Attending/resident from hell horror stories

[SouthernSurgeon]

Fair point. I guess I am focused on the first few weeks as those are supposedly the hardest weeks of a new internship/residency/job/fellowship/etc.

The anesthesia programs I'm familiar with (which is admittedly limited) all make the same assumption I mentioned above - that incoming residents know pretty much zilch. They start their year with a formal boot-camp training program with didactics and skills teaching, as well as direct supervision by a senior resident in the OR until they are comfortable.

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[neutropeniaboy]

However, quick question - Do you think it is important for med students (especially future ER/Anesthesia/ENT residents but across all fields) to learn (and practice) how to intubate and/or bag-mask ventilate while they are in medical school?

I think it is great if they do, but I don't think it's critical. Your inter year is specifically designed to help you acquire the foundation of basic skills.

I really have no expectations of interns. I assume they don't know much and have little experience. Frankly, that doesn't bother me in the slightest since internship and residency are created for the acquisition of skills and advanced, specialized medical knowledge.

So, if a pgy-1 is on the ENT service and knows how to intubate, that's great. If not, there is plenty of time to learn that skill.

I'm not of the opinion that medical students should be seen not heard, but after the patient, I need to ensure that my resident is competent. After that, I don't mind letting the medical students get engaged if it is commensurate with their previously demonstrated knowledge. That is to say that if a medical student wants to close the incision but doesn't know anything about the anatomy or dozed off during my mastoidectomy, he's not going to be asked if he wants to close the incision.

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[neutropeniaboy]

I really don't think its that hard to change: just add mandatory minimum numbers of procedures to medical school like you have for Intern year.

Have you ever sat on a medical school committee, a subspecialty committee or an ACGME committee?

I do all three.

This will never happen as you suggest. You just don't "add mandatory minimum numbers" to a medical school curriculum. Given the wide array of opportunities, grading systems, rotations, available academic departments, RRC regulations, ACGME regulations, credentialing committee requirements, malpractice considerations and patient factors to name a few, you would have to demonstrate first that your mandatory requirement is even feasible let alone necessary in today's medical system.

... nvm

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[neutropeniaboy]

However, it seems like some attendings who post on this forum want to have their cake and eat it too. They want interns to come in with experience with basic procedures but don't want to allow their medical students to actually learn (and practice) how to do those procedures.

Who said this?



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[Top Gun]

For the med students, the bottom line is this:

Yes, you should be allowed to at least attempt procedures such as intubation. But after the med student has tried twice, and not succeeded, there comes a point when its time to stop screwing around and get the job done. Remember, these are people's lives at stake, and its the attending's a$$ on the line if a mishap occurs, not yours! You will have many other opportunities to practice procedures, whether in the same rotation or your future residency program. As an intern, you're not going to be thrown to the sharks. You will practice procedures under supervision by an attending or your senior until you become comfortable.

 

[neutropeniaboy]

I think some things are being lost here on this thread as they usually do. It started with some OPs who basically felt entitled to do something simply because they were on a rotation. That sort of narcissism will get you shot down every time.

The larger concept here is medical education in general and preparation for the future.

Students are generally excited and want to learn and get experience. I get that. I was there. Good on ya for being involved.

The issues are bigger than that, and they begin with the patient and move down the resident chain until the student is reached.

While I agree that snatching something from a medical student is usually unnecessary, I will say that snatching is occasionally needed for a plethora of reasons.

Much if what medical students learn is of no use to them. I did dozens of LPs on my neurology rotation. Never did one as an intern or resident. I suppose I could fumble through one now... But why would I? Never did a single central line as a medical student, but I did 100 or more as an intern. Haven't done one since and don't care to. I wouldn't know how to remove an appendix if my life depended on it since I never did one. Now, one could argue that some of these are basic skills that I should know and that way back when I didn't know what I would be in the end, but as some of the others have stated here, there will be a definitive time for you to acquire what you need to be a successful physician, regardless of your specialty.

Some things don't turn out the way you think they will, and I can guarantee you that your time will come. And when it does come, and if it's with me, I'll have no expectations and give you your shot. But, I'll be watching.

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[Jorts]

I think some things are being lost here on this thread as they usually do. It started with some OPs who basically felt entitled to do something simply because they were on a rotation. That sort of narcissism will get you shot down every time.

