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Saba students complete clinical rotations at leading medical centers across the US and Canada.

The ‘Darkest Time’ in Med School—Prepping for Your Third Year Clinical Rotations

 

Just a few years ago, you could sum up a medical education quite simply as two years in the classroom (i.e., learning the basic sciences) and two years making rounds (i.e., your clinical clerkships.)

But now leading medical schools, including Saba University School of Medicine, have overhauled their curriculums to better integrate the clinical side much earlier.

There are many reasons for this change, but one often overlooked aspect is the realization that making such a stark transition from classroom to clinicals in the third year wasn’t healthy for anyone—not the students themselves and not their patients.

According to Danielle Ofri, a medical school professor and author of the book What Doctors Feel: How Emotions Affect the Practice of Medicine, the “ice-water plunge” into primal clinical experiences produces a welter of emotions, not all of them positive. Coming to grips with the messy realities of disease and death, observing egos and medical hierarchies, witnessing fear, anger, grief, humiliation in patients and doctors alike—and going through all of this for six-weeks, before being whisked off to start over again in other rotation—these are all reasons why the third year is often referred to as the “darkest” year of med school.

Ofri points to studies that document the decline of empathy and moral reasoning in medical trainees during the third year—emotions that can profoundly affect what kind of doctors these students become and the quality of medical care they can give to their patients.

On a positive note, she points to the growing recognition of this challenge as schools such as Saba reorient their clinical curriculums, introducing greater clinical exposure well before the third year and implementing more hands-on mentorship.

For more about Dr. Ofri’s observations, see her article The Darkest Year of Medical School.

For more about Saba’s clinical program, including interviews with deans and students, go to http://www.saba.edu/academics/clinical-education

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Which Medical Specialty is Seeing Rising Demand?

 

Here’s a quiz: which of the following five medical specialties was most in demand in New York State in 2015:

1.       Neurology

2.       Child & Adolescent Psychiatry

3.       Radiology

4.       Family Medicine

5.       Emergency Medicine

It’s a tough one, but if you answered family medicine you got it right. But don’t feel bad if you missed this one. This is the first time family medicine has topped the demand list since the Center for Health Workforce Studies (CHWS) began compiling a “demand index” of medical specialties in the late 1990s.

Back when the CHWS began measuring demand by surveying residents and fellows—factoring in things like the number of offers received by respondents, trends in starting income and the percentage of respondents having difficulty finding a satisfactory practice position—family medicine was far closer to the bottom of the list. Since 2008, however, family medicine has seen increasing demand. Efforts to reform healthcare delivery, such as the Affordable Care Act, are seen as likely factors in the changing demand index.

Because about 15 percent of all residents and fellows in the US (including graduates of Saba University School of Medicine) do their training in New York State, the rise in demand for family doctors there is seen as an indicator of the growing importance of family medicine.

Overall, the survey found that demand for generalists—family medicine, emergency medicine, adult, psychiatry, dermatology, and general internal medicine—appeared very strong.

See the Health Affairs Blog for a summary of the report, co-authored by one of the original designers of the demand index. And you can read the full report here.

 

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Doctors, Skilled Workers and Protocols

It’s a never-ending debate, made more intense in this era of cost-control and evidence-based medicine: What kind of latitude should doctors have in treating patients? Should doctors be looked upon as “skilled workers” performing highly complex work, but following strict protocols or should they be seen as professionals, working independently and applying their knowledge to an unending stream of unique situations.

Consider just a few examples:

  • A 57- year old man slips on the ice, breaks his hip and goes to his local hospital where a general surgeon pins the shattered bones back together—well, almost. When the hip failed to heal correctly the patient sought out an orthopedic surgeon specializing in trauma conditions at a large urban hospital who said simply, “I can see the problem right away. They followed the protocol, but in your case it wasn’t enough.”
  •   A resident being "trained" by an attending doctor was about to administer a drug using the protocol developed by that hospital's clinical department. The attending doctor interrupted and said, "Don't do it that way. I've been a doing this for over 20 years, and that way is stupid."
  • An ob/gyn practicing in an extremely rural environment—the nearest other ob-gyn is more than an hour’s drive away—says that “the only thing keeping my patients and me safe is well established and tested protocol and procedure.”

Here at Saba University School of Medicine, our students wrestle with questions like these every day—in the clinical training that starts from virtually the moment they step on campus, in classes on medical ethics, and in the research program on medical literature all students are required to complete by the end of their fifth semester. Learn more about Saba’s Curriculum

Of course, there are no simple answers. Today’s protocols are in many cases based on extensive clinical research that far exceeds the independent experience of any one physician. At the same time, no protocol can be right 100% of the time and there are numerous examples in the history of medicine of practitioners who bucked the prevailing consensus and were proved right.

