Question re: clinical rotations in Boston hospitals

[john_boston]

I'm currently a paramedic student thinking about which hospital to do my clinical rotations at. I live in Boston and have no transportation apart from the subway and bus so that limits my choices. I have been leaning toward doing my time at BMC but have heard mixed things about medic students working in city hospitals -- namely that it's difficult to get your 'points' because there are far too many medical students, interns, etc. and that most of the codes are run by the code team.

Of course everybody's individual experiences will vary and much of one's success depends on how outgoing and helpful one is, but I would be interested in hearing from medics who have done their rotations at any of the Boston city hospitals and had either a great or terrible experience.

Thanks in advance!

[VentMedic]

Does you program not already have some type of arrangements with the hospitals?

We won't allow students into our ED unless they have a clinical coordinator to answer to. We also had to stop allowing Paramedics students from doing intubations and rotating through L&D due to some serious problems with some medic programs and their students. The Paramedic students can not "run" codes but can be present and the person leading the code might ask them what next.

On the other hand, a teaching hospital is one of the best places to gain knowledge and an insight on patient care. You can also get as many IVs in as you need plus extra. IVs is probably one of skills that some lack when they enter the field. You can participate in rounds and have access to a wide variety of medical professsionals who are use to teaching. You will gain vast knowledge of what happens to a patient once they enter the ED and know what professionals are looking for in way of assessment and information.

It will be more about your attitude and expectations. If you have no previous hospital experience, this will be your chance to learn. Most look only at the skills aspect which is why very few of the medical professionals will waste their time on someone who has no interest in the knowledge that goes with the skill. That could be the reason for some students "bad" experiences.

[p3medic]

As vent stated, your program will need to have a clinical coordinator at the facility you want to do your time at. There are several hospitals in Boston that accomodate various programs, so it will depend on which ones your program is affiliated with.

The BMC, MGH, and Carney all have medic interns from various programs. If you are relying on the T for all your travel, the MGH would be the easiest, Red line Charles/MGH T stop. Carney is a few blocks south of the Ashmont T station on the Red line, it isn't a trauma center, but you will likely get more "hands on" as a team member there. BMC isn't too close to any subway stop, Broadway on the Red line, Mass Ave on the Orange line, however there are busses conecting to BMC from both. I'm not sure about BWH or BIDMC about medic intern opportunities, they might, but I'm not sure. They would be a quick walk from the Green line Longwood stop. Faulkner? Not sure, a long walk from Forest Hills on the Orange. St. Elizabeths is way out in Brighton, but a Green line stop at Cleveland circle or close to it would get you in the vicinity. Tuft/NEMC? don't know if they have any medic interns. They don't have an EM residency program there, so it might not be a bad gig if you can get in, Orange line Chinatown.

Anyway, good luck.

What program are you with? What is more important, ease of commute, "hands on", variety of medicine/trauma?

[JPINFV]

They don't have an EM residency program there, so it might not be a bad gig if you can get in, Orange line[s:ac6220be7e] Chinatown[/s:ac6220be7e] New England Medical Center.

The NEMC stop drops you off right at the hospital instead of a block away. ER entrance is across the street and to the right (or you can go through the atrium).

[p3medic]

Thanks for the correction, although Chinatown gets you pretty damn close!

[JPINFV]

You know, that is one thing that bugs me about the Orange Line. When I can look down the track and that the next station is an entire 2-4 minute walk away, I have to wonder who decided where the stops would be.

[john_boston]

I am a student at ERG (Educational Resource Group) a new group run by some of the guys at Attleboro Fire. Northeastern was out of the question (due to cost, travel to Burlington, worsening reputation of the program), Pro's class didn't start for another few months that I didn't want to wait, and ERG came at the recommendation of a few paramedics that I work with and respect.

ERG say they have relationships with "many" hospitals, including BMC, which is the one I inquired about. The impression that they gave me was that if they do not have a relationship with a hospital that one of their students would like to do some time at, it is an easy thing to arrange.

I have a couple of concerns about doing rotations. A medic that I respect who did his time there acknowledged that BMC was a fantastic place to see and learn a lot, but that the moment the resident or whoever you are talking with notices your paramedic intern nametag, they completely ignore you. Of course, much depends on one's attitude, but I would hate to think that one of the most exciting and engrossing early chapters in my medical education will be marred by condecension coming from those who view me as an ambulance driver and an interloper because I want to be there just as badly -- if not much more -- than most people. If I would be better off traveling to a smaller hospital where I would receive more direct tutelage and be trusted to know what I'm doing and act with some degree of autonomy, it would be worth it.

However...can't be St. E's. I spend far too much time there at work as it is and can't really stand the place.

[VentMedic]

ERG say they have relationships with "many" hospitals, including BMC, which is the one I inquired about. The impression that they gave me was that if they do not have a relationship with a hospital that one of their students would like to do some time at, it is an easy thing to arrange.

That's exactly the crap that the medic mills tried to pull at our hospital and couldn't verify their insurance with our risk managers. That is why their students can not touch any of our patients and will observe from afar if the hospital even decides to allow them inside for the day.

If you want to do skills inside a hospital, your school had better make sure they have got you covered and the hospital knows what you can and cannot do or what the hospital sees fit to allow you to do.

It should not be a mystery and all arrangements should already be made and your school coordinators should check schedules to get you in when other students are trying to get intubation time.

[p3medic]

I wouldn't let some pissy resident scare you away, your there as part of your education process too. The biggest place for competition with the resident is the OR for tubes, with increasing LMA for cases, fewer tubes = more competition. Be polite, but agressive, show up early, stay late, and don't just tube and screw, stick around for the case, that would be my advice anyway.

The ED both adult and pedi is a different animal. You won't be competing for many skills. You won't be intubating down there, but you'll start more lines, drips, and meds than you could ever want. The trauma rooms have a code team assigned with predesignated roles, you will be primarily and observer there, maybe do some compressions or ventilation during a code. You will get to defibrillate, but if your a wallflower, you snooze, you lose.

[VentMedic]

I wouldn't let some pissy resident scare you away, your there as part of your education process too. The biggest place for competition with the resident is the OR for tubes, with increasing LMA for cases, fewer tubes = more competition. Be polite, but agressive, show up early, stay late, and don't just tube and screw, stick around for the case, that would be my advice anyway.

If his school has not made the proper arrangements, the residents and anyone else has every right to kick him to the curb. If they have not filed the correct paperwork for invasive procedures, it will be observation only at a distance. I can not imagine the hospitals in Boston being that much different than any other hospital.