The larger concept here is medical education in general and preparation for the future.

Students are generally excited and want to learn and get experience. I get that. I was there. Good on ya for being involved.

The issues are bigger than that, and they begin with the patient and move down the resident chain until the student is reached.

While I agree that snatching something from a medical student is usually unnecessary, I will say that snatching is occasionally needed for a plethora of reasons.

Much if what medical students learn is of no use to them. I did dozens of LPs on my neurology rotation. Never did one as an intern or resident. I suppose I could fumble through one now... But why would I? Never did a single central line as a medical student, but I did 100 or more as an intern. Haven't done one since and don't care to. I wouldn't know how to remove an appendix if my life depended on it since I never did one. Now, one could argue that some of these are basic skills that I should know and that way back when I didn't know what I would be in the end, but as some of the others have stated here, there will be a definitive time for you to acquire what you need to be a successful physician, regardless of your specialty.

Some things don't turn out the way you think they will, and I can guarantee you that your time will come. And when it does come, and if it's with me, I'll have no expectations and give you your shot. But, I'll be watching.

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I do appreciate this post, even if I disagree with your stance on intubation per say as there are lots of procedures that I will never do in my career so why do them in medical school and put the patient in harm? For instance, I knew I never wanted to be a surgeon, and although I enjoyed scrubbing in to see stuff I will never see again, I really had no desire to be too involved. However, there is something to be said for a broad education and learning a broad set of skills. And yes the patient comes first, however, at teaching hospitals education is just as important. If patients dont want med students/residents in their care or attendings dont want medical students and/or residents then they should go to non-teaching hospitals (There are also attendings at my hospitals who use residents to put in orders/write notes and teach them nothing/let them do nothing - prominent when I was on my surgery rotation. These people should get NPs and stop working on a teaching service). The point is medical education has gone downhill and we are not being trained as well as in the past.

Now to intbuation and airway management, I believe this is a skill ALL physicians should know, even if one ends up in dermatology. You are still a doctor and these are skills everyone should be able to perform if the situation arises. When I was on my ED rotation, an ENT attending was evaluating a patient in the ED (forget what for?) and the patient coded. The attending yells "I need a doctor in here, this patient is in cardiac arrest" At which point the ER docs come to run ACLS in as the ENT stands back. Think if this wasn't in the ER, and he had to run the show.

 

[neutropeniaboy]

And yes the patient comes first, however, at teaching hospitals education is just as important. If patients dont want med students/residents in their care or attendings dont want medical students and/or residents then they should go to non-teaching hospitals

Education is very important, but I'm sorry, it's not equally important. It's just not. You're a fool if you think that's the case.

With respect to teaching hospitals, I used to think as you do. You'll find that being awarded the status of "teaching hospital" is very easily acquired and loosely applied. As for patients who come to teaching hospitals, you'll find that most patients don't go to them. Most don't go for various reasons, and the possibility of having a medical student or resident work on them is one of the reasons. Furthermore, there are many people who have no option other than to go to a teaching hospital - no insurance, bad insurance or complicated medical history or procedures. And as far as I can tell, there's nothing in my hospital's bylaws or on any consent from that they MUST allow residents and students to work on them. It's implied and stated in our consents, but patients have the right to refuse care. I get around this by refusing to operate on people (elective procedures) if they don't consent to resident care. If it's an emergency and they refuse, I usually get around this as well by reminding them that I'm not going to be there 24 hours a day and that if care is needed a resident will perform it.

Things just not as simple as you lay them out. I hate saying that because I hate it when people say that to me, but you're just not seeing things as they are.

The attending yells "I need a doctor in here, this patient is in cardiac arrest" At which point the ER docs come to run ACLS in as the ENT stands back. Think if this wasn't in the ER, and he had to run the show.

Heh. Sounds like something I would yell...

Remember your story (and your implied disapproval) 20 years from now when a patient is in dire straights and you don't know what to do (but I'm sure you will be able to handle it).


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[Jorts]

Education is very important, but I'm sorry, it's not equally important. It's just not. You're a fool if you think that's the case.

