# Trial By Fire-- Medical students doing EMT school



## Shishkabob (Jul 23, 2011)

http://healthland.time.com/2011/07/22/trial-by-fire-training-medical-school-grads-as-emts/




> UCSF's Dr. Cooke notes that working as an EMT far outstrips passive shadowing of doctors, which can be not only boring, but fairly useless. "The student is actually providing a service. Patients being attended to by EMTs by definition need help and, while EMTs cannot provide more than limited medical interventions, in the settings in which they work, they actually are more capable than physicians, as any honest doctor who has stopped at an accident scene will tell you," says Cooke.






Long story short, medical students at this school are being required to get certified as an EMT, and do multiple ride-outs on ambulances in the first 2 years.


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## Pneumothorax (Jul 23, 2011)

I think that's great. Perhaps as MD's they will be more compassionate to their EMS counterparts. 
=]


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## silver (Jul 23, 2011)

Thats pretty cool. Its interesting to see how all these newer medical schools are trying non-traditional methods.

There was a NY Times article about what they call MMI, multiple mini interviews. same idea about having people skills, but entirely different approach.

http://www.nytimes.com/2011/07/11/h...0374847-1WYtn Ju4/ax/xMxGo Skw&pagewanted=all


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## Sasha (Jul 23, 2011)

I think thats ridiculous.

Sent from LuLu using Tapatalk


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## JPINFV (Jul 23, 2011)

Waste of time, especially for all of the medical students who don't want to go into EM, and a gimmick for their stated purpose.


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## medicdan (Jul 23, 2011)

I think if nothing else it's interesting exposure to the problems of the healthcare system-- and a great primer on Medicare and Medicaid...


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## JPINFV (Jul 23, 2011)

emt.dan said:


> I think if nothing else it's interesting exposure to the problems of the healthcare system-- and a great primer on Medicare and Medicaid...



Past Physician Declarations of Necessities, what does the -average- EMT know about Medicade and Medicare? Additionally, how much time are they actually going to work in a month once they are licensed, and given that this is NJ and that they will probably be working for a volunteer service, exactly how large do you think their call volume is going to be?



""Our students will be taught the cellular basis, how they develop  thrombi or acute plaque within the coronary vessels, as opposed to just  learning the terms,"

Umm, shouldn't you be doing that anyways in the entire "medical school" portion of your EMT/MD program?


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## MrBrown (Jul 23, 2011)

Waste of time, Brown thinks a PGY1 House Officer is required to do ONE 12 hour shift with Ambulance here


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## DrParasite (Jul 23, 2011)

JPINFV said:


> Additionally, how much time are they actually going to work in a month once they are licensed, and given that this is NJ and that they will probably be working for a volunteer service, exactly how large do you think their call volume is going to be?


#1, it's NYC and Long Island not NJ.  #2.  in NJ, in an 8 hours shift, you can do as many as 6 calls in 8 hours, depending on which volunteer agency you are with.  The busiest paid city agency in NJ I am aware of goes between 12 and 20 jobs during a 12 hour shift per unit. Pretty busy if you ask me.  but NY is not as busy (per ambulance and per agency) as NJ.

and as for the overall concept, I think it's a GREAT IDEA.  Having a newly graduated MD have to go through the EMT program will show them exactly how limited the education of EMTs are.  Putting said newly certified MD and EMT on an ambulance will force them to experience what it's like to operate out of a hospital, with limited diagnostic equipment, with limited light, space and/or manpower.  EM docs would probably gain the most, but even other MDs will get to experience some of the issues that occur in the prehospital environment, and what little you can do with limited resources.


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## JPINFV (Jul 23, 2011)

DrParasite said:


> #1, it's NYC and Long Island not NJ.  #2.  in NJ, in an 8 hours shift, you can do as many as 6 calls in 8 hours, depending on which volunteer agency you are with.  The busiest paid city agency in NJ I am aware of goes between 12 and 20 jobs during a 12 hour shift per unit. Pretty busy if you ask me.  but NY is not as busy (per ambulance and per agency) as NJ.



Opps.. NY. My bad. However, do you really think that they are going to be put on with a paid service? How much is the school going to be willing to pay the ambulance company to put up with the headaches of a third rider.



> and as for the overall concept, I think it's a GREAT IDEA.  Having a newly graduated MD have to go through the EMT program will show them exactly how limited the education of EMTs are.  Putting said newly certified MD and EMT on an ambulance will force them to experience what it's like to operate out of a hospital, with limited diagnostic equipment, with limited light, space and/or manpower.  EM docs would probably gain the most, but even other MDs will get to experience some of the issues that occur in the prehospital environment, and what little you can do with limited resources.



