

many of the early pa programs gave the md FP board exam as their exit exam from school. some of the best pance prep is actually FP board review stuff like swanson's.

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It varied for me - in general I was expected to operate as MS3/4, but there were some places where I functioned to the level of an intern and it was stated that that was the expectation (this is in regard to medical decision making, rounding requirements, lab and imaging interpretation, etc. NOT order writing).  By the end of my family practice rotation I was expected to see a full panel of IM patients daily with minimal consultation with my preceptors (an MD, senior PA, and senior NP).  So, it varies.  Regardless, you should expect that each rotation builds on the previous one and work to make it that way - by the end of clinical year, you should begin to feel comfortable in your shoes. 

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It varied for me - in general I was expected to operate as MS3/4, but there were some places where I functioned to the level of an intern and it was stated that that was the expectation (this is in regard to medical decision making, rounding requirements, lab and imaging interpretation, etc. NOT order writing).  By the end of my family practice rotation I was expected to see a full panel of IM patients daily with minimal consultation with my preceptors (an MD, senior PA, and senior NP).  So, it varies.  Regardless, you should expect that each rotation builds on the previous one and work to make it that way - by the end of clinical year, you should begin to feel comfortable in your shoes. 

 

I have an incredible amount of clinical autonomy but what you describe is illegal unless I am misunderstanding you.

 

So I have some clarification questions:

 

1.  Did you write the clinic note that went into the official record with NO addendum and NO cosignature from a preceptor?

2.  Were you the ONLY one who set foot into the room to see the patient?

 

This level of autonomy is what interns get.  Some of them get it immediately, others get it phased in over a few months.  But even the slow learners get this level of autonomy half way thru intern year.  

 

If those things occurred then your preceptors were breaking the law, not just in terms of improper medical supervision but in terms of billing fraud.  When I was in PA school many years ago, an MD oncologist lost his medical license because he allowed MD students to see his patients solo, never going into the room at all.  The patients thought that the MD students were their oncologist!

 

The "supervision" can be cursory, the preceptor doesnt have to do a full physical exam or even do a history, but he has to at least step foot in the room for a second.  

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many of the early pa programs gave the md FP board exam as their exit exam from school. some of the best pance prep is actually FP board review stuff like swanson's.

 

I was allowed to take the ABS pediatric surgery qualifying exam (aka peds surgery boards) as an "exempt" status.  I scored at the 97th percentile, so my preceptors refer to me as an un-official board certified pediatric surgeon.

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I was allowed to take the ABS pediatric surgery qualifying exam (aka peds surgery boards) as an "exempt" status.  I scored at the 97th percentile, so my preceptors refer to me as an un-official board certified pediatric surgeon.

 

How were you able to take that exam?  What hoops did you jump through and why did you take the exam?  I have often wondered if PAs with 5-10 yrs. of experience in FM could challenge the FM boards to just see where we land.  Even tho officially we can't it sure would validate our knowledge base as equivalent to a FM boarded physician......(if we passed, that is!).

 

I used Swanson FP board review book for my first PANRE and will again for my second one coming up in 18 months. 

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I have an incredible amount of clinical autonomy but what you describe is illegal unless I am misunderstanding you.

 

So I have some clarification questions:

 

1.  Did you write the clinic note that went into the official record with NO addendum and NO cosignature from a preceptor?

2.  Were you the ONLY one who set foot into the room to see the patient?

 

This level of autonomy is what interns get.  Some of them get it immediately, others get it phased in over a few months.  But even the slow learners get this level of autonomy half way thru intern year.  

 

If those things occurred then your preceptors were breaking the law, not just in terms of improper medical supervision but in terms of billing fraud.  When I was in PA school many years ago, an MD oncologist lost his medical license because he allowed MD students to see his patients solo, never going into the room at all.  The patients thought that the MD students were their oncologist!

 

The "supervision" can be cursory, the preceptor doesnt have to do a full physical exam or even do a history, but he has to at least step foot in the room for a second.  

 

I guess I can clarify further if need be -

 

I was expected to operate at the level of an intern in all of the ways I described, but still had final approval and cosignature by the doc.  Didn't mean to say that I had the same autonomy or functioned as an intern- the docs expected that I could do it as if I were an intern.  So yes, foot was set in the room but we had reviewed my plan ahead of time. 

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How were you able to take that exam?  What hoops did you jump through and why did you take the exam?  I have often wondered if PAs with 5-10 yrs. of experience in FM could challenge the FM boards to just see where we land.  Even tho officially we can't it sure would validate our knowledge base as equivalent to a FM boarded physician......(if we passed, that is!).

 

I used Swanson FP board review book for my first PANRE and will again for my second one coming up in 18 months. 

 

The ABS (american board of surgery) let me take it as an "exempt student" which means that it was not considered official.  But it was scored and graded against MDs just the same.  This was several years ago, so I'm not sure if they still allow that.  

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