How to deal w/ med students?

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IFNgamma

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I think ideally the resident-student interaction should be mutually beneficial to both. The resident would want some good help from the student while the student expects to learn something in return for doing the scutwork, of course that doesn't always happen (sad to say, but usually the resident doesn't fulfill his/her end of the bargain :p). So how to handle them? What are some of the things you have done to make it a positive experience for the student and at the same time getting some good free help?

And is it the responsibility of the intern to teach the students or is it the more senior residents' responsibility?
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You will get a lot of different responses. While our medical students follow patients and are expected to know their information, none of us depends on them to help us do our work... it is a medicolegal nightmare. At one point, they were not even allowed to put notes on the charts, and a lawsuit was recently won/settled (not at my hospital) in which the medical student's note was the one used to prove malpractice. :eek:

Having said that, teaching is key. If I have an interested and available medical student, they can see what I see, help with small procedures, and of course ask questions and interact with the attendings. We also get students who don't show up/are not interested/are disrespectful/don't ever read, and I have a harder time with that.

Generally, it is easier for the junior levels to teach students, because they remember what it is like to know nothing. I have had students who are better than some of our interns, and they spend a lot more time with me and even one-on-one with the attending even if a resident is not around.

Bottom line, it depends on how much you want to teach and how much your students want to learn. Good luck!:)
 
Show 'em which end of the retractor to hold.
 
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I might have a biased, jaded opinion about medical student education, but heres my take on it as a soon-to-be medical school graduate. I think a large segment of medical student rotations during the third year amount to alot of BS..basically alot of having to 'act' interested (whether you are or not), having to act like you 'really are' doing something (when your usually not), and often doing activities that are often more efficiently done by the intern. I always hated the idea of doing work just so someone else could do the same exact thing (usually because they have to bc I was just a student). Likewise, I always hated 'following around the intern' like I was some external hemorrhoid waiting to be told to go home. Most of us don't have to fake our interest in surgery because thats what we've chosen to do..likewise, we dont have to 'act all enthusiastic and happy' when we're getting ready to leave at night but something comes up that is going to require 2 more hours of our time. A medical student has to do both (well, at least an MS3..but the time your a MS4 you dont put on the fascade anymore :))

Particularly when it comes to surgery, the vast majority of medical students that rotate through the services are NOT going into surgery..thats just a reality. I feel like medical student education should be in 3 main parts (and in this order of importance):

1) education
2) sh*ts and giggles
3) taking care of patients

Educate them so that they appreciate certain things about surgery that they will be able to take into whatever field they go into (things like postop care, preop evaluation, fluid management, fever workup etc) in addition to the requisitite 'surgery info' (ie whats a whipple). 2ndly, for heaven's sake try and set up the rotation so that they actually enjoy it instead of having to dread every single day that they get up early. Most of them don't want to be there from 5 am to 7 pm, particularly when what they're doing doing doesnst amount to a whole hell of alot.

Similiarly, if your not EDUCATING them at 5 pm in the afternoon - SEND THEM HOME etc. Likewise, if they're taking their shelf exam on friday, dont be a douch and give them a problem when they ask about taking thursday off to study..because their exam is more important to them than being on rounds or being in the OR thursday afteroon etc. Stuff like that would always get to me.

Its neither a crime nor a loss for a medical student to look at his surgery rotation as a time when he saw some cool, neat stuff and learned a few cool things that he'll take with him when he goes into something else (like most do).
 
MS3er said:
likewise, we dont have to 'act all enthusiastic and happy' when we're getting ready to leave at night but something comes up that is going to require 2 more hours of our time. A medical student has to do both (well, at least an MS3..but the time your a MS4 you dont put on the fascade anymore :))
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I will point out from this end that if a student does not appear enthusiastic (not manic, just interested in learning) they are not invited to extra cases/interesting consults/procedures... maybe some residents dragged you around, but we really don't have time to do that. On the other hand, I have let medical students dissect, sew, help place lines and chest tubes, etc. if they demonstrate an interest in surgery.

MS3er said:
Particularly when it comes to surgery, the vast majority of medical students that rotate through the services are NOT going into surgery..thats just a reality. Educate them so that they appreciate certain things about surgery that they will be able to take into whatever field they go into (things like postop care, preop evaluation, fluid management, fever workup etc) in addition to the requisitite 'surgery info' (ie whats a whipple).
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Agree that there are basics everyone should know, and we work hard to teach them in a formalized manner as well as in the course of roungds/OR, etc.

MS3er said:
Most of them don't want to be there from 5 am to 7 pm, particularly when what they're doing doing doesnst amount to a whole hell of alot. Similiarly, if your not EDUCATING them at 5 pm in the afternoon - SEND THEM HOME etc.
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Usually we do this, but we have been bitten when students report in their evals that we "did not involve them" because we said they could leave even though something might happen later. We can't please everyone, and for sure, there are terrible rotations in all specialties out there. Like I said before, bottom line is teaching will be what you put into it, and what the student wants to get out of it.

A couple of examples from this side:
1. I had a student who, for an entire month (without exception, it was morbid to watch) would show up on OR days, enter the hospital, change into scrubs, scrub at the scrub sink, and enter the room ready to have the nurse dress her. It does not take a rocket scientist to see what is missing here... rounding, meeting resident/attending, reading the chart, introducing yourself to the patient, helping set up the room, getting your own gloves... I tried over and over the explain this, to no avail.

