Attendings who keep their medical school students until 5pm

[twospadz]

I am really frustrated with this. If we aren't doing anything, why make us stay? Opinions?

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[235009]

Attendings who keep their medical school students until 5pm

is this a typo? ...did you mean 8pm?

 

[racerwad]

I am really frustrated with this. If we aren't doing anything, why make us stay? Opinions?

Maybe they are waiting for you to actually do something useful besides filling out applications to be an Uber driver?

 

[KinesiologyNerd]

Because we have none of the responsibility and all of the fun!

What? Watching interns put in orders isn't fun? Blasphemy!

 

[pushthatepi]

No, there really isn't. If the attending were keeping you until 11 PM and then expected you to show up at 4 AM for pre-rounds, I could see you being justified by saying something. But getting off at 5 PM every day? Bring a medical review book, offer to help out whenever you can, and don't complain.

 

[Terry Toma]

Wait, you're telling me that I might have to stick around until 5PM on some days once I'm a med student? I knew med school was going to be tough, but I never imagined I'd have to endure that kind of hell.

 

[Azete]

Maybe OP means during pre-clinical years. We do some brief exposure during the first 2 years and if we were forced to stay a full 9 hours, during exam week, that would drive me insane.

 

[Brorthopedic]

Maybe OP means during pre-clinical years. We do some brief exposure during the first 2 years and if we were forced to stay a full 9 hours, during exam week, that would drive me insane.

I highly doubt OP is referring to your special-case scenario

 

[Merely]

OP sounds like a tool

 

[BusinessAndMedicine]

Not sure why everyone is piling on the hate here. The job of a med student is to learn basic science, clinical medicine, and professionalism.

OP isn't shirking responsibilities or being unprofessional. I think it is legitimate to want to leave the clinic/hospital if all the work is done for the day. In all likelihood the OP wants to get home to spend a little time unwinding before studying for the shelf exam and reading up on cases.

I would guess you are being kept until 5 because:
a) The Attending is indifferent to your presence and it is easier to ignore you until the end of the day.
b) The Attending actually wants you to stay until 5 because the he/she believes it is the professional thing to do and "trained before the 80-hour work week and used to spend 167 hours a week in the hospital".

I think you just have to feel out the situation. Next time you are waiting around until 5 ask him/her if it is ok if you head out because you want to get some reading done/use your qBank/whatever and gauge the reaction. Most people are understanding of the fact that med students need time to read and I would guess that leaving before 5 won't be an issue as long as you are interested, friendly, and competent during the day.

 

[TheFutureFatMan]

Grow up. That is seriously one of the most pathetic comments I have ever seen from an adult, much less a future physician.

 

[235009]

If this is an inpatient rotation keeping the med student until 5pm in case something interesting happens isn't unreasonable. You should be practicing writing notes during that time or if it really is quiet bring a review book to read.

If this is an outpatient rotation I'm guessing the attending has patients scheduled until 5pm. If he's just doing paperwork during that time you should be practicing writing notes or reading review book during that time.

The only scenario I can think of where this whining may be justified is if it's an outpatient rotation, the last patient is scheduled at noon and the attending insist you stay until 5pm.

 

[TheFutureFatMan]

No, there really isn't. If the attending were keeping you until 11 PM and then expected you to show up at 4 AM for pre-rounds, I could see you being justified by saying something. But getting off at 5 PM every day? Bring a medical review book, offer to help out whenever you can, and don't complain.

It isn't justified. Ever. Show up. Put out. Take it with a smile.

 

[IM88]

It isn't justified. Ever. Show up. Put out. Take it with a smile.

Can't tell if this is sarcastic. Staying until 11PM and arriving at 4AM violates the ACGME duty hour rules that mandate 10 hours off between shifts. While these rules are often bent by residents in training, the medical school's goals for student learning are for the most part separate from the goals of the hospital/residency program. You're the customer of one, and the employee of the other. Your student affairs office at the medical school is more likely to lend a sympathetic ear and actually enforce more reasonable work hours. Complaining about a 40-50 hour work week is a bit ridiculous.

 

[pushthatepi]

You're a pre-med. With all due respect, your opinion on this carries no weight whatsoever. There have been times where attendings and residents demand far more time than is reasonable from students. There's a difference between being kept a few hours later than necessary (O.P.'s situation) and being ignored and forgotten in a call room for 18 hours despite offering to help out/see patients/witness procedures throughout the shift (as happened to me). I'd absolutely encourage a student to say something in such a situation. it's justified.

