One of the more common questions on this forum regard doing away rotations. I wanted to provide you all with an example of how not to act if you want to make a good impression on the program. We had this visiting med student start at our program last week and he has pretty much already left himself with no chance at getting in our program.

For starters, just because your dad used to be a resident at our program and is now a "great cataract surgeon" (the student's own words) don't come in acting like you know everything about ophthalmology and cataract surgery.

For example, when my capsulorrhexis runs too peripheral and my attending steps in to save it don't come up to me after the surgery and tell me how bad my rhexis was and that your dad does it much better. Yes this a**hole really did say this.

And during the next case don't tell me I'm putting the lid speculum in backwards, especially when I'm putting it in correctly. Not cool

Don't just stand there in the OR and make no attempt to help with anything involved setting the patient up. Obviously you've seen daddy do this enough times to know how to put a lid speculum in. This looks especially bad when 2 previous visiting students made every effort possible to help with things in the OR.

Don't announce to everyone in the OR that you've seen enough surgery and you want to go to clinic.

Once you arrive in clinic and you are told by an attending to follow around one of our residents don't refuse. Do not state that you already have your own lenses and you already know how to do everything. If you do that's great but it's not wise to openly disagree with an attending and argue.

As you can imagine the likelihood of this guy getting in our program at this point are pretty minimal. If you are already acting like this much of a jerk as med student, what in the world are you going to be like as a resident. Scary:eek:

It's been a while since we've seen a student like that.

On top of that, as a general rule, it's probably not a good idea to rip on any of the residents or attendings behind their backs.

If I see any students with letters from your program, I might have to contact you about it. ;)

Since we're on the topic of aways... Im going on mine in October. I think my month here at home has prepared me pretty well as far as basic exam skills. Im comfortable with refraction, slit lamp exam, tonometry, and getting better at the fundoscopic exam with the indirect/indirect+slit lamp. Is there anything else you guys suggest i learn that would help me to be more useful to the residents?

Since we're on the topic of aways... Im going on mine in October. I think my month here at home has prepared me pretty well as far as basic exam skills. Im comfortable with refraction, slit lamp exam, tonometry, and getting better at the fundoscopic exam with the indirect/indirect+slit lamp. Is there anything else you guys suggest i learn that would help me to be more useful to the residents?
I love medical students that can take a great history. This helps me out greatly. This includes HOPI, PMH, past ocular hx, allergies, social, medications, etc. The biggest thing is going over what eye drops a patient is on. I've been at the VA for the last 5 months and nothing annoys me more than when our technicians just simply copy and past the previous note's eye drop list. It is so important to go over the patient which eye drops they are taking and figuring out if they are taking them as directed.

Hope that helps.

I wrote about this in response to Dr. Wolverine's response to my thread about letters of rec. . . .and of course this has little or no relation to the autrosities of med student spoken of above . . . BUT . . . .

As a med student you are not only at an away rotation to impress them but to learn learn learn. When I say I know how to use an indirect, I am not saying give it to me I should be a doctor. . . .I'm saying, "now that I know how to find an image, I'm ready to keep practicing at every opportunity and hopefully get to see what you are seeing, please teach me more." Unfortunately there's no time for that little preamble in a busy clinic so it almost looks bad.

How should we put it so that our attendings understand this? Students like above mentioned make it frustrating for those eager to learn. I wonder if that student just finished a rotation at the school I am rotating because I am so genuinely here to learn and they look at me like I'm a fraud.

I wrote about this in response to Dr. Wolverine's response to my thread about letters of rec. . . .and of course this has little or no relation to the autrosities of med student spoken of above . . . BUT . . . .

As a med student you are not only at an away rotation to impress them but to learn learn learn. When I say I know how to use an indirect, I am not saying give it to me I should be a doctor. . . .I'm saying, "now that I know how to find an image, I'm ready to keep practicing at every opportunity and hopefully get to see what you are seeing, please teach me more." Unfortunately there's no time for that little preamble in a busy clinic so it almost looks bad.