2. Some students only show up for morning report or for the first case, or for lunch. We have had several in the last year, who despite prompts, offer of assistance, etc, refuse to see patients whose operations they observed.

3. I had one who I told about a case a week in advance, and reminded him several times that it was approaching. That day, we were discussing the disease process, and it only took one or two questions to be clear that he had not read, so I asked him, "did you read for this case?". "No." I asked why not, and the answer was something like, "oh, I just didn't think about it."

4. Had another who, two weeks into rounding with the team on every patient, asked why our patient (with a colovesical fistula) had stool in her foley bag. It's a good question if you are not clear on the disease process, except that I had spent time explaining it on his first day, and he never asked any questions (or read apparently).

I remember being a student frustrated with teachers, but your teachers see all kinds too. Just treat your students as you wanted to be treated and you should do fine. Sorry for the rant.

Oooh, and I forgot some of the truly disrespectful comments we have heard, like the student who told an attending he could shove it up his a** if he thought the student would go do something.... story for another time. :eek:
 
Tigger14 said:
I will point out from this end that if a student does not appear enthusiastic (not manic, just interested in learning) they are not invited to extra cases/interesting consults/procedures... maybe some residents dragged you around, but we really don't have time to do that. On the other hand, I have let medical students dissect, sew, help place lines and chest tubes, etc. if they demonstrate an interest in surgery.



Agree that there are basics everyone should know, and we work hard to teach them in a formalized manner as well as in the course of roungds/OR, etc.



Usually we do this, but we have been bitten when students report in their evals that we "did not involve them" because we said they could leave even though something might happen later. We can't please everyone, and for sure, there are terrible rotations in all specialties out there. Like I said before, bottom line is teaching will be what you put into it, and what the student wants to get out of it.

A couple of examples from this side:
1. I had a student who, for an entire month (without exception, it was morbid to watch) would show up on OR days, enter the hospital, change into scrubs, scrub at the scrub sink, and enter the room ready to have the nurse dress her. It does not take a rocket scientist to see what is missing here... rounding, meeting resident/attending, reading the chart, introducing yourself to the patient, helping set up the room, getting your own gloves... I tried over and over the explain this, to no avail.

2. Some students only show up for morning report or for the first case, or for lunch. We have had several in the last year, who despite prompts, offer of assistance, etc, refuse to see patients whose operations they observed.

3. I had one who I told about a case a week in advance, and reminded him several times that it was approaching. That day, we were discussing the disease process, and it only took one or two questions to be clear that he had not read, so I asked him, "did you read for this case?". "No." I asked why not, and the answer was something like, "oh, I just didn't think about it."

4. Had another who, two weeks into rounding with the team on every patient, asked why our patient (with a colovesical fistula) had stool in her foley bag. It's a good question if you are not clear on the disease process, except that I had spent time explaining it on his first day, and he never asked any questions (or read apparently).

I remember being a student frustrated with teachers, but your teachers see all kinds too. Just treat your students as you wanted to be treated and you should do fine. Sorry for the rant.

Oooh, and I forgot some of the truly disrespectful comments we have heard, like the student who told an attending he could shove it up his a** if he thought the student would go do something.... story for another time. :eek:
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These students sound terrible. I have been worried about how to do well on my 3rd year rotations when I don't have any experience. I've heard the horror stories about students being abused/taken advantage of/yelled at for not knowing more, but what I'm getting from this is that genuine interest, conscientiousness, and politeness will take you a long way.
 
Tigger14, what % of your med students were like that....I could never imagine doing things like that....after all the residents write evaluations that determine your grade.

When I was a med student doing ob-gyn, me and another med student were sitting with the PGY-1 in the triage area of the OB floor. The resident asked for a cup of coffee. When the other student got it, he said it was too hot asked that a few ice chips be put in it :rolleyes: . The med student went ahead and did it. However on his exit interview, the med student brought it up to the program director :D
 
Louisville04 and Tired Pigeon, These are not the routine medical students. My point is that for every student who has a bad experience, there is a teacher who has one too. We get very good medical students for the most part, but just like your worst teachers stand out, so do our medical students. And yes, in most situations, "genuine interest, conscientiousness, and politeness will take you a long way."

A couple of other doozies now that I am post call and on a roll...
Doing a lap chole and get into terrible bleeding (the worst I have seen on a chole)... we are opening, calling for the argon, suture, equipment we need, and opening the abdomen as fast as we can... the medical student peers in and says, "is it supposed to bleed like that?"

I dropped my 5-0 prolene, and many of the vascular instruments have frustrating magnetic qualities, so it takes a couple of grips to realign the needle... "do you want me to get that for you?"

Closing an incision in an interrupted fashion, and the attending paused, suture in hand, to make a comment to me. The student broke in with "aren't you going to finish this?"

Doing a colon resection, and after the attending and I open the colon on the back table and are removing our gown and gloves to change... "oh, are we finished?"

And I will throw in a resident story... one of ours was perpetually late because "I don't have enough time to do my hair and makeup."