With respect to teaching hospitals, I used to think as you do. You'll find that being awarded the status of "teaching hospital" is very easily acquired and loosely applied. As for patients who come to teaching hospitals, you'll find that most patients don't go to them. Most don't go for various reasons, and the possibility of having a medical student or resident work on them is one of the reasons. Furthermore, there are many people who have no option other than to go to a teaching hospital - no insurance, bad insurance or complicated medical history or procedures. And as far as I can tell, there's nothing in my hospital's bylaws or on any consent from that they MUST allow residents and students to work on them. It's implied and stated in our consents, but patients have the right to refuse care. I get around this by refusing to operate on people (elective procedures) if they don't consent to resident care. If it's an emergency and they refuse, I usually get around this as well by reminding them that I'm not going to be there 24 hours a day and that if care is needed a resident will perform it.

Things just not as simple as you lay them out. I hate saying that because I hate it when people say that to me, but you're just not seeing things as they are.



Heh. Sounds like something I would yell...

Remember your story (and your implied disapproval) 20 years from now when a patient is in dire straights and you don't know what to do (but I'm sure you will be able to handle it).


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I do think thats the case because without good education then patient care suffers as we are not trained up to par. Remember med students and residents become attendings and then are responsible for the patient. If they are not trained as well as they should be then all their patients they are now solely responsible for will will have worse outcomes than someone that recived better training. Therefore there is a direct correlation between education and improved patient care. Teaching hospitals actually have better outcomes than non-teaching hospitals. You would think that with all those damn residents/med students messing up they would be worse?

In my short 2 years on the wards there has been only 1 patient that has refused residents/med students (this was in the ICU, and it was mainly the patients family). The attending was furious and basically told them, like you said above they would not be in house 24/7 and the resident was their doctor and would be taking care of them.

 

[VisionaryTics]

. When I was on my ED rotation, an ENT attending was evaluating a patient in the ED (forget what for?) and the patient coded. The attending yells "I need a doctor in here, this patient is in cardiac arrest" At which point the ER docs come to run ACLS in as the ENT stands back. Think if this wasn't in the ER, and he had to run the show.

This is just a stupid story. I'm sure if the patient coded from local anesthestic toxicity in an outpatient clinic, the ENT attending could probably do chest compressions and slap some AED pads on there. But this happened in a room where there were probably a dozen physicians within 50 yards that could run ACLS in their sleep, while most ENTs have never run a code.

Let's flip the example. Let's say the ENT attending was finishing a consult note on a COW outside a room where a patient with angioedema obstructs and can't be oxygenated. ED attending tries to tube and sees nothing. Would you think he was a lesser physician if he called the ENT attending in to get a surgical airway?

 

[MerickManual]

I would think calling out that the patient is coding is a good thing, since you can't resuscitate a patient by yourself anyways?

 

[pianoman511]

No, the ED physician would perform the surgical airway as they were trained to do.

 

[VisionaryTics]

No, the ED physician would perform the surgical airway as they were trained to do.

That's why I chose that example. The ED physician is trained to obtain a surgical airway and could, but would likely defer to the dedicated airway surgeon 10 feet away.

 

[pianoman511]

Doubt it if the patient is crashing the ER doc would do the cric at bedside. ENT docs are not "airway surgeons". A surgical tracheostomy is an elective case which a general surgeon is more than capable of doing.

 

[neutropeniaboy]

No, the ED physician would perform the surgical airway as they were trained to do.

Your answer is non sequitur.

Nevertheless, I suspect a well-trained EM physician would have performed a cricothyrotomy had no otolaryngologist been there. In my experience, when a more qualified physician is present during any type of situation, most reasonable physicians defer to the one with the most experience. I've been put into situations during which I had to perform an intubation and have always handed it over to the anesthesiologist to do when they are present. I recall once last year one of my patients coding and we all started ACLS on the patient and since the patient was already intubated, airway wasn't an issue. Had to put in a central line, and as I was in the process of starting this, the MICU resident arrived and I asked her to take over the line, which she did. I have no ego about this stuff any more. Some people do many things better than I.

It's just common sense: When someone with more experience is around you, especially in an emergency situation, you let the more experienced person do it.

BTW: Survey says...

Now your turn to find me something that's to the contrary.

 

[neutropeniaboy]

Doubt it if the patient is crashing the ER doc would do the cric at bedside. ENT docs are not "airway surgeons". A surgical tracheostomy is an elective case which a general surgeon is more than capable of doing.