...except we aren't talking about putting new grads on an ambulance. We're talking about putting 1st and 2nd year (presumably) students on an ambulance. More importantly, if I'm going into, say, radiology, why should I care what takes place on an ambulance? Only a tiny fraction of a percent of my patients are going to need an ambulance for anything more than a horizontal taxi ride, and even that percent the limited diagnostic equipment is relatively irrelevant because my overall expectation would be for you to deliver my patient to an emergency department. Why should I care about the limited diagnostic capabilities if I'm looking for transport? Furthermore, outside of either idiots who refuse to move their patient to a larger room (you [generic "you"] really don't need to run a code in a narrow hallway, sometimes a small delay in compressions is less important than the efficiency gained) or things like trench rescues, there ultimately is little difference between prehospital space and hospital space. In the end, there's only so much space around a gurney.


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## Shishkabob (Jul 23, 2011)

JPINFV said:


> More importantly, if I'm going into, say, radiology, why should I care what takes place on an ambulance?



Ummm...


Why should a Paramedic care what goes on in a cath lab?
Why should a nurse that's going to work in Ob/Gyn care what happens in radioactive medicine?
Why should a Doctor that wants to do family medicine ever step foot in anything but a family clinic?

How is this any different than requiring clinical time in different parts of a hospital to get exposure and see how things are done, so you can better understand medicine in general?




For someone who always advocates further education and experiences, I'm surprised you're against this.  It's not like they hide it from their students.



A huge part of contention in medicine is one part not knowing / understanding what another part does.  Nurses and medics, nurses and RTs, nursing home and ER, etc etc.


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## silver (Jul 23, 2011)

JPINFV said:


> Opps.. NY. My bad. However, do you really think that they are going to be put on with a paid service? How much is the school going to be willing to pay the ambulance company to put up with the headaches of a third rider.



In NY many large academic centers have their own ambulance services. North Shore-LIJ, their university hospital, has a pretty large one.


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## JPINFV (Jul 23, 2011)

Linuss said:


> Ummm...
> 
> 
> Why should a Paramedic care what goes on in a cath lab?


MIs, just as the emergency physician should care what goes on in a cath lab. How many paramedics rotate through physical therapy and work with a PM&R doc? 



> Why should a nurse that's going to work in Ob/Gyn care what happens in radioactive medicine?


Teratogenicity...



> Why should a Doctor that wants to do family medicine ever step foot in anything but a family clinic?


Things like post op, etc. A family physician, much like emergency physicians are going to treat a little bit of everything. Are we comparing the range of what a physician is expected to treat to a paramedic? Continuity of care from the provider standpoint is an issue prehospital providers generally do not have to deal with. 



> How is this any different than requiring clinical time in different parts of a hospital to get exposure and see how things are done, so you can better understand medicine in general?




For someone who always advocates further education and experiences, I'm surprised you're against this.  It's not like they hide it from their students.[/quote]

First, this isn't being argued as an important piece of clinical exposure, but what is essentially a team building exercise. As an exercise in team building, how is this anything other than a gimmick? 

Second, many emergency medicine clerkships require ambulance ride time anyways.

Third, how is training someone to be a physician, then limiting what they can do with that knowledge to the level of an EMT supposed to be educational. "Yes, all of those things about reactive oxygen species and the like we taught you in biochem? Yea, ignore that, give a NRB to everyone since that's the standard you're going to be held to as an EMT. Yea, we just taught you about decompressing chests for tension pneumos, but you can't do that either because you can't operate as a physician while on the ambulance." How is that educational again?




> A huge part of contention in medicine is one part not knowing / understanding what another part does.  Nurses and medics, nurses and RTs, nursing home and ER, etc etc.


...yet if we forced physicians to rotate through every specialty we'd have to add on another year to the curriculum, at least.


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## Shishkabob (Jul 23, 2011)

JPINFV said:


> MIs, just as the emergency physician should care what goes on in a cath lab.



So a doctor shouldn't care what is done in an ambulance BEFORE they touch a patient, but Paramedics should care what happens in a cath lab AFTER the release the patient?


(PS, I loved my time in the cath lab)


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## medicdan (Jul 23, 2011)

JPINFV said:


> Past Physician Declarations of Necessities, what does the -average- EMT know about Medicade and Medicare?



I think seeing the scope of medication and therapy non-compliance in the wild, or incompetence of SNFs, or what a patient looks like when they're not on a clean, variable height bed.