I don't think I could make these up.
 
i love this. dealing with medical students is hard. i think as an attending, i am considered one of the nicer attendings. today, my "pimping" was described as a mild question session. damn, and i was trying to be a hard ass:D.

i think in dealing with students, understand that they have no idea of what needs to be done most of the time, they have to be give some sort of leadership. the rules need to be spelled out. there needs to be a mid term evaluation prior to the end of the rotation so that they can correct some of their flawed ways. this should come from the chief of the service (resident chief). by laying down the rules, then they understand when they have broken them. you tell them we expect you to be here at X for rounds; the day before the cases are distributed, so they no what to read; if no cases, you give them some guidance of what things will be important to read for future tests. i do feel it is important to let them know what is expected of them.

for the resident, if you are not over worked, you may actually go over cases, consults, and/or clinic patients with the student at a slow portion of the day (try not to do it at 7pm when everyone is ready to go home), this could be a teaching session. it helps you both, it forces you to put the information together in your head to present it to them; and it helps them but hearing it in words that are probably more at their level than some textbook. although dealing with an uninterested medical student (resident) can be frustrating, you will get more out of education them than you will from just reading the book. it does take some effort on your part though.
 
Tigger14 said:
Doing a colon resection, and after the attending and I open the colon on the back table and are removing our gown and gloves to change... "oh, are we finished?"
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Now is that really THAT bad? I mean, what to you always do at the end of the case? You take of your gloves and gown. Perhaps this student had never been in on a case before that required changing during the middle of the case. Maye s/he thought that you saw something that made the patient inoperable or something like that. Maybe they just got confused (heaven forbid).

When it comes to actually being in the OR, most 3rd year med students have as much knowledge about what actually happens as the patient does.
 
I'd say it would be THAT bad if the patient was still open on the OR table as it sounds like he/she was... that would qualify as a dumb question :)

pillowhead said:
Now is that really THAT bad? I mean, what to you always do at the end of the case? You take of your gloves and gown. Perhaps this student had never been in on a case before that required changing during the middle of the case. Maye s/he thought that you saw something that made the patient inoperable or something like that. Maybe they just got confused (heaven forbid).

When it comes to actually being in the OR, most 3rd year med students have as much knowledge about what actually happens as the patient does.
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This may or may not have been what was going on, but a lot of med students ask questions too quickly when they're nervous. One of my residents warned me about this tendency early on, and commented that before I ask a question, I should count to ten and see if I already knew the answer. If not, I should ask. That rule has saved me a lot of dumb questions -- maybe you should pass it on to your students?

Best,
Anka
 
pillowhead said:
Now is that really THAT bad? I mean, what to you always do at the end of the case? You take of your gloves and gown. Perhaps this student had never been in on a case before that required changing during the middle of the case. Maye s/he thought that you saw something that made the patient inoperable or something like that. Maybe they just got confused (heaven forbid).

When it comes to actually being in the OR, most 3rd year med students have as much knowledge about what actually happens as the patient does.
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I think the point was that the patient was still open on the table.

Actually, I have been shocked by med student behaviors. Students who leave the hospital mid-day "just because" without telling anyone or asking permission, students who tell me they "don't care", students who walk into the OR late despite being sent to the OR early from rounding and then ask the attending "so what surgery are we doing now?" and "why does this patient need surgery?". Students who lie about labs, vitals or other patient information. Students who lie about where they are or have to be (if students have lecture, ALL the students are in lecture, not just 1 student). Students who ask to go home on call. Students (3rd yrs) who refuse to see new admits because it's "not educational" even though it's totally a good student case. Or students who refuse to do something involving patient care when asked because they "don't want to."

I am respectful of student's time and am good about sending them home or away to study if I am not doing anything educational for them...and I try to make them look good to the chief and attendings and try and do teaching sessions before they go into the OR and protect them from getting in "trouble" from accidental errors that they might make, but certain behaviors are inexcusable and hard to overlook.
 
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Smurfette said:
Actually, I have been shocked by med student behaviors. Students who leave the hospital mid-day "just because" without telling anyone or asking permission, students who tell me they "don't care", students who walk into the OR late despite being sent to the OR early from rounding and then ask the attending "so what surgery are we doing now?" and "why does this patient need surgery?". Students who lie about labs, vitals or other patient information. Students who lie about where they are or have to be (if students have lecture, ALL the students are in lecture, not just 1 student). Students who ask to go home on call. Students (3rd yrs) who refuse to see new admits because it's "not educational" even though it's totally a good student case. Or students who refuse to do something involving patient care when asked because they "don't want to."
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Alas. I have noticed this far too often this year, too. I went to medical school in a different region of the country from where I am completing intern year...and I was shocked at the vast difference in medical student attitude, schedule, and behavior. Maybe it's just an aberrant experience for a few of us, Smurfette...I just refuse to believe that this is happening everywhere.

Laziness was overwhelmingly rampant. Third and fourth year medical students that "capped" at two patients on call, showed up for work at 9AM (then left after morning rounds at 11AM!), frequently lied about when they had "lectures," and flatly refused to leave resident noon lectures to see patients in the ED when we were on short call! I had one former RN refuse to see a patient because it wasn't a good teaching case, and the same girl later refused to do a lecture I assigned her on SAH. Unbelievable.
 
PediBoneDoc said:
i think in dealing with students, understand that they have no idea of what needs to be done most of the time, they have to be give some sort of leadership. the rules need to be spelled out. there needs to be a mid term evaluation prior to the end of the rotation so that they can correct some of their flawed ways. this should come from the chief of the service (resident chief). by laying down the rules, then they understand when they have broken them. you tell them we expect you to be here at X for rounds; the day before the cases are distributed, so they no what to read; if no cases, you give them some guidance of what things will be important to read for future tests. i do feel it is important to let them know what is expected of them.
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Well said. In alot of my rotations, particularly surgery, I felt like what was critically lacking was for someone taking 5 simple minutes the first day to sit down and explain what goes on and how things work (even if its as simple as having to explain how to do a wet-to-dry dressing). But often those 5 minute explanations were missing and it would end up resulting in a month of trial and error (and pain) that didn't have to occur. Then just as I began to 'figure things out' it was time to leave the service.

