Quality of student rotations

[ALC0313]

I overhead a PA student in our office tell someone that she did urgent care for her internal medicine rotation. Does this strike anyone else as odd? I understand there may be some overlap between UC and IM but I don't think it should serve as a substitute. With more and more PA programs opening it seems like they're having trouble finding enough quality rotations, which I find concerning. Is there any oversight of this from PAEA?

[sas5814]

Nope...not even close. I did FP twice because we didn't have IM where we were and that was a reasonable substitute but UC makes no sense to me.

[UGoLong]

Not so much PAEA, but ARC-PA, the accrediting body, does care. Reviewing clinical year experiences can be a big part of their reviews.

The big deal is exposure to enough patients with a good distribution of ages, disease states, surgical procedures, and the like.


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[mgriffiths]

I had two FM and two IM rotations, with an ED/UC rotation.  UC is definitely not an IM rotation and honestly if Arc-PA finds out that your school is doing this it could put their accreditation at risk.

[camoman1234]

I agree that UC is not a good substitute for IM. 2 different worlds that are not relatable. There could be serious problems with the school if the ARC-PA finds out.

[ALC0313]

So I just asked the PA student about this and she confirmed that yes she did UC for her IM rotation, and she did geriatrics for her family medicine rotation. So this student who is graduating in 3 weeks has never done a full rotation in basic general medicine- crazy! When I went to PA school in FL 10yrs ago there were 4 schools in our state, now there are almost 15... no wonder there are not enough good rotations to go around.

[LKPAC]

This is unacceptable.

When I went to PA school the rotations were very good quality.  All set up by the school with clinical preceptors that were skilled in their areas.  Separate rotations in FP, IM, ortho, gen surgery, ER, OB/GYN, Peds, psych.  All were full time rotations, 40+ hours per week.  The preceptors reviewed us, and we reviewed them to make sure it was a good learning experience

This is one of the things that separate us from some other APPs.  They often set up their own rotations with no quality control to determine if the rotation will be a good clinical learning experience.  Also they do way fewer hours.

I am disappointed to hear that any PA program is using UC for IM!

[skyblu]

My site of employment is an Urgent Care clinic and we serve as FP or ambulatory rotation for some students.

Understanding the obvious shortcomings, my colleagues and I have, with the input of our FP and IM docs, put together several handouts and ask our students to do research and presentations on several primary care topics.

The school has FP, ambulatory, OBGYN, and IM (outpt and inpt), so the powers that be feel it is okay to have UC as one of those since they can sometimes be repetitive.

This is the oldest and most prestigious PA program in Boston, so I think if done thoughtfully and right, it can work.

We've gotten nothing but excellent feedback from our students and they've all aced their EOR exams.


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[camoman1234]

Skyblu: Still there is a difference (as you should know) in FM and UC. I have done both and again not relatable. Two different patient populations with the providers mindset in a different gear.

[skyblu]

Of course. I'm not saying they're the same. I'm saying that if a student ALSO has had outpt and inpt IM, plus some sort of ambulatory med rotation, plus peds, plus OBGYN, then perhaps it is okay to stretch the FP rotation to be done in an UC. Especially since the market is a bit saturated with new programs and true primary care FP sites can be very hard to find.


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[EMEDPA]

This is becoming a lot more common unfortunately. there is a program near me that doesn't have enough peds and obgyn sites so they assign extra fp instead. clearly not the same. I can't imagine graduating without ever taking care of pregnant pts in labor, assisting C-sections, taking care of really sick kids, etc.

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[cg02186]

I did an Urgent Care rotation for my Family Medicine rotation but we did have two IM rotations, one inpatient and one outpatient.  I actually much preferred it that way but can see how some people would disagree.  I knew I wasn't going to do Family Medicine or IM and was going to go into orthopedics or emergency so it actually helped me out a lot.  I graduated with a job already lined up in ortho and had 5 offers and all but one of them commented how they really liked that I had an urgent care rotation as well as two ED and two Ortho rotations. 

[sas5814]

cg this is kind of interesting to me (being an old fart) because I always thought rotation requirements were spelled out and other than some electives there wasn't much  wiggle room for choosing to do more or less in any particular area.

Is this latitude common?

[Zach]

17 minutes ago, sas5814 said:

cg this is kind of interesting to me (being an old fart) because I always thought rotation requirements were spelled out and other than some electives there wasn't much  wiggle room for choosing to do more or less in any particular area.

Is this latitude common?

We don't have that much latitude where I go. We get two elective rotations but everything else is specifically determined by the program and there are no substitutions. 

[Reality Check 2]

I find it disheartening that we don't have enough rotation sites or proctors but we keep opening new and more PA programs.

The ARC-PA can set standards but it sounds like programs aren't meeting them or just skirting by. 