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## JPINFV (Jul 23, 2011)

Linuss said:


> So a doctor shouldn't care what is done in an ambulance BEFORE they touch a patient, but Paramedics should care what happens in a cath lab AFTER the release the patient?
> 
> 
> (PS, I loved my time in the cath lab)



Outside of ambulances going to emergency departments and critical care transports, how much care is actually provided on ambulances? Most physicians are not going to be on the receiving end of an emergency ambulance transport.


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## Aprz (Jul 23, 2011)

I may be extrapolating too much, but I hope this program will help EMS. It would be lovely if an EMT program could mimic the same educational standards e.g. talk about it at the molecular level. I am doubtful though.

I agree with JPINFV, if they are taught to perform algorithms that EMTs are typically taught then this will be a waste of their time.

In the caption of image, it says they'll be doing it with North Shore Ambulance in New York. The students will be discounted at the school for their time spent on the ambulance.



> As an added perk for being guinea pigs, students in the inaugural class (who range in age from 21 to 36 years old) will receive a $20,000 discount on the estimated $69,494 cost of attendance each year.


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## JPINFV (Jul 23, 2011)

emt.dan said:


> I think seeing the scope of medication and therapy non-compliance in the wild, or incompetence of SNFs, or what a patient looks like when they're not on a clean, variable height bed.




...because non-compliance doesn't make it's way to clinics, or do they magically become compliant when they do go and see a physician? Similarly, do you not think that physicians are exposed to SNFs, especially physicians involved with primary care? Finally, does it really make that big of deal if a physician who only sees patients on clean, variable height beds knows what a patient looks like when they are not on a clean, variable height bed? Sorry, but that last one feels like sour grapes more than anything else (I'm waiting for the "and take a blood pressure while going 80 mph down a side street with the lights and sirens on and being thrown into the wall of the ambulance"). 

Actually, let's take that one further. We should require all medical students to rotate through combat units in Iraq and Afghanistan so that they know what it's like to take care of a patient on the dirty with bullets whizzing by their head!


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## Shishkabob (Jul 23, 2011)

JPINFV said:


> Actually, let's take that one further. We should require all medical students to rotate through combat units in Iraq and Afghanistan so that they know what it's like to take care of a patient on the dirty with bullets whizzing by their head!



No need, just send them to DC or Detroit.


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## JPINFV (Jul 23, 2011)

Aprz said:


> I may be extrapolating too much, but I hope this program will help EMS. It would be lovely if an EMT program could mimic the same educational standards e.g. talk about it at the molecular level. I am doubtful though.



Something else to consider. If they are placed on ambulances with a non-standard EMS education are they going to be led to suspect that that is what normal EMS education is held to IN ADDITION TO holding their partner to that level? Think it's bad enough when physicians don't know what the education standards are like, imagine what it's going to be like when they have a legitimate claim to believe that the education standards are far more stringent than they actually are.


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## JPINFV (Jul 23, 2011)

Linuss said:


> No need, just send them to DC or Detroit.









On another note, don't GIS "rimshot." It's not pretty.


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## Aerin-Sol (Jul 24, 2011)

Are EMTs licensed or certified?

It would be good if this school required students to become EMT-B certified & work a few shifts *before* attending the school, because as the dean says, it's better than "passive shadowing of doctors." I was avidly pre-med for awhile and read far too many stories of MDs who don't have real patient interactions until they're too far into their education to turn back. It's ridiculous that you can go to medical school without having been exposed to the negative parts of medicine. 

But... once you're actually in medical school, it seems quite silly to make MD students do ambulance ridetime instead of hospital clinicals, especially when the dean admits EMTs can only do "limited medical interventions." Make them work as CNAs if you want to force human interaction on them.




JPINFV said:


> Past Physician Declarations of Necessities, what does the -average- EMT know about Medicade and Medicare?



I know a lot about how much Medicare/Medicaid abuse goes on, and I thought that's what the poster was referring to.


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## SanDiegoEmt7 (Jul 24, 2011)

> Third, how is training someone to be a physician, then limiting what they can do with that knowledge to the level of an EMT supposed to be educational. "Yes, all of those things about reactive oxygen species and the like we taught you in biochem? Yea, ignore that, give a NRB to everyone since that's the standard you're going to be held to as an EMT. Yea, we just taught you about decompressing chests for tension pneumos, but you can't do that either because you can't operate as a physician while on the ambulance." How is that educational again



As a paramedic one can decompress a chest, does this mean that seeing a tension pneumo as an EMT (while in paramedic school) is a wasted experience?

But it is a little backwards to send med students into the field, regardless if they can gain insight/experiences, if thats not what they are going to do in their career.


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## JPINFV (Jul 24, 2011)

Aerin-Sol said:


> Are EMTs licensed or certified?