I would agree with Tigger that there are alot of medical student mess ups, but I would venture to suggest that a large majority of medical student mishaps (or even dumb comments like the one cited) are more the result of just not thinking and not 'knowing how things work'. I also think much more difficult to be enthusiastic about learning when you aren't actually 'doing something' and aren't actually given responsibilities and aren't actually explained much like many medical students find themselves.

I just feel in the balance of resident-educating-medical-student VS medical-student-making-resident's-life-easier, that it should clearly be more for the former and not the latter. The medical student has his entire residency to do the same work as the resident does and to carry the same responsibility (and hassles) that the resident does..let his clerkship be something enjoyable and educational, not bogged down by having to do other work that even residents would not choose to do if they did not have to.
 
Smurfette said:
I think the point was that the patient was still open on the table.
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This is correct. The bowel was still stapled at the ends (not anastomosed) and the patient was still in the bookwalter retractor.

Smurfette said:
Actually, I have been shocked by med student behaviors. Students who leave the hospital mid-day "just because" without telling anyone or asking permission, students who tell me they "don't care", students who walk into the OR late despite being sent to the OR early from rounding and then ask the attending "so what surgery are we doing now?" and "why does this patient need surgery?". Students who lie about labs, vitals or other patient information. Students who lie about where they are or have to be (if students have lecture, ALL the students are in lecture, not just 1 student). Students who ask to go home on call. Students (3rd yrs) who refuse to see new admits because it's "not educational" even though it's totally a good student case. Or students who refuse to do something involving patient care when asked because they "don't want to."

I am respectful of student's time and am good about sending them home or away to study if I am not doing anything educational for them...and I try to make them look good to the chief and attendings and try and do teaching sessions before they go into the OR and protect them from getting in "trouble" from accidental errors that they might make, but certain behaviors are inexcusable and hard to overlook.
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We get these too. Thank goodness it is not the majority.
 
i love this thread about med students and how to treat them. you want to know why, because we have very similar problems with residents. the 80 hr work week is not the problem. the problem i see is the same thing you all are seeing with medical students.

residents not showing up on time for a case. resident not feeling case is "worthy" of their level and sending a PA or resident to do the case. not preparing for a case. showing up to the OR not knowing what case they are doing and why we are doing it.

these are problem that are pervasive now. they can't sneak out to a lecture because we know when the lectures occur, but they can hang out on the floor or in the er to avoid clinic or OR. you may say, "well, they work hard and get paid little." i would respond, "this is true. but, one day you have to be done with residency, and there is no Frankenstein machine that shock the information into you." when yo graduate you don automatically know exactly what to do an how to do it. like the old saying goes "if you don't do it in practice, you will not do it in the game."
 
PediBoneDoc said:
residents not showing up on time for a case. resident not feeling case is "worthy" of their level and sending a PA or resident to do the case. not preparing for a case. showing up to the OR not knowing what case they are doing and why we are doing it.
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wow, that just boggles the mind. in our program, i think we would be fired for that sort of behavior. as a resident, i understand that most attendings are making a sacrifice to teach and i am probably slowing them down during the case.

anyway, i whole-heartedly agree with ms3er and pedibonedoc. it is the responsibility of the chief resident to explicitly spell out the expectations to new students on the first day of service. also, it's important to give constructive feedback about what they are doing well and what they are not doing well mid-way through the rotation so they have a chance to improve. i think most students genuinely want to do well, but just need a little direction about what is appropriate and how things work.

i like to give little informal presentations to students on topics i read about, because it helps me to remember them better myself. i think both senior and junior residents have things to teach students. junior residents -- how to evaluate common things interns are paged about, e.g. tachycardia (hypovolemia? pain? fever?). senior residents -- pathophysiology, indications for surgery, operative approach, etc. i think teaching and learning is a 2-way street. there is a mutual responsibility.

that said, it is frustrating to see students eyes glaze over when you try to teach. i am not asking that students want to go into surgery, but at least bei interested in getting something out of the rotation. heck, psychiatry wasn't my cup of tea, but i felt that i better learn all i could in those 8 weeks since that would the only 8 weeks in my life to learn about it. worst student i had would complain incessantly about staying late -- to the point that i just sent them home because i couldn't stand listening to the whine anymore; it was affecting my own morale.
 
I agree that a lot of time is wasted and often the student learns nothing by following a resident around. And I also really hated being told to go do an H&P only to have the resident come later and repeat everything I just did. I just don't want to have my students go through the same experience.

So it seems like the best thing to do is explain what is expected in the beginning and and then from there it is up to the student to put in the effort or not. For those that don't seem to be interested or don't show up, I could really care less, I'll just tell them to go read in the library, heh.

Wow, I can't believe the stories of lazyness/cluelessness of those students. I don't think the worst student at my hospital even approached that.
 
For every 'medical student' horror story there is likewise no shortage of resident horror stories that medical students could relate back. Everything from being made into scut monkeys to getting yelled out. Heck, I was verbally abused by my chief resident IN FRONT OF MY PATIENT for not presenting something properly (nevermind you it was like the 2nd or 3rd day into my surgery rotation as an MS3 and I had no clue how things even worked).