Watching the posts here concerns me - students expected to find their own sites, extensive travel and lodging expenses, etc.

Corporate medicine has blocked many teaching opportunities and definitely eliminated shadowing for prospective students.

It would be best for our profession if schools weren't allowed to open or continue operation when and if they have such shortages and shortcomings for rotations. It is not fair to the student and certainly not appropriate for the profession to present a new graduate to society with limited exposure to needed medical situations.

The shortcoming of my program 25 years ago was that we were heavily hospital based in a medically underserved area in a trauma hospital. We didn't get as many "private practice" experiences. My OB rotation was a hospital run clinic and served me well by sheer volume - we had "belly days" - all pregnant women all day - 2 days a week. But I had limited family practice exposure - funny, that's what I do - as there were few private FP clinics for students back then and the hospital run clinics were more herded chaos of UC nature than anything else.

Is ARC-PA monitoring these programs and doing inspections, reviews, etc? 

How can we ensure that students get the needed exposure?

[EMEDPA]

one of my criteria for choosing pa programs to apply to was " does the program have a robust list of rotations in all specialties that are arranged by the program for the student".

having to find your own rotation sites is a non-starter as far as I am concerned.

[Michigander]

My peds rotation was in an ER. Several classmates were at rotations where students far outnumbered preceptors and many started days or a week late because of last minute problems. And my program is trying to double it's class size. So no, I don't think ARC-PA is monitoring programs or looking at capacity for rotations when approving seats/programs.

[EMEDPA]

I did peds ER for peds as well, but by choice. we had a list of many more peds sites than students and the peds er lined up better with my future goals. I did trauma surgery for surgery too.

[MT2PA]

I was recently speaking to someone starting PA school this summer and we were comparing curriculum between our programs - she will have 6 primary care rotations which apparently cover her FP/OBGYN/Peds/psych and possibly more.  The only separate rotations I can remember are internal med and surgery.  While you might see all of those situations in FP, I just can't imagine they are quality substitutes for 4-6 weeks of focused specialty time.

[Reality Check 2]

Just a thought

Perhaps taking all this into account - lack of specific rotations combined with PANCE/PANRE ----

Are we seeing a mismatch in clinical training with testing?

Don't yell - PANRE and PANCE still have inherent issues - I got that.

Just pondering - are we seeing a negative outcome of oversaturation and lack of clinical training sites?

[Kaepora]

The closest PA program's specialty rotations (peds,OB, etc) are 3 weeks long.  The thought being the students will see more of the same in ER, FP and on the wards in IM.  

[IDPA2012]

I absolutely would not choose my PA school again based on the abyssmal rotations that were set up after they boasted how great their rotations were due to being located in a big city. I am absolutely playing with a large handicap since I never had an internal medicine rotation. Mine was in a cardiology practice where I watched caths half the time. I wish I would have understood the importance of rotation assignments prior to attending PA school.  

[amwillaert]

As a current Clinical Coordinator who takes great pride in finding the best possible clinical placements we can (no UC for IM here) I can tell you that this happens for two reasons - 1. Lack of time and 2. Lack of willing preceptors (or willing sites) 

It takes an extraordinary amount of time to find rotations for each of our students, as we are a private institution not affiliated with a medical school. Day after day, dozens upon dozens of emails go out, in addition to the networking I do while working at my clinical job, cold calling, etc.

There are so many barriers to obtaining adequate clinical experiences (far more than I can go into detail about in a short post). Anytime I meet with pre-PA students I tell them the same thing. Your didactic education will be pretty standardized. There's only so much programs can do to get creative with it. Plus you can do a lot of supplementing on your own if you have a lecture or subject area that is weaker. But your clinical experiences will be made or broken by the quality of your Clinical Coordinators/Clinical team. Make sure to ask questions about how your rotations will be scheduled during clinical year. 

[thinkertdm]

So...if the pa who is seeing my wife had an "urgent care" "rotation" in place of a real im rotation, I'm going have her schedule with the MD.  Their rotations and residencies seem to be better monitored and restricted so that this very problem doesn't happen.  In my mind, medicine is not "fast" "walk-in" and should not be taught that way, and the system that led to it is broken.  We have flooded the market with cheap poorly made products, not the fine, lovingly made, well crafted well rounded pas we once we're.

[MCHAD]

In my opinion my program fell very short of the mark when it came to clinical rotations.  I had a good experience because I found or specifically requested almost all of my clinical sites well in advance.  I had classmates however that were very poorly placed.  There was a site that was labeled "adult medicine" i believe that was literally an Adult Daycare primarily serving elderly/dementia patients whose family needed a place to take them to be babysat.  My classmates spent a month playing bingo and putting together puzzles.  I wish I was exaggerating.