Quality of rotations

[fakingpatience]

Hi everyone!

 

I have been lucky enough to be offered a seat at pacific for the class of 17. I was wondering if any current/ recent students could speak to the quality of rotations available. I have no problem moving for rotations, and in some respects would welcome the experiences around the country, but want to ensure I will come out with a quality education. I understand they do not have enough Peds and OB sites, so students do not do single rotations through those, however from the programs I have seen, this is becoming increasingly common.

 

 

Thanks in advance!

[dholmb]

Hello all,

 

I was also offered a seat and am seeking advice from current/former students. During my interview, I was very impressed with the program. The only concerns that I have are for the clinical year.

 

They didn't seem to want to give out too many details about what to expect for the clinical year. I think that was in order to not give any promises that would be hard to fulfill.

 

For Pacific students/grads, during your clinical year how much did you really travel? Were a lot of your sites within the PNW? How many hours would you say that the average site was from Portland? Any overall thoughts about the clinical year?

 

Thank you so much!

[EMEDPA]

The pacifc NW is tight for PA rotations for all 3 local programs. lots of local medstudents to compete with as well. there are sites for everyone, but some folks at all programs comment that they don't get the specialty electives they want. I precept for all 3 programs at several different places. Expect to travel for a few rotations regardless of which of these programs you attend.

[CorpsmanUP]

One of the things people seem to forget is that there is just not the population density in the PNW as there is in the Northeast, and the four med schools get first priority in most clinical rotation sites.

 

One of the concerns in clinical education is finding not only good clinical sites sites, but good preceptors, something easier said than done. The clincial team works at finding sites that have a good diversity in case loads with preceptors that are vested in teaching. Another concern is to find sites that are willing to let PA students "get their hands dirty"; something harder and harder to find in today's risk adverse healthcare environment. If you look at the clinical year with their first priority being to get you the best medical education possible then I think you will have a much better handle on the situation.

 

If you present them with a goal for what you are trying to do, then they will work with you as much as possible in making it happen; with the understanding that your education is the priority not your location.

 

Case in point: I currently have the following rotations penciled in as I am looking at focusing on rural EM after graduation.

 

Family Practice: Rural health care clinic with a preceptor that gives a long leash

Family Practice: IHS clinic were you are treated as staff

Surgery: General Surgery/Cardio Thoracic

EM: A medium volume high acuity ED working 6 12s a week.

Inpatient IM: Trauma Medicine

Outpatient IM: Cardiology

Community Health: Prison

Primary Care Focus: Peds Ed

 

While I will be all over the U.S. away from my family, I think the experience gained is worth the trade off in the long run.

[rev ronin]

My info will be 5 years out of date by the time you will be in clinical rotations.  They are constantly trying to improve rotations, adding sites, removing sites... Since my class, they've made any number of changes, and continue to hone the program.

[CorpsmanUP]

As an example, one of the changes was adding back in end of rotation exams during clinical year, and then alternating the exams from your rotation. So that while on your surgery rotation you may be studying for a Peds EOR exam. It is a reminder that there is a breadth of medicine you have to hold onto and the file and forget method many students use during didactics doesn't work long term. Since implementing those changes they have moved to a 100% PANCE pass rate. While it is not the only reason for the jump in score, from talking to the recent 2014 grads, it was a huge help. One thing I will give to the faculty at Pacific is that they are constantly reevaluating and seeking to improve upon what works in the program and what doesn't.

[gbrothers98]

While I dont know what you will hear from Pacific students, I think PA programs nationwide have had struggles with clinical rotation sites based upon several distinct factors.

 

First, there are deep pocket programs whom will pay for sites. There may be that initial reaction of that isnt fair but there is great rationale for this. Students are given attention and priority. There is a commitment made and planning can be done. Preceptors can be held accountable to actually precept and hold students responsible to meet standards.

 

2nd, clinicians are under pressure every day to see patients and fitting a student in can be a drag on productivity unless the preceptor is experienced with students and the students are at the top of their game. I have precepted students in our low volume ED whom have been placed there because they need a significant amount of attention. They would be dead in the water if they had to actually see someone on their own in a fast paced office. 

 

3rd, especially in nonacademic rotations, patients have expectations that need to be met. Seeing a student, then a preceptor eats into their day, especially if they did not want to see a student to begin with. Think about the last time you were at the grocery store and got stuck in the cashier in training line. Same concept, much less tolerance.

 

4th, Peds and OB especially are tough rotations. Parents dont want their kids to be practiced on and expectant moms go through quite a bit of inconvenience. When they actually have a choice to skip some, such as a student doing their exam or someone bugeyed on the periphery of their delivery, no wonder they say no. I had male classmates whom spent a majority of their OB rotation in the hallway. Female classmates fared better.

 

I think a majority of programs are keeping the rotation year under wraps because to a certain extent, till they start placing students, they just dont know. Rotations can fall apart at the last minute, the progress of students through the academic and clinical year can determine where students are placed, there may also be new sites to place students that werent available nor known until a year plus later after the interview sessions.

 

Alternatively you may get a recommendation to attend a program with a close affiliation with a medical center and a guarantee of rotations. But the medical center is where you compete with other students and residents. It can be a large,complicated and confusing place, your rotation can be negatively affected by these factors. It truly is not a guarantee. I went to a program associated with an academic medical center and I would say at least 80% of my classmates did not do one rotation there due to these factors.

 

I think your ultimate decision has to be based upon your own internal determinants such as geographic preference, finances, family and personal situation. PA education is certainly in flux, you can take a group of successful graduates from any program and they will give you differing perspectives. In the end, you have to focus on your goal and make the best of what you encounter. There will be no perfect path.