 

[DrBowtie]

Can't tell if this is sarcastic. Staying until 11PM and arriving at 4AM violates the ACGME duty hour rules that mandate 10 hours off between shifts. While these rules are often bent by residents in training, the medical school's goals for student learning are for the most part separate from the goals of the hospital/residency program. You're the customer of one, and the employee of the other. Your student affairs office at the medical school is more likely to lend a sympathetic ear and actually enforce more reasonable work hours. Complaining about a 40-50 hour work week is a bit ridiculous.

ACGME rules don't apply to students.

 

[BusinessAndMedicine]

Can't tell if this is sarcastic. Staying until 11PM and arriving at 4AM violates the ACGME duty hour rules that mandate 10 hours off between shifts. While these rules are often bent by residents in training, the medical school's goals for student learning are for the most part separate from the goals of the hospital/residency program. You're the customer of one, and the employee of the other. Your student affairs office at the medical school is more likely to lend a sympathetic ear and actually enforce more reasonable work hours. Complaining about a 40-50 hour work week is a bit ridiculous.

First of all the OP isn't complaining about a 40-50 hour work week. He/she is complaining/questioning why the Attending seems to be keeping them in the clinic when there is no apparent reason to be there besides for the fact that it is before 5 pm. Also, some may say that this is only semantics but I don't think talking about a "xx hour work week" is appropriate for a med student. This isn't a job, it is a graduate program preparing you for residency. There is a huge amount of material you need to read to master the fundamentals and spending too much time in the clinic/hospital can be detrimental to your education.

IMO any resident who doesn't let their med student go after all meaningful learning opportunities for the day are over is doing them a disservice. I don't need you to help me change dressings on 10 patients at the end of the day and you don't want to watch me do them. I could ask you to come along and carry the supplies/help write notes so you can prove that you are a team player and see what being a resident is really like. But I don't because soon enough you will find out and we both know you want to go into Internal Medicine and your forced enthusiasm is wearing on me (jk...kind of).

 

[hmockingbird]

If this is an inpatient rotation keeping the med student until 5pm in case something interesting happens isn't unreasonable. You should be practicing writing notes during that time or if it really is quiet bring a review book to read.

If this is an outpatient rotation I'm guessing the attending has patients scheduled until 5pm. If he's just doing paperwork during that time you should be practicing writing notes or reading review book during that time.

The only scenario I can think of where this whining may be justified is if it's an outpatient rotation, the last patient is scheduled at noon and the attending insist you stay until 5pm.

This. You're there to learn. There are plenty of things you can do at home, that you can also do during downtime at the hospital, like q-banks and reading. Staying until 5 is hardly the end of the world. And someday you will be a doctor and might even have to stay late to get things done. It's called a job. You are essentially an apprentice for one. Suck it up.

ETA: Better yet, ask if there is anything else you can do, so that you actually have something to do. (And if you don't, maybe they will remember you are there and send you home early. Some attendings like you to stay the full day though, to have that experience, and just in case something happens, so you just have to deal with it.)

 

[kavorca]

You need to be careful asking to leave early. Broach it first with the resident who seems the most simpatico. That can be a fire starter with the wrong resident or attending. I have seen it ruin the rotation for the student a couple times. I always sent the student home once nothing was left except scut work.
You do get spoiled the first two years. Your time is pretty much your own, which changes completely in the clinical years.

 

[BusinessAndMedicine]

I didn't go into psych but I'm diagnosing all the med students in this thread with Stockholm Syndrome.

 

[sloop]

At this point, getting out at 5 is a cherished moment.

I think getting out before 5 is totally reasonable to want on some rotations versus others. If you're on psych and you started at 8 or 9 and you're complaining of being kept until 5, I think you're being a little unreasonable.

I think surgery rotations are notorious for keeping students long hours and I think this is silly. If you're expected to be at the hospital at 5am, I think it's too much to keep the student until 5 every day, especially if nothing is going on. Students have shelf exams that largely determine their grades and they need to study for them. They also may have lectures to prepare, have various tasks regarding scheduling 4th year, residency application stuff at the end of the year.
Some students also live somewhere that requires like 30 min to 1hr one way travel time to the hospital. To get a healthy amount of sleep students on such a rotation likely have to get to bed at 9 or 10 pm. If you're making it so they only get home at 6 pm, then still have to make dinner, you're only leaving like 2 hours a day for studying, some minimal relaxation, etc. That's not fair to the student.

 

[cbrons]

No, there really isn't. If the attending were keeping you until 11 PM and then expected you to show up at 4 AM for pre-rounds, I could see you being justified by saying something. But getting off at 5 PM every day? Bring a medical review book, offer to help out whenever you can, and don't complain.

If they are simply making you shadow them, then you shouldnt be there at all.

If you arent allowed to actually participate in patient care, then yes, being forced to stay till 5pm is an outrage.