Regardless of the specific noun used, the way the law works is more towards the definition of a "license." Alternatively, you wouldn't need the card from the government to work as an EMT. 



> I know a lot about how much Medicare/Medicaid abuse goes on, and I thought that's what the poster was referring to.


However, does it matter? Does a bank teller need to know the ins and outs of check fraud before being hired as a bank teller?


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## johnrsemt (Jul 26, 2011)

He is right;  Medics can needle decompress a chest:  how many medics out there have done it, or seen it done?  How many basics could diagnose it if they had one


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## jjesusfreak01 (Jul 26, 2011)

johnrsemt said:


> He is right;  Medics can needle decompress a chest:  how many medics out there have done it, or seen it done?  How many basics could diagnose it if they had one



Diminished breath sounds on one side with difficulty breathing and possibly diminished saturation, leading to hypotension, cyanosis, and severe respiratory distress when it moves to tension pneumothorax. Should be suspected in tall thin males and individuals with blunt or penetrating trauma to the thoracic cavity. Do I win a prize?


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## MrBrown (Jul 26, 2011)

Somebody with a 100 hour course is more capable than a Physician? 

Well then by all means, let us get rid of all the PRIME and BASICS Doctors and start putting EMTs on the helicopter .... seeing as how they are more capable than the helicopter Doctors


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## Shishkabob (Jul 26, 2011)

MrBrown said:


> Somebody with a 100 hour course is more capable than a Physician?
> 
> Well then by all means, let us get rid of all the PRIME and BASICS Doctors and start putting EMTs on the helicopter .... seeing as how they are more capable than the helicopter Doctors



Someone who does something fairly often is less capable than someone who has probably never done something?


How does that logic pan out?


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## MrBrown (Jul 26, 2011)

It pans out that Brown could teach somebody to put together a scoop stretcher or put a hard collar on somebody in five minutes.

Can some 100 hour course person differentiate between appendicitis and a missed septic abortion? Can some person with a 100 hour course differentiate between when it is appropriate and not appropriate to give somebody oxygen or leave them at home? No.

So therefore, some person with a 100 hour course is nowhere near as capable as a physician.

And there is still really no point in putting medical students on an ambulance, why? because more than likely the two walking Galls or 511 catalouge models are going to be standing there going "come on hurry up lets get him on the spine board and race him lights and sirens to the hospital already that Golden Hour is almost up!"


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## Shishkabob (Jul 26, 2011)

MrBrown said:


> Can some 100 hour course person differentiate between appendicitis and a missed septic abortion? Can some person with a 100 hour course differentiate between when it is appropriate and not appropriate to give somebody oxygen or leave them at home? No.



So, you jumped to a conclusion not anywhere based in what was spoken in the article... and that pans out the logic?



The article never stated that an EMT knew more / was better than doctors in medical type things... just that EMTs have some experiences that medical students could benefit from (IE, running a team with minimal help, minimal backup, minimal resources, and minimal equipment, and problem solving from that).  The article specifically states that when they write "as any honest doctor who has stopped at an accident scene will tell you"


With the caveat of it being done right...


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## MrBrown (Jul 26, 2011)

If your medical students are that deficient and lacking in teamwork and people skills that they need to be given a 100 hour course and put on an ambulance to try and fix the problem ... then all Brown can say is that your system of medical education is pretty flawed and needs serious work.

Brown is not sure about how the US works but we have a five year undergraduate medical degree, where students are put into community and clinical experience with real live patients and expected to you know, talk and function with others, from the first year of medical education.

But then again, we do not have to pass a "standardised test" which the Americans seem to love ... hmm :unsure:


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## Shishkabob (Jul 26, 2011)

So... they will learn absolutely nothing at all doing 2 years of ambulance rides?  Is that what you're stating?


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## MrBrown (Jul 26, 2011)

Linuss said:


> So... they will learn absolutely nothing at all doing 2 years of ambulance rides?  Is that what you're stating?



Medical education has existed for thousands of years long before the formation of the Ambulance Service.  

Yet somehow, it has reached a point whereby the students undertaking said medical education are so deficient and lacking in teamwork and interpersonal skills that this problem must be solved by putting medical students on an ambulance.  There must not be anything that medicine has collectively learned in the thousands of years it has existed which would enable it to solve whatever problem exists intrinsically so it must only be solved by putting medical students on an ambulance.  

Fix whatever problem exists with the system of medical education rather than put them on an ambulance.

If the idea of putting medical students on an ambulance for two years is such a good one, gosh how come nowhere else in the world does it?

Could it be just another poor attempt at symptom based management rather than fixing the underlying problem?


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## Shishkabob (Jul 26, 2011)

So... they can learn absolutely nothing, period, at all, with their time spent on an ambulance...???