I believe the resident is in a superior position in this relationship both in knowing how the system (ie, surgery) works and actually having responsibility in a day to day basis for their actions. When the resident wakes up in the morning and goes to work, there is usually a certain set of activities he needs to get acomplished before his day is done. If he finishes those activities early, great the day goes by easier and he goes home earlier. If he finishes them at 10 pm then he goes home at 10. The student on the other hand shows up with no responsibility put on his shoulders, no 'set of activities' that he needs to finish to get done, often no set of direction in his day..but is instead expected to 'want to be there' and 'learn'. I mean thats just not always realistic to expect some huge level of enthusiasm, especially when most of those students dont want to go into surgery. Its alot easier to 'want to be there' when what your doing actually has meaning and you have some goal or set of tasks to accomplish.

I cant tell you how many times I've shown up on some clerkship (not just surgery) and felt like I was having some resident tell me to do something just to find a way to 'keep me busy'..excuse me, I can find a way to keep myself busy. If they'res work to be done I'm all about getting it done. I'll never skirt responsibilities I'm given..but if theres no such of activities I'm deemed capable enough to do, I'm much able to find a better way to entertain myself on my own. As a resident, you won't have someone else telling you to do stuff just to 'keep you busy'. If there is work to be done you'll do it, if not you wont.

In my opinion the residents should be teaching students with the idea and understanding that they're at a stage of life and career where what their grade in their clerkship is or what their shelf exam score is is often more of a concern for them then what the 'differential diagnosis of a small bowll obstruction' are or even patient care. Clerkships to me where less about pure learning and more about trying to figure out what I wanted to do with the rest of my life. I had a natural curiousity about the things I learned but the hell of if I was all 'enthusiastic and happy' when asked to make a presentation on pediatrics on 'the management or asthma' or whatever. I mean lets be realistic here about what expectations we have on students..
 
I agree with a lot of what MS3er said. One of my biggest frustrations as a student was not being told what was expected of me, and then getting penalized when these unknown expectations weren't reached. My favorite residents were the ones who told me what they wanted from me, and gave me constructive feedback on what I was doing right and what I was doing wrong, taught me something relevant, and then let me go study when there wasn't anything going on. I was always happy to go do an H&P for a new patient or go on a new consult; following someone around on a call night as they wrote orders for AM labs and or fetching their dinner wasn't so helpful. St udents have tostudy for the shelf exam and that has more educational value than writing orders for AM labs.
 
I guess I've developed my own system for dealing with students. At my place they're pretty terrible. They don't preround on their own patients. They come and copy MY note on a patient. They rarely read before the OR, despite getting case assignments at least two days ahead of time. Their idea of "taking call" is to page me at 7 pm to a long distance number from their cell phone when they're at home -- "Hey, I'm taking call with you tonight. Would you mind calling me if any interesting cases come in?" My answer (as I drive from one ER to the other) is, "You bet" and I hang up the phone. Students have learned to ask to be on call with me because they NEVER get called in.

If a student reads for a case and asks intelligent questions, they're a superstar. If they page me before they leave the hospital when they're "on call", I'll let them sew. If they beat me to a patient in the morning, I worship at their feet. Otherwise, I ignore them. It's the best for both them and me.
 
ahhh .... feel my pain. and when i worte med students are soft in my blog (and residents) people got so upset. i find this totally awesome.:D
 
Sweet Tea said:
I agree with a lot of what MS3er said. One of my biggest frustrations as a student was not being told what was expected of me, and then getting penalized when these unknown expectations weren't reached. My favorite residents were the ones who told me what they wanted from me, and gave me constructive feedback on what I was doing right and what I was doing wrong, taught me something relevant, and then let me go study when there wasn't anything going on. I was always happy to go do an H&P for a new patient or go on a new consult; following someone around on a call night as they wrote orders for AM labs and or fetching their dinner wasn't so helpful. St udents have tostudy for the shelf exam and that has more educational value than writing orders for AM labs.
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Agree with above. Tell me what you expect, and I will do everything in my power to meet or exceed your expectations. Just don't expect me to be able to read your mind.

Oh, and please stop asking me to run to Starbucks for your caramel macchiato, to drop off your smelly dry cleaning, to do research for your kid's science paper, or to bring your car around because you're too tired to walk out to the garage. I don't mind doing the occasional favor, but you lose credibility and my respect when you try to tell me that's 'how we do it in medical school'.

Sorry, all, feeling a little downtrodden today.:(
 
Tired said:
Another guess: Do you have any input into final evaluations? Do your attendings care what you thought of the students?
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Actually yes...but I generally give them all good grades. I see myself as having very little ability to actually help them with evals...but too much ability to hurt them. So I try and be as benign as possible. Mind you, this is after the rotation...when the constructive criticism and call and work are all done.

And finally, I'm disillusioned about the ultimate point of my trying to motivate them to work. If they lack the self-motivation and conscience at this late juncture...they certainly aren't going to get it from my evals.

Perhaps their future attendings will drive the point home.
 
Tired said:
Another guess: Do you have any input into final evaluations? Do your attendings care what you thought of the students? I'm guessing not. If all the students who did these eggregious things failed, the word would spread and behavior would quickly change.
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While not addressed to me, thought I'd pipe up...