Sent from my SM-N910P using SDN mobile

 

[hmockingbird]

My friends in the "real world" also stay at their 8/9-5 jobs until the end of the day even if they have downtime. I don't think it's really any different. Like someone else said, it's not like they are violating hours (stuff like >80hr/week and not having the 10hr break between shifts still apply to med students I think... we get asked about that on every evaluation).

ETA: I've been there and I understand the frustration but if you've asked/hinted to leave and they said no you just have to deal with it.

 

[IM88]

ACGME rules don't apply to students.

This depends on the school. Where I am the medical school policies expressly state that ACGME rules apply to students, and there is likely some sort of duty hour policy in place for liability reasons. While on surgery students were following along with guidelines of the intervention arm of the FIRST trial like the residents.

IMO any resident who doesn't let their med student go after all meaningful learning opportunities for the day are over is doing them a disservice.

Totally agree.

 

[DrBowtie]

This depends on the school. Where I am the medical school policies expressly state that ACGME rules apply to students, and there is likely some sort of duty hour policy in place for liability reasons. While on surgery students were following along with guidelines of the intervention arm of the FIRST trial like the residents.


Totally agree.

Again, the ACGME rules do not apply to medical students. Your school may have rules that mimic them, however the ACGME does not have anything to do with student hours.

 

[Seroquel]

Totally agree OP. There's a huge difference between staying to help out/learn vs staying and sitting around somewhere studying on your phone when you could be studying at home/library. I can't tell you how frustrated I was during my peds rotation. We spent the first several hours rounding and the rest of the day I was kept along with other med students in the resident lounge and so much time was wasted. We would ask to help out but were told to go study in that noisy lounge and we had to stay until 6 pm after coming in at 6 am. Ridiculous.

 

[twospadz]

A lot of the people against me are tools. Today, we did patient presentations, rounded, went through didactic lectures, and I finished my note. All we had to do in the afternoon was do a quiz packet while we were in hospital which we could have done at home. Luckily our residents which recognized this and were trying to send us home earlier, were finally able to. If there is nothing for med students to do, let us study at home and use materials we have access to there but not the hospital. Luckily, I have had really good residents who recognized this and let us go if we were useless and not learning anything. Honestly, this is really is an attending problem. Its like they forget when they were once medical school students. If there is something for us to help with or learn, I want to to it or learn. But if we are just sitting around and doing nothing, then its not helpful to just be there. And lastly, I'm not a idiot. I have never asked to leave early or implied. I always ask to help.

P.S: I am having a really really hard time accepting that all these people on sdn are perfect shining angelic students that have pure hearts and don't question anything in life.

 

[themockjock]

I think surgery rotations are notorious for keeping students long hours and I think this is silly. If you're expected to be at the hospital at 5am, I think it's too much to keep the student until 5 every day

Uh, what? 12 hour days are light. I would kiss the ground that my chief walked on if I worked 5-5 every day when I was a student.

We took q3 30+ hour call on surgery when I was a student. Now I regularly have days where I work 4:30a-9p and my call responsibilities will start ramping up real quickly real soon.

The thing that people don't realize about med school is that if you're completely sheltered and work 9-5 banker's hours, your school is actually doing you a disservice. Because even though as a student you're expendable and therefore feel like you should work easy hours, when July 1 of your intern year hits, you suddenly are needed to have the output of a coked up worker bee. And if you've never physically been in the hospital for more than 12 hours at a time, when you're suddenly expected to run around like crazy for 16 straight hours, you're going to feel like you got hit by a truck.

I got worked as a medical student and my transition to intern year was relatively painless because of it. My co-residents who had cushy M3 and 4 years definitely had a much steeper learning curve.

And before I hear the "I'm not going into surgery so why should I have to do this," question, the answer is because no matter what field you go into, you're going to have brutal days as an intern. Yes, derm residency is easy but what about when you're a TY intern cross-covering 20 MICU patients at night? How is that going to feel if you've never had any expectations put on you?

And finally... in regards to this:

...especially if nothing is going on. Students have shelf exams that largely determine their grades and they need to study for them. They also may have lectures to prepare, have various tasks regarding scheduling 4th year, residency application stuff at the end of the year.

If nothing is going on, instead of daydreaming about going home, why not study for the shelf in the hospital? Why not prepare whatever lecture in the hospital? etc. You can easily slip away to a quiet place while still being available if something of value arises. Or you can find a similarly unoccupied resident on your team and ask them to go over stuff with you. We had a quiet night on trauma the other day and I spent an hour talking to my M3 about fluid and blood product resuscitation while I took them through the SICU and pointed out the rationale for various fluid regimens on our patients.

Some students also live somewhere that requires like 30