For interesting discussions of these questions see Doctors are more than just skilled workers. Here’s why. And "Protocols are for nurses."

 

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Wearing a White Coat—Who, What, When, Where and Why

 

At Saba University School of Medicine, all first semester students undergo the rite of passage known as the White Coat Ceremony—you don a short white coat, a symbol of your status as a full-fledged medical student. Upon graduation from Saba, that short coat will be replaced by a long one, a sign of your status as a full-fledged physician. End of story? Not by a long shot.

 For starters, a lot of professionals in the medical world now wear long white coats. To an anonymous, young, female physician blogging on KevinMD, this is troubling: “As a female physician I often will enter a room and introduce myself as Dr. (last name), and I cannot tell you how many times the patient or family member will remark to another person in the room or on the phone, and say “Oh, the nurse is here.”

 This physician isn’t putting down non-physician colleagues—simply wondering if there isn’t a way that other medical practitioners can acquire a distinctive, professional attire, symbolizing the dedication and skill they bring to healthcare, without it being the long white coat traditionally worn by physicians.

 For Shivam Joshi, MD, the issue is not who wears the white coats, but where. Writing in his blog AFTERNOONROUNDS, he reports being aghast at running into a fellow physician wearing his white coat at the grocery store.

 Dr. Joshi cites studies showing how much bacteria has been found on white coats and notes that Britain’s National Health Service now bans doctors from wearing white coats in the hospital and the United Arab Emirates’ Ministry of Health bans them outside the hospital.

 The Society for Healthcare Epidemiology in America (SHEA) recently recommended that healthcare providers should possess two or more white coats, launder them regularly and have access to hooks where the white coat (or other long-sleeved outerwear) could be placed prior to patient contact.

 So, that first-semester White Coat ceremony? It’s a rite of passage into the world of healthcare in more ways than you might have realized.

Photo: White Coats at Saba

 

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Saba Clinical Program: Breadth, Depth and Results

One of the top questions we hear from prospective students is “Where will I do my clinicals?”

It’s an important question because clinical rotations—particularly your electives—invariably have a major impact on the kind of doctor you become.

Our clinical program is a major strength of Saba University. It has the range and the depth to get you where you want to go:

  • Saba students complete their core rotations at the nearly two-dozen medical centers that are part of the Saba clinical program.
  • Once their core rotations are done, Saba students can take their elective rotations at virtually any medical center in the US and Canada.
  • Saba students have completed electives at over 1000 institutions—from New York’s Memorial Sloan Kettering, to the University of Toronto, the Cleveland Clinic, Cedars-Sinai in Los Angeles…to name just a few.

Whatever your goal— Critical Care, Trauma Surgery, Pediatric Neonatal and Perinatal Medicine, or any of the dozens of medical sub-specialties—be assured that Saba has the reputation that gets you where you want to go.

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Saba Students Undertake a Wide Range of Clinical Rotations

One of the top questions we hear from prospective students is “Where will I do my clinical rotations?” It’s a very important question because where you do your clinical rotations—particularly your elective rotations—has a big impact on where you do your residency.

Saba students complete clinical rotations at medical centers across the US and Canada. Here is a snapshot of Saba graduates since 2000.

 

 

18,000+ Rotations: While Saba is a relatively small school—our class sizes are just a fraction of what you will see at some of the other medical schools located in the Caribbean—Saba students have completed more than 18,000 elective rotations across the US and Canada.

Every Specialty Represented: The American Medical Association groups physicians into 26 specialty groups, from Allergy/Immunology and Anesthesiology to Surgery and Urology. Saba students pursued electives in every one of those 26 specialties, as well as other “ungrouped” specialties such as Hospitalist and Wilderness Medicine.

Top Specialties for Electives: The top areas for Saba students to pursue elective rotations were Internal Medicine, Surgery, Psychiatry, Pediatrics, Obstetrics/Gynecology, Family/General Practice, Cardiology, Emergency Medicine and Radiology.

Numerous Subspecialties: Saba students pursued elective rotations in numerous subspecialties. For example, Saba students completed electives in surgical subspecialties including Burn Surgery, Cardiovascular, Colon & Rectal, Craniofacial, Endovascular Surgical Neuroradiology, Pediatric Cardiothoracic, Critical Care ICU, Transplantation, Trauma and Wound Care.

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