Apparently quite a few places disagree with you, beginning with this medical school, along with local hospitals near me that send new nurses to spend time time on ambulances, to other places that have physicians do ride-outs as well.



The only thing they are doing different is certifying them as an EMT... I make you a promise that wont make their IQ or medical reasoning go down or be detrimental to their future as a physician.


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## MrBrown (Jul 26, 2011)

Brown would argue a medical student in community and clinical placements from Year 1 to Year 5 is going to learn a hell of a lot more that is relevant and contemporary to the practice of medicine than spending time on an ambulance.

Yes, medical and nursing students have to do one or two 12 hour shifts with the Ambulance Service here but it's not expected of them to actually do anything; it is simply to gain an appreciation of the role of Ambulance and Ambulance Officers.

Brown got "teamwork" and "interpersonal" skills from being a cook at KFC, so should we send everybody to KFC during their House Surgeon year?

Do your medical students get ANY clinical placements during their first two years?


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## JPINFV (Jul 26, 2011)

Linuss said:


> So... they will learn absolutely nothing at all doing 2 years of ambulance rides?  Is that what you're stating?


How often are they on the ambulance during those 2 years? It's not going to be 3 24s  a week plus medical school. 

How many of the things taught should be taught during years 3 and 4 when the students actually, you know, start to act like physicians.


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## MrBrown (Jul 26, 2011)

Do you only get clinical placements during year 3 and 4?


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## JPINFV (Jul 26, 2011)

MrBrown said:


> Do you only get clinical placements during year 3 and 4?


It depends on the school. 3rd and 4th year are when we are in the hospital full time, however some schools have limited clinical experiences during 1st and 2nd year and essentially all schools run volunteer health fairs (health screenings, youth sports physicals, etc), have options to volunteer in free or low cost primary care clinics, or do shadowing (which, when it comes to medical students shadowing, is very similar to rotations, just without the continuity).


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## MrBrown (Jul 26, 2011)

JPINFV said:


> It depends on the school. 3rd and 4th year are when we are in the hospital full time, however some schools have limited clinical experiences during 1st and 2nd year and essentially all schools run volunteer health fairs (health screenings, youth sports physicals, etc), have options to volunteer in free or low cost primary care clinics, or do shadowing (which, when it comes to medical students shadowing, is very similar to rotations, just without the continuity).



Wow, this is so different! We get clinical experience in all five years of the MBChB and its not "shadowing" or "volunteer" we are actually expected to apply our knowledge and you know, small steps but it is structured formal clinical exposure and practical based learning to complement the problem based learning done in class.

All of health professional degrees have clinical and practical components from year 1 including Paramedic and Nursing.

Perhaps this explains the aforementioned problem and a change in learning methodology would be better than putting people on an ambulance?


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## Aerin-Sol (Jul 26, 2011)

MrBrown said:


> Wow, this is so different! We get clinical experience in all five years of the MBChB and its not "shadowing" or "volunteer" we are actually expected to apply our knowledge and you know, small steps but it is structured formal clinical exposure and practical based learning to complement the problem based learning done in class.



What JPINV described is the "traditional" model: 2 year of didactic + 2 years of clinicals. There are a variety of new models being developed that are more like what you described. I know Indiana Univrsity has much more clinical integration throughout the program.


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## JPINFV (Jul 26, 2011)

MrBrown said:


> Wow, this is so different! We get clinical experience in all five years of the MBChB and its not "shadowing" or "volunteer" we are actually expected to apply our knowledge and you know, small steps but it is structured formal clinical exposure and practical based learning to complement the problem based learning done in class.


What clinical knowledge first year? That's part of the problem with early exposure is that often the exposure can surpass what the student knows. As for volunteering, it depends on how it's set up. The local clinic that the majority of students at my school is set up with 4 students and a resident where the student goes in, does the history and physical, and then reports back to the resident. How is that going to be significantly different than the clinical experience you gained during your first few years when you are mastering basic science material? Similarly, how is shadowing going to be any different than a preceptorship short of the time commitment. All of this is, again, on top of 3rd/4th year clerkships and subinternships.


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## Too Old To Work (Jul 29, 2011)

JPINFV said:


>



He's here all week, folks. Try the veal



> On another note, don't GIS "rimshot." It's not pretty.



And if you want to visit the web site of ****'s Sporting Goods, don't type in "****s.com". 

On a more serious note, have to wonder if they are going to be JAFOs or actually treat the patients? Will they be supervised by experienced EMTs? If the idea is for them to get "hands on" experience, why can't they do that in hospitals and clinics under the supervision of doctors?


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