This is one of the most ridiculous things I have ever read on this forum.

 

[pianoman511]

An ER physician is just as capable as an ent to perform an emergency cric.

 

[neutropeniaboy]

An ER physician is just as capable as an ent to perform an emergency cric.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876318/pdf/wjem-14-654.pdf

 

[pianoman511]

OK... So if ER residents cric a cadaver they feel more comfortable... That proves what?

 

[neutropeniaboy]

OK... So if ER residents cric a cadaver they feel more comfortable... That proves what?

This is off topic, but doing a procedure on a bloodless cadaver or a dead person is not anywhere as emotional as doing one on a crashing patient. The point of the articles are that experience with surgical airways, for whatever reason, is declining. I can imagine that doing a procedure on a cadaver makes one more comfortable; I did plenty of ear and skull base procedures on cadavers to perfect my skill, but as we all know, doing it on a real person is quite a different thing.

 

[pianoman511]

Agreed, but I would venture a guess, as a pub med search does not reveal a direct comparison, that EM physicians perform not ready emergent surgical crics than ent surgeons.

 

[SouthernSurgeon]

An ER physician is just as capable as an ent to perform an emergency cric.

This is truly one of the dumbest things I have ever seen on this forum

 

[Siggy]

If patients dont want med students/residents in their care or attendings dont want medical students and/or residents then they should go to non-teaching hospitals

The assumption that patients always have a choice is false. My county teaching hospital is the only burn center for the largest county by area in the US (which, per Wikipedia, is larger than 7 individual states, the 4 smallest states combined, and 71 different countries). It also, IIRC serves other counties nearby that lack burn centers. It's one of the major trauma centers and splits patients with the local university trauma center. We often had patients transferred to us from remote mountain hospitals who might simply not have any EM trained physicians in the ED and felt uncomfortable doing some procedures that should be standard for any residency trained EM physician.

...but your right, they should just die instead of coming to the big county hospital that also has a ton of residents and medical students.

Now to intbuation and airway management, I believe this is a skill ALL physicians should know, even if one ends up in dermatology.

Airway? Yes. you should be able to hand a BVM and an NPA to any physician and get comptent care until paramedics arrive (yes... I know... not all areas have paramedics). Maintain intubation skills? Um, sorry, but the physicians who don't regularly intubate are going to be dangerous when trying to intubate the cardiac arrest patient when the physician's last intubation was a decade ago. Heck, paramedics are having issues with intubations due to skill dilution (too many medics, not enough intubation), and intubation is much more pertinent to their job than the dermatologist.

You are still a doctor and these are skills everyone should be able to perform if the situation arises. When I was on my ED rotation, an ENT attending was evaluating a patient in the ED (forget what for?) and the patient coded. The attending yells "I need a doctor in here, this patient is in cardiac arrest" At which point the ER docs come to run ACLS in as the ENT stands back. Think if this wasn't in the ER, and he had to run the show.

So a non-emergency physician seeing a patient in a department dedicated to emergencies and surrounded by people who's job is taking care of emergencies engages the experts in emergencies when an emergency occurred? Sounded like the physician made a timely stat consult when he knew that his knowledge base and skill set wasn't the best for the patient at that exact time.

In regards to the office? What's the number for 911 again? Knowing when and how to call for help is the most important skill any physician can have.

 

[calvnandhobbs68]

Doubt it if the patient is crashing the ER doc would do the cric at bedside. ENT docs are not "airway surgeons". A surgical tracheostomy is an elective case which a general surgeon is more than capable of doing.

An ER physician is just as capable as an ent to perform an emergency cric.

lol wut

Oh yeah thats why they overhead page EM or gen surg not otolaryngology when they need a surgical airway. Kind of how they page EM not anesthesiology when they need an intubation.

 

[KnuxNole]

There are a LARGE amount of doctors who I would never, ever expect to know how to intubate, especially if they never go near a hospital.

 

[Top Gun]

An ER physician is just as capable as an ent to perform an emergency cric.

This has got to be the most absurd statement I have ever read on SDN.

 

[Winged Scapula]

lol wut

Oh yeah thats why they overhead page EM or gen surg not otolaryngology when they need a surgical airway. Kind of how they page EM not anesthesiology when they need an intubation.