How should we put it so that our attendings understand this? Students like above mentioned make it frustrating for those eager to learn. I wonder if that student just finished a rotation at the school I am rotating because I am so genuinely here to learn and they look at me like I'm a fraud.
Neuronerd, I completely understand where you are coming from. Usually we love students and are impressed when there are eager to see patients on their own, refract, use the indirect, etc.
Basically the day this student came to clinic was a particulary busy day and there were no open rooms to allow him to work from, and my attending thought it would be easier to just have him follow a resident around. Instead of understanding this, he acted like "a total jerk about it" as my atttending would tell me.
In your situation I would just politely say "Hey I'm able to do this, this, and this and if there's time I'd like to practice this stuff on same patients" Any reasonable attending or resident should allow you do do some things on patients. i.e. when we are done using the BIO give it to you to look at the retina while we finish our note or move on.
The problem with the med student aformentioned was more his attitude about everything. It was clear within 5 minutes of meeting this guy he thought he was god's gift to ophthalmology.
So I guess what I'm trying to say that if you show initiative and just act like a normal interested med student you should be fine.

Thank goodness for residents and attendings like ones on this forum. You guys take the time to write these things for us when we are all well aware of what kind of busy lives you lead. You and Dr. Wolverine have resparked some faith in me and I hope that I will be giving the same advice to med students five years from now.

As for that med student, I hope you read these forums and realize you've been a douche.

Since we're on the topic of aways... Im going on mine in October. I think my month here at home has prepared me pretty well as far as basic exam skills. Im comfortable with refraction, slit lamp exam, tonometry, and getting better at the fundoscopic exam with the indirect/indirect+slit lamp. Is there anything else you guys suggest i learn that would help me to be more useful to the residents?

in reality, most university eye clinics are very busy, and will not likely allow a med student to take lots of time working patients up. you'll find that the best way to be helpful to the resident/attending is to fill in the gaps, and help clinic run more efficiently. this may not prove that you're a great examiner etc etc, but that's not the point. the point of an away rotation is to leave that program on a positive note. anyone can learn how to refract/indirect etc etc, and really, that is what residency is for. an away elective is more like an audition: is this student pleasant to work with? that's really the main thing.

I have found that med students that impress the most are the ones that find ways to be helpful in otherways. "I will walk the patient to get photos", or has the script pad out when the patient at the end of the exam says, "by the way I need a refill on 3 medications". Offering to do the scut work goes a long way and often when residents and attending see you offering, they will not make you do anything and are more apt to get you involved.

As far as working up patients, I do not believe that an attending can use any part of the physical exam as billable. So in general it is advisable to not work up, but maybe grab the charts after the tech sees the patient and before the attending, then present the patient to the attending. Patients like it b/c of the extra attention and the attendings seem to like it too. If you have no clue, then just follow and ask how you can be helpful.

good luck

I have found that med students that impress the most are the ones that find ways to be helpful in otherways. "I will walk the patient to get photos", or has the script pad out when the patient at the end of the exam says, "by the way I need a refill on 3 medications". Offering to do the scut work goes a long way and often when residents and attending see you offering, they will not make you do anything and are more apt to get you involved.

As far as working up patients, I do not believe that an attending can use any part of the physical exam as billable. So in general it is advisable to not work up, but maybe grab the charts after the tech sees the patient and before the attending, then present the patient to the attending. Patients like it b/c of the extra attention and the attendings seem to like it too. If you have no clue, then just follow and ask how you can be helpful.

good luck

True and not true. The attending has also to examine the patient himself and then write in the record a note of sufficient length and detail as to indicate he has taken a meaningful role in the assessment and disposition of the patient's care. Merely writing "agree" and signing is not sufficient.

If you do a fellowship where you hold attending status, you will learn this well; it is how you will be paying your way in your department.

I wrote about this in response to Dr. Wolverine's response to my thread about letters of rec. . . .and of course this has little or no relation to the autrosities of med student spoken of above . . . BUT . . . .

As a med student you are not only at an away rotation to impress them but to learn learn learn. When I say I know how to use an indirect, I am not saying give it to me I should be a doctor. . . .I'm saying, "now that I know how to find an image, I'm ready to keep practicing at every opportunity and hopefully get to see what you are seeing, please teach me more." Unfortunately there's no time for that little preamble in a busy clinic so it almost looks bad.

A resident's job is also to learn learn learn, but they still have work to do. The smart med students see that they and the resident are on the same team, and then do everything they can to help the residents and attendings get the work done (even if it's not directly eductaional from an ophthalmology standpoint). However, along they way they will get taught a lot if the clinic is any good.

If you're a med student and you act like it's the resident's and attendings obligation to cater to your learning needsl, and you don't want to help out with the work, then you're not going to make them very happy.

If you're a med student and you act like it's the resident's and attendings obligation to cater to your learning needsl, and you don't want to help out with the work, then you're not going to make them very happy.

I agreee with Mirror Form and bucknutt. With the attitude that is being described, internship and residency will be a very long and painful process!