I've seen students kiss up to Chief residents and attendings but treat the interns pretty horribly. Perhaps they don't understand that we ask the interns and other residents on service what their experience was with Med Student X, and I take those comments seriously. After all, the med students spend more time with the interns and junior residents and tend to be less guarded in their interactions with them. Some may feel pressure from attendings or the medical school not to fail students except in the most aggregious situations.

I've been fortunate not to have the experiences that others have listed here; for the most part, my students were interested, hard-working and tuned in. There have been a few who are unable to feign interest or keep their eye-rollling or comments about "yet another hernia" to themselves, but there are always a few bad apples in each bunch.

Besides, its easy to forget what it was like to be a med student...I was probably rolling my eyes during FM when the attending kept telling me how only he, the lowly rural physician, figured out what was wrong the patient X, or how his kind kept medicine running...grass roots style...not the big-wigs at the ivory towers.:rolleyes:
 
I though I would chime in with my two cents, since I somewhat (and respectfully) disagree with some of you.

I think that med students get the most from a rotation, both in learning the actual medical knowledge as well as getting a feel for a specific field, from being a part of the team. When you are part of the team, you do what you can for that team, not necessarily what is best for you individually. Even though the residents absolutely should teach the med students, they have a long check-list of things they have to do for patient care. If they don't get these things done, at best they get reamed by their chief or attending and at worst, patient care suffers. If a med student comes along and can help the resident get some of the "less glamourous" or "less educational" tasks done, the intern/resident will finish their to-do list sooner and be more likely to sit down and teach the student something.

I came from a school where some of my classmates pulled some of the ballsy crap detailed above, so I found the residents jaded when it came to their approach to students. A sincere offer of help went a long way. I hated the busy work and the crappy admissions as much as everyone else, but hey--someone HAS to do it, and I'm willing to help. I definintely found that students who were willing to act a little less entitled were rewarded with more teaching, good cases and got to know the residents better--which meant the rotation went better in the long run.

Med students need to remember that unlike the first two years, where the primary focus for the vast majority of faculty was to educate students, this is not the case on the wards--real patients are really sick and real doctors are doing real treatments, and the med student is along for the ride. Just because you are paying tuition does not mean you get to dictate how things are going to run.
 
IFNgamma said:
I think ideally the resident-student interaction should be mutually beneficial to both. The resident would want some good help from the student while the student expects to learn something in return for doing the scutwork, of course that doesn't always happen (sad to say, but usually the resident doesn't fulfill his/her end of the bargain :p). So how to handle them? What are some of the things you have done to make it a positive experience for the student and at the same time getting some good free help?

And is it the responsibility of the intern to teach the students or is it the more senior residents' responsibility?
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You have been a med student not too long ago...so just ask yourself what would want as a student...and just do it with what you want...if as a student you wished to be treated nice...then you should treat your student nice as well.

Or maybe you can ask what you liked the attending to do for you? and you can do the same for the student.
 
Bitsy3221 said:
Med students need to remember that unlike the first two years, where the primary focus for the vast majority of faculty was to educate students, this is not the case on the wards--real patients are really sick and real doctors are doing real treatments, and the med student is along for the ride. Just because you are paying tuition does not mean you get to dictate how things are going to run.
Click to expand...

i think bitsy hit the nail on the head head. something that i have noticed, and this also goes for some residents, is that in some way the learner (student) feels s/he knows more of what they need to learn that he educator (resident/attending). understand that the clinical years are for learn how to do "patient care," this requires a number of things be learned. how can someone who has not yet rendered patient care know what information is needed so that they may adequately perform patient care. how can the student tell the educator whether or not something is a good teaching case?

i think that many people (med studs and residents) feel that magically when they are done, they will know how to provide got patient care. oh contraire mon frair. part of giving patient care is understanding the logistics of your hospital, the roles of the care givers, how do "work the system", so that your patient's care is not compromised. as surgeons, most if not all have at some point run blood to the lab for a stat order, taken patients from the ER to the OR, and even helped clean the OR to get cases moving. these are not tasks in my job description, but sometimes are necessary in the care of patients. these are not things that can be learned in a text book or are tested in a shelf exam.
 
Tired said:
So either your stories are exagerated, or you are a big pushover.

Either way, don't impotently complain about your students behavior if you're not making your expectations clear or backing up your words with actions.
Click to expand...

I'm a pushover, and I make my expectations clear.

I retain the right to complain. I just don't have a malignant streak in me, and see precious little to be gained by raping people on evaluations.
 
Basically, I treat medical students as future colleagues. If I have some isssues/am pissed off, I will point out to them right away. However, I hate to put it in writing on their evaluations. I guess I always give my medical students good evals as long as they show up on time and are respectful to patients and the team. I know I am a pushover but I just do not think a maligant eval will gain both him and me anything.

Moreover, remember what goes around comes around. You never know what will happen in future. A MS3 right now might be you future boss in 20 years.

Treat anyone respectfully and do not be maligant.
 
One interesting thing I heard from a chief resident was that she always passes her students, and the lowest grade she ever gave out was a C, and she really hated that guy and he was simply terrible. The reason she didn't give him an F even though he deserved it was cuz if she did, he would have to repeat the rotation, and she would have to deal w/ him again.

One other thing I'm wondering about is whether student evaluation of the residents matter at all. Have any resident been told by the PD or chairman "you are not doing a good job w/ the students" or "this student complained you mistreated him/her"? I wrote some not so good things about some OB residents at my hospital but evidently nothing happened, since all the students continue to complain about the same residents.
 