They page those specialties because:

1) EM is more easily available than anesthesiology (who may be not be readily able to leave the OR)

2) there are more general surgeons around than ENTs.

The above is exactly why the "code team" at many community hospitals exists not of Anesthesia and Surgeons but ED personnel.

An ER physician is just as capable as an ent to perform an emergency cric.

Yeah. That just isn't true. Surgical airways aren't all that common and you can bet that the physician who is an expert in head and neck anatomy and surgical management of the neck is going to be a lot more experienced.

 

[calvnandhobbs68]

lol wut

They page those specialties because:

1) EM is more easily available than anesthesiology (who may be not be readily able to leave the OR)

2) there are more general surgeons around than ENTs.

The above is exactly why the "code team" at many community hospitals exists not of Anesthesia and Surgeons but ED personnel.



Yeah. That just isn't true. Surgical airways aren't all that common and you can bet that the physician who is an expert in head and neck anatomy and surgical management of the neck is going to be a lot more experienced.

Sorry, sarcasm doesnt translate well on the internet...I tried with the "lol wut". They most certainly do page the specialties I mentioned at my hospital.

 

[Winged Scapula]

Sorry, sarcasm doesnt translate well on the internet...I tried with the "lol wut". They most certainly do page the specialties I mentioned at my hospital.

Ah...That was probably perfectly clear. I just missed it after a long day in the office.

 

[Armadillos]

As a medstudent one of our anesthesia attendings made a big point of saying that medstudents/interns get way to gung-ho to intubate, basically said in most cases unless your intubating several people a week its much better to just bag mask until someone who intubates "for a living" can show up. So on my rotation I mostly bag masked and did a couple of intubations on easy patients but attending was always reminding me that doing a couple intubations on surgical patients means nothing about my ability to do something more emergent 2 years from now.

 

[SouthernSurgeon]

As a medstudent one of our anesthesia attendings made a big point of saying that medstudents/interns get way to gung-ho to intubate, basically said in most cases unless your intubating several people a week its much better to just bag mask until someone who intubates "for a living" can show up. So on my rotation I mostly bag masked and did a couple of intubations on easy patients but attending was always reminding me that doing a couple intubations on surgical patients means nothing about my ability to do something more emergent 2 years from now.

Learning effective bag-masking technique is an extremely underrated (and overlooked) skill

 

[Siggy]

Learning effective bag-masking technique is an extremely underrated (and overlooked) skill

...and when the fecal matter hits the rotary air accelerator, if someone can take over simply holding a mask seal it becomes an extremely useful skill for a medical student to have.

 

[e30ftw]

As a pgy-2 EM resident, if I needed an emergent surgical airway and an ENT resident/attending happened to be hanging out at the COW outside the door I would buy him a bottle of 30 year old single malt for christmas after he cric'd my patient..

cric is a procedure we train for on models but (hopefully) rarely get the opportunity to perform. I would never perform this procedure if anyone more experienced were present.

Unfortunately there is about a 0.01% chance of ENT being there at 0300 in the community when your patient is blue, bradycardic and you can't ventilate/can't intubate.

 

[alpinism]

Lets be honest though, unless you're at an knife/gun club county hospital most ENT attendings (and GS/EM) haven't done more than a handful in their career. They sure as hell don't have one every month at my shop.

Obviously ENT is the expert on airway anatomy and surgical procedures.

However, FWIW I'd rather have the person with the most experience doing the procedure.

 

[sylvanthus]

I have to disagree with some of the attendings on here acting like an intubation in a controlled environment is an extremely complicated procedure. Yes, the **** COULD hit the fan, but come on, how common? If we acted like only the most senior, experienced person could and should do procedures for the patient's own safety, people less experienced would never learn and would never be allowed to perform any procedure if someone more senior and experienced were around.

Hell, paramedic students for crying out loud would go into the OR I trained at as a medical student and intubate. I did 50+ in a month as a 4th year. Lets tone it down a bit on the whole controlled intubation is god awful complicated drama a bit.

 

[evilbooyaa]

I think it is great if they do, but I don't think it's critical. Your inter year is specifically designed to help you acquire the foundation of basic skills.