 

Good luck.

G Brothers PA-C

[nikki23]

Is it true that Pacific will allow you to coordinate your own rotations if you are able?

[zoopeda]

Is it true that Pacific will allow you to coordinate your own rotations if you are able?

Yes.  The clinical coordinator actually gave a long presentation and Q&A session during the interview day.  She mentioned she loves it when students find a quality rotation--especially one that can be re-used year after year.  The problem is the paperwork end of the logistics.  She mentioned that even if the potential preceptor green lights your proposal, "about 50% of the time, it actually works out."  She emphasized that the vast majority of the 50% that get rejected are due to logistical snags well outside the student or preceptor's control.  50%.  Don't spend your first year distracted by setting up your own rotations.  For so much tuition and study, you should be able to count on the program to do this for you.  Good luck. 

[zoopeda]

One of the things people seem to forget is that there is just not the population density in the PNW as there is in the Northeast, and the four med schools get first priority in most clinical rotation sites.

 

 

I just don't understand this.  There's a school in Central Valley, Pennsylvania (DeSales)--population 8,000.  100% of their rotations are commutable (within 1 hour).  The vast majority of those are within 30 minutes.  The nearest (and only) commutable city is Allentown--population 120,000.  1 hour from Philadelphia (i.e., multiple medical schools and a billion PA schools).  Likewise, the new Penn State program in Hershey, Pennsylvania has, again, 100% commutable rotations--the vast majority provided by the Penn State Hershey Medical Center.  (Hershey population: almost 15,000.  No large nearby cities.)

 

So it CAN be done (even at new programs in the middle of nowhere).  I simply can't figure out how--with large population centers like Seattle, Portland-Vancouver (as well as Salem, Eugene)--3 PA programs can't lock down a couple hundred stable, local rotations.  It's not a population density thing.  It's a networking thing.  At my DeSales interview, I asked the medical director how they were able to secure local rotation sites.  He replied "with a lot of hard work and focus on networking.  We have a rolodex of 1800 preceptors I could call tomorrow to host a student shadow or to begin a rotation."  Impressive for a program in the middle of Amish country, one hour from perhaps the highest concentration of PA programs in the country (Philadelphia).  And the Hershey Med Center MD students aren't competing for rotations; the med center is providing them.  I can't figure it out, but I think it's a problem with NW programs' ability to arrange a local network of preceptors.  Too bad, because (with all the PA job postings around the area) there's lots of demand for PAs in the pacific NW...

[nikki23]

Does Pacific compensate you for the cost of moving?  I wouldnt mind moving for a couple rotations but couldnt afford to do if for every rotation.

[a177]

There's no compensation for moving - there is an increase in loans allowed for the second year to make up for additional costs of travelling. 

[EMEDPA]

many sites in the PNW make it very difficult to host a student. I had to jump through lots of hoops last year to increase the number of medex students I take. I am currently the only em pa in my group who takes students and I have one almost every month. my hospital has a policy that PAs can't be primary preceptors because we are "dependent providers"( NPs can-but we don't use them in em) , so my SP of record and dept chief who never work with me had to sign off on me having students. total BS. they never even meet them once. There is also a GME director who throws up lots of roadblocks to PAs taking students.

there are 3 local pa programs, 3 local med schools, and many students from all over the country trying to do elective rotations here. it's very tight for sites. most peds and gyn providers also only take females, so males get stuck doing "extra fp". it's not the same.

[rev ronin]

Does Pacific compensate you for the cost of moving?  I wouldnt mind moving for a couple rotations but couldnt afford to do if for every rotation.

No, and sure you could.

 

As I pointed out on another Pacific thread, it is less expensive because you just give up your apartment, put your stuff in storage, and move from one rental room to another over the course of the clinical year.  That year, you will definitely feel uprooted no matter what as you switch places every 6 or 12 weeks, and changing the place you sleep isn't particularly more disorienting than changing the place you spend the majority of your waking hours.

[EMEDPA]

OHSU has rented appts for their students near some of their rural sites. I work with their students at one of my rural per diem jobs and they walk a few blocks to the hospital for em, hospitalist, and surgery rotations. they try to schedule students in a block of 2-3 rotations at that site so they don't have to move as often.

[zoopeda]

Does Pacific compensate you for the cost of moving? I wouldnt mind moving for a couple rotations but couldnt afford to do if for every rotation.

It's a lot more expensive if you have a family back home or some other reason you can't ditch your place in Hillsboro. If you can lose your place, then the only added cost you'll incur is travel. Car, flights, etc

[rev ronin]

OHSU has rented appts for their students near some of their rural sites. I work with their students at one of my rural per diem jobs and they walk a few blocks to the hospital for em, hospitalist, and surgery rotations. they try to schedule students in a block of 2-3 rotations at that site so they don't have to move as often.

Of my 10 rotations, I had to arrange novel housing at only three.  One was international and was school-arranged, and the other six had me back at my home of record or staying in Hillsboro with my family.  When we had all moved out of our Hillsboro rental, we sublet it to other students.  When my last two rotations were within driving distance of my house in Washington, we lived back there.

 

Of the three rotations where I had to self-house, one was back in Washington near my hometown, and I rented a room from a fellow firefighter.  Up in Forks, I used Craigslist and ended up with a short-term furnished rental that worked well for my whole family.

 

Honestly, it really wasn't much of a big deal to arrange your own housing.  Even the traditional age college students (we had no one younger than 22 starting with my class) did fine, and the class ahead of us and our own class freely passed around tips about best places to stay at rotations.