It seems that many students have a sense of entitlement. If they are not taken aside, and spoon-fed instructions/information, then they feel as if they are being ignored. Occasionally I meet medical students who actually pay attention to their surroundings. They notice things like: dressings come off on pod #2, and the foley comes out on pod#1, etc... These students just watch and learn, and then start doing stuff. They actually read about cases/problems on their own at home, and don't depend on an overworked intern to walk them through everything.

My reaction to entitled students ("page me if anything interesting comes up") is to ignore them. My reaction to interested students is to include them as much as I can on anything we're doing.

It does seem like we are getting more and more entitled types, but then, maybe it has always been that way and I just notice it because I am on the resident side.
 
MS3er said:
In my opinion the residents should be teaching students with the idea and understanding that they're at a stage of life and career where what their grade in their clerkship is or what their shelf exam score is is often more of a concern for them then what the 'differential diagnosis of a small bowll obstruction' are or even patient care. Clerkships to me where less about pure learning and more about trying to figure out what I wanted to do with the rest of my life. I mean lets be realistic here about what expectations we have on students..
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Sorry, i couldn't keep my mouth shut any longer and had to respond to this.

This attitude above is what really annoys me about clerks. They are about to be given a doctorate degree and become a medical doctor. Clerkship is not about trying to figure out what they want to do for the rest of their life. It's an integral part of their medical education. It's where they are supposed to extrapolate from their basic book knowledge and apply it to real patients. For some people it's their only exposure to certain specialties in their entire career.

STudy for your exam on your own time. Take advantage to any teaching the residients are doing. When you are out in family practice in 5 years and you're faced with a SBO you might appreciate that lecture that the resident gave, and your shelf mark won't really help you at that point. This isn't a trade school - you aren't spoon fed what you need to pass the exam and that's it. This is medical school.
 
tussy said:
Sorry, i couldn't keep my mouth shut any longer and had to respond to this.

This attitude above is what really annoys me about clerks. They are about to be given a doctorate degree and become a medical doctor. Clerkship is not about trying to figure out what they want to do for the rest of their life. It's an integral part of their medical education. It's where they are supposed to extrapolate from their basic book knowledge and apply it to real patients. For some people it's their only exposure to certain specialties in their entire career.

STudy for your exam on your own time. Take advantage to any teaching the residients are doing. When you are out in family practice in 5 years and you're faced with a SBO you might appreciate that lecture that the resident gave, and your shelf mark won't really help you at that point. This isn't a trade school - you aren't spoon fed what you need to pass the exam and that's it. This is medical school.
Click to expand...

I agree with most everyone's points regarding overly-entitled 3rd and 4th year medical students. I was fortunate not to be at a school where this was overtly rampant. It would benefit everyone if all students went into rotations with the attitude that this is something that will complement their careers in the future and not a chore that is being forced down upon them. If they always knew they wanted to be a Psychiatrist, but the thought of doing internal medicine, surgery, gross anatomy, etc repulses them -- then they shouldn't go to medical school because the curriculum is what it is. They would be better served getting a MS or PhD in Psych and avoiding doing things that they are not mentally prepared for -- and in conjunction making the experience for the associated interns, residents, students and attendings much better. (This sort of editing during the application and interview process for medical education is sadly lacking and obscurred by numbers (grades, MCATS, etc.))

However, strictly speaking, professional schools are trade schools by definition. The US and Canada are the only countries where law and medicine are "elevated" to the rank of doctoral/graduate programs.

But back to the issue at hand. The only thing, we, as interns and residents can do. Is try to make our craft interesting. If they don't want to learn, or help, there is very little we can do other than try to effect the type of students that come into medicine.
 
I want to know what med school lets students NOT preround!!! I never had more than 9 patients at a time but one of my classmates regularly prerounded on as many as 15 by 6am! I think it is as one of the posters mentioned - us MS3s will work our asses off if we feel like a useful part of the team (even though no one is less interested in surgery than I am). I knew my resident wouldn't double check labs and frankly didn't see patients if I said they were doing well so I made sure to get things right. Of course there were no interns at the hospital where I rotated for general surgery and I never saw an attending outside the OR... I am sure it was all a lawsuit waiting to happen but it was educational.
 
tussy said:
Sorry, i couldn't keep my mouth shut any longer and had to respond to this.

This attitude above is what really annoys me about clerks. They are about to be given a doctorate degree and become a medical doctor. Clerkship is not about trying to figure out what they want to do for the rest of their life. It's an integral part of their medical education. It's where they are supposed to extrapolate from their basic book knowledge and apply it to real patients. For some people it's their only exposure to certain specialties in their entire career.

STudy for your exam on your own time. Take advantage to any teaching the residients are doing. When you are out in family practice in 5 years and you're faced with a SBO you might appreciate that lecture that the resident gave, and your shelf mark won't really help you at that point. This isn't a trade school - you aren't spoon fed what you need to pass the exam and that's it. This is medical school.
Click to expand...

In an ideal world what your saying would be true, but I don't believe that to be the reality the majority of the time. I believe the purpose of rotations is to get a gestalt of what being a doctor is about and what people do in different specialities, though I'm not sure I quite agree that the large majority of the 'medical facts' that I learned on many of my rotations I won't just end up forgetting because I am going into a different speciality where I won't encounter that. I mean really, how many chief residents here could rattle off to me the developmental milestones for kids the first 5 years of life? Or, the different classifications and subtypes of schizophrenia and the criterias for each? Probabably not most.