I really have no expectations of interns. I assume they don't know much and have little experience. Frankly, that doesn't bother me in the slightest since internship and residency are created for the acquisition of skills and advanced, specialized medical knowledge.

So, if a pgy-1 is on the ENT service and knows how to intubate, that's great. If not, there is plenty of time to learn that skill.

I'm not of the opinion that medical students should be seen not heard, but after the patient, I need to ensure that my resident is competent. After that, I don't mind letting the medical students get engaged if it is commensurate with their previously demonstrated knowledge. That is to say that if a medical student wants to close the incision but doesn't know anything about the anatomy or dozed off during my mastoidectomy, he's not going to be asked if he wants to close the incision.

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Fair stance. I get having to educate the resident first, but if the Anes resident is in the final year of residency, would doing an additional 10-20 surgical intubations really make a difference in their learning? I just got the feeling that the Anes attendings who didn't want to let me even have a shot at intubating (on easy cases) was just trying to move things along (even if the case was starting right on time or the surgery team had just gone to scrub).

Who said this?



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No one on this thread. Just stuff I've picked up from previous threads, mainly in the EM forums (as I read them from time to time).

As to the discussion about EM vs ENT for a cric... I'd probably want an ENT if possible.

 

[JustPlainBill]

Jorts, with your limited experience doing just about everything that has to do with medicine, I think I'll rely on my acquired knowledge and experience as a teaching physician - who above all else has the patient's best interest in mind - to judge who has the privilege to perform any procedure on my patients when in front of me.

It's funny: I know a lot of your professed great teaching physicians (i.e., not the "crazy" ones like me who shouldn't be in a teaching institution) who pull me aside when they are having surgery to request that no students or residents touch them.

Yes, medical students need to acquire skills, but not before I've judged my residents to be competent and never for the sake of "practice" or if I deem the situation unsuitable for a student.

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OP -- You need to face the fact that you are on the bottom of the food chain so to speak and any procedures your attending lets you attempt need to be regarded as a gift. If he/she stops you after you attempt, it's their call and that does not mean they are "mean". That's why 3rd and 4th year rotations are called "Clerkships" -- you are a freakin' clerk, sent to scribe notes, learn by observation and get the coffee/donuts -- anything else you do is a gift -- and don't get the idea that you "manage" patients -- you don't.

You will get your opportunities for procedures that you need in your chosen speciality during residency -- not having intubations the first day likely will not be a deficiency and if so, that's what senior residents are there for -- to teach you -- you may be dumped in the deep end of the pool but generally seniors won't let you kill anyone unless you get stupid and go off the reservation by yourself.

And like the post quoted above -- there's no way in hell I'm letting a med student participate in any part of my therapy other than to stand there, shut up and listen. I've seen a whole lot of interns cowboy up and luckily their seniors were able to stop them before they upgefucht a patient ---

 

[Siggy]

and don't get the idea that you "manage" patients -- you don't.

[pedantic]
I thought the whole point of clerkships was to learn how to [air quotes]"manage patients" [/air quotes][/pedantic]

Granted [airquotes]"managing patients"[/airquotes] and managing patients are two completely different things.

 

[Bacchus]

The CRNA wouldn't even let me stand at the head of the bed today .

 

[calvnandhobbs68]

OP -- You need to face the fact that you are on the bottom of the food chain so to speak and any procedures your attending lets you attempt need to be regarded as a gift. If he/she stops you after you attempt, it's their call and that does not mean they are "mean". That's why 3rd and 4th year rotations are called "Clerkships" -- you are a freakin' clerk, sent to scribe notes, learn by observation and get the coffee/donuts -- anything else you do is a gift -- and don't get the idea that you "manage" patients -- you don't.

You will get your opportunities for procedures that you need in your chosen speciality during residency -- not having intubations the first day likely will not be a deficiency and if so, that's what senior residents are there for -- to teach you -- you may be dumped in the deep end of the pool but generally seniors won't let you kill anyone unless you get stupid and go off the reservation by yourself.

And like the post quoted above -- there's no way in hell I'm letting a med student participate in any part of my therapy other than to stand there, shut up and listen. I've seen a whole lot of interns cowboy up and luckily their seniors were able to stop them before they upgefucht a patient ---

This is the kind of d*ck attitude of the residents that all the medical students hate. Thanks for being "that guy".

 

[Bacchus]

OP -- You need to face the fact that you are on the bottom of the food chain so to speak and any procedures your attending lets you attempt need to be regarded as a gift. If he/she stops you after you attempt, it's their call and that does not mean they are "mean". That's why 3rd and 4th year rotations are called "Clerkships" -- you are a freakin' clerk, sent to scribe notes, learn by observation and get the coffee/donuts -- anything else you do is a gift -- and don't get the idea that you "manage" patients -- you don't.

You will get your opportunities for procedures that you need in your chosen speciality during residency -- not having intubations the first day likely will not be a deficiency and if so, that's what senior residents are there for -- to teach you -- you may be dumped in the deep end of the pool but generally seniors won't let you kill anyone unless you get stupid and go off the reservation by yourself.

And like the post quoted above -- there's no way in hell I'm letting a med student participate in any part of my therapy other than to stand there, shut up and listen. I've seen a whole lot of interns cowboy up and luckily their seniors were able to stop them before they upgefucht a patient ---

This kind of attitude is beyond depressing. Not a single resident in my program has this mindset. Med students may be "clerks," but scutting them out to scribe notes or get you coffee is ****ing ridiculous. Residents and attendings can have a direct effect on what field a student goes in to. I had two very influential attendings steer me into my specialty. After they did that, the residents are what made me choose the program.

If I were your co-resident, or even a resident in another program at your institution, I would be speaking up on behalf of the student you're treating like ****.

You were there not too long ago. Don't forget that. Make a good lasting impression, not one that will possibly keep students from applying to your program.

Edit: Would have never guessed you're in FM.

 

[Jorts]

This is the kind of d*ck attitude of the residents that all the medical students hate. Thanks for being "that guy".

Exactly Justplainbill is an idiot. Residents/attendings that act like this everyone hates. Way to marginalize medical education, sorry you dont carry about your future. And siggy as a fourth year getting ready to graduate yes I can "manage patients." The best attendings/residents let me think for myself, come up with a plan, present it and then discuss which parts they agree with and which parts they do not and why. This is how you learn and yes it is managing patients, even if it is not making the final decisions. Sorry, Im not in medical school to get doughnuts, scribe notes, and other BS.

 

[neutropeniaboy]

For the record, I was never espousing the views of JustPlainBill.

While I do think part of being a student is writing notes and getting records or films, they are not servants.

When it comes to coffee, I don't drink it. However, I do have coffee rounds and the student is required to drink at least tea if not coffee, which all my residents seem to be addicted to...

Sent via Tapatalk

 

[JustPlainBill]

Edit: Would have never guessed you're in FM.

I won't go into the litany of abuses that occurred in my training environment - both physical and mental - to the residents -- I have had a few too many medical students rotate through with the attitude that because they had been admitted to a "power" institution in the SouthWest, their defecation wasn't odiferous -- I've watched them regularly pitch fits when an intern trying to get their OB numbers asked them to give up the delivery, watched them refuse to give up computers in the charting area for residents that were trying to work and see patients -- even after being told that there were laptops available for students ....and the list goes on and on -- the OP, with his/her initial post, struck me as one of these -- and would have been treated accordingly -- However, lest you think I have to pull the skin down from around my head to wash my neck, the ones that were genuinely interested, had reasonable people skills, were there to learn all they could and asked in a professional manner for learning experiences, generally got quite a bit -- especially if they didn't throw a hissy fit when they were told,"It's probably not appropriate with this patient".

I generally don't mind helping/teaching people but the "entitled ones" tend to piss me off rather quickly -- this BS about "I'm paying for this education and have a right to"...not with that attitude....

Yeah, Bacchus, I'm in FM -- and trained at a large institution of "ologists" -- and the environment was toxic -- verbal and sometimes physical abuse were the norm....

 

[Bacchus]

I won't go into the litany of abuses that occurred in my training environment - both physical and mental - to the residents -- I have had a few too many medical students rotate through with the attitude that because they had been admitted to a "power" institution in the SouthWest, their defecation wasn't odiferous -- I've watched them regularly pitch fits when an intern trying to get their OB numbers asked them to give up the delivery, watched them refuse to give up computers in the charting area for residents that were trying to work and see patients -- even after being told that there were laptops available for students ....and the list goes on and on -- the OP, with his/her initial post, struck me as one of these -- and would have been treated accordingly -- However, lest you think I have to pull the skin down from around my head to wash my neck, the ones that were genuinely interested, had reasonable people skills, were there to learn all they could and asked in a professional manner for learning experiences, generally got quite a bit -- especially if they didn't throw a hissy fit when they were told,"It's probably not appropriate with this patient".