I would venture to suggest that if we took an informal poll of attendings or residents and asked if they remembered their clerkship years of medical school as being such an 'amazing, gratyifying, learning experience' that 'helped shape the doctors they are today' and 'greatly contributed' to their understanding of medicine, I just dont think most would say yes. In my opinion clerkships are a time when as students you have time to talk to patients, develop those communication skills that open, no-responsibility sorta situation allows. But just the nature of being a student, ones mind is often not very far away from grades, shelf exams etc. That mentality only starts to change in most I think as your ending medical school and beginning residency, when you begin to see your PURPOSE of being at work to help patients.

As a student, if I'm not at work one day or if I don't know something, very rarely has that ever hurt a patient or been a barrier to patient care. On the other hand if a resident is not at work one day or doesn't know something he should, patient care suffers. As a medical student I'd be the first to say that I didn't read all that much for shelf exams or during clerkships..as I much hated studying for the sake of some grade or number (lol and my clerkship grades generally reflected that). But the last few months I've found myself reading more and more on my own when we don't really have any exams that are forcing me to..mostly because i'm scared crapless of the idea of doing something that might hurt a patient when I do have actual patient care responsibility come july. So we shouldn't underestimate what effect having actual responsibility toward patients has on a person's motivation to learn for the sake of learning (as opposed to learning for the sake of some exam).
 
MS3er said:
In an ideal world what your saying would be true, but I don't believe that to be the reality the majority of the time. I believe the purpose of rotations is to get a gestalt of what being a doctor is about and what people do in different specialities, though I'm not sure I quite agree that the large majority of the 'medical facts' that I learned on many of my rotations I won't just end up forgetting because I am going into a different speciality where I won't encounter that. I mean really, how many chief residents here could rattle off to me the developmental milestones for kids the first 5 years of life? Or, the different classifications and subtypes of schizophrenia and the criterias for each? Probabably not most.

I would venture to suggest that if we took an informal poll of attendings or residents and asked if they remembered their clerkship years of medical school as being such an 'amazing, gratyifying, learning experience' that 'helped shape the doctors they are today' and 'greatly contributed' to their understanding of medicine, I just dont think most would say yes. In my opinion clerkships are a time when as students you have time to talk to patients, develop those communication skills that open, no-responsibility sorta situation allows. But just the nature of being a student, ones mind is often not very far away from grades, shelf exams etc. That mentality only starts to change in most I think as your ending medical school and beginning residency, when you begin to see your PURPOSE of being at work to help patients.

As a student, if I'm not at work one day or if I don't know something, very rarely has that ever hurt a patient or been a barrier to patient care. On the other hand if a resident is not at work one day or doesn't know something he should, patient care suffers. As a medical student I'd be the first to say that I didn't read all that much for shelf exams or during clerkships..as I much hated studying for the sake of some grade or number (lol and my clerkship grades generally reflected that). But the last few months I've found myself reading more and more on my own when we don't really have any exams that are forcing me to..mostly because i'm scared crapless of the idea of doing something that might hurt a patient when I do have actual patient care responsibility come july. So we shouldn't underestimate what effect having actual responsibility toward patients has on a person's motivation to learn for the sake of learning (as opposed to learning for the sake of some exam).
Click to expand...

I Agree. It is hard to really care for a patient when you are very limited in what you are allowed to do. Heck, most times my H & Ps and progress notes are not even looked at (I am a 4th year). You will learn only when you are given responsibility and are in the front lines. As far as medical students, well, I think it is important to provide them with structure and let them know of what you expect of them, especially the first day. If they abide, then you can teach them more and get them more involved, if they don't, they are adults and let them screw off. Spoon-feeding is a big no no. It should be up to the student to be agressive and seek out opportunities to learn. They should also be the ones to approach residents after two weeks and ask how they are doing. As far as evals, students should be evaluated very honestly. If I have a star Sub I and a not so star Sub I, it is to the benefit of both to be honest with them. I don't think evlas should be used as paybacks under any circumstance.
 
maxheadroom said:
Their idea of "taking call" is to page me at 7 pm to a long distance number from their cell phone when they're at home -- "Hey, I'm taking call with you tonight. Would you mind calling me if any interesting cases come in?" My answer (as I drive from one ER to the other) is, "You bet" and I hang up the phone. Students have learned to ask to be on call with me because they NEVER get called in.
Click to expand...

How is this even possible? You'd think the resident was working for them or something. My first day on surgery I got a call schedule and directions to the ED. If I didn't see all the patients that came in on my night I'd get reamed by the attending, pure and simple. And what the hell is up with "interesting cases?" It always pissed me off when I was assigning the OR cases and my classmates would complain that they weren't getting any interesting cases. I understand that we'd all like some excitement but the dude with the appendicitis needs medical help, even if you've scrubbed in on 2 of them (shock!) in the last week.

I think that it highly disrespectful and if I was the intern/resident then I'd have to pull the student aside and talk about it. If things didn't change then someone would have a bad eval waiting. Students should always be respectful no matter if the person is an attending or a brand new intern. It's just the principle.

Still I shouldn't complain too loud cause I've pulled some of this shady stuff myself. Like paraphrasing the EM doc's history (by which I mean, standing beside him as he sees the patient instead of taking my own) and lying about how long a lecture is supposed to be. I'm not proud of it but it happened.
 
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