I generally don't mind helping/teaching people but the "entitled ones" tend to piss me off rather quickly -- this BS about "I'm paying for this education and have a right to"...not with that attitude....

Yeah, Bacchus, I'm in FM -- and trained at a large institution of "ologists" -- and the environment was toxic -- verbal and sometimes physical abuse were the norm....

Well for that I am sorry. Did you know this going in? None of the programs I interviewed at gave me this vibe. It's sad your training jaded you so much :\. Maybe the northeast is different.

 

[JustPlainBill]

Well for that I am sorry. Did you know this going in? None of the programs I interviewed at gave me this vibe. It's sad your training jaded you so much :\. Maybe the northeast is different.

No, I did not know it going in -- the program was very good at providing plausible deviations from the truth to candidates -- and the boom got lowered after one month -- it sucked from there on out -- and to make it worse, I had people from my med school recommend the program and once there, tell me how much it sucked -- to the point that I thought of Stockholm Syndrome....

I'm out now and recovering but I do not have fond memories of that place....

 

[Siggy]

And siggy as a fourth year getting ready to graduate yes I can "manage patients." ... This is how you learn and yes it is managing patients, even if it is not making the final decisions.

"Can" and "are" are two different words. Until your signature is on the order sheet, you aren't managing patients and aren't ultimately responsible for them. 3/4 year clerkship [air quotes] managing [/air quotes] is simply learning to crawl so you can walk, however crawling, walking, and running (attendings) are still completely different things.

 

[Bacchus]

"Can" and "are" are two different words. Until your signature is on the order sheet, you aren't managing patients and aren't ultimately responsible for them. 3/4 year clerkship [air quotes] managing [/air quotes] is simply learning to crawl so you can walk, however crawling, walking, and running (attendings) are still completely different things.

It's like on July 1 when you're afraid to even order fluids or tylenol. "OMG, does the patient has a BNP, ECHO and CXR to demonstrate there is no fluid overload? Where's their CMP to show they don't have transaminitis?????" haha

 

[Top Gun]

OP -- You need to face the fact that you are on the bottom of the food chain so to speak and any procedures your attending lets you attempt need to be regarded as a gift. If he/she stops you after you attempt, it's their call and that does not mean they are "mean". That's why 3rd and 4th year rotations are called "Clerkships" -- you are a freakin' clerk, sent to scribe notes, learn by observation and get the coffee/donuts -- anything else you do is a gift -- and don't get the idea that you "manage" patients -- you don't.

You will get your opportunities for procedures that you need in your chosen speciality during residency -- not having intubations the first day likely will not be a deficiency and if so, that's what senior residents are there for -- to teach you -- you may be dumped in the deep end of the pool but generally seniors won't let you kill anyone unless you get stupid and go off the reservation by yourself.

And like the post quoted above -- there's no way in hell I'm letting a med student participate in any part of my therapy other than to stand there, shut up and listen. I've seen a whole lot of interns cowboy up and luckily their seniors were able to stop them before they upgefucht a patient ---

Now just a minute. I agree that med students shouldn't act like they're entitled to procedures. And I did say that after the med student has attempted a procedure once or twice without success, its time for the resident or attending to take over. But I did not say that med students should just stand there and shut up. They should be offered the opportunity to at least attempt a procedure once in a relatively stable patient. And no, med students are not there just to write your notes for you or to bring you your coffee or donuts. They are there to learn. You should at least be making an effort to teach the student. For instance, when they're writing progress notes, you should try to discuss the assessment or plan with them so they actually get some value out of doing it. Your attitude toward students is all wrong. While there are exceptions, I have found that most med students are willing to work hard and are eager to learn. Attitudes like yours actually do a disservice toward the future of medicine in this country.

 

[MerickManual]

To the attendings on this thread:

How much exposure to procedures/patient management did you have as a medical student? Do you feel the way you are treating them is the way you were treated at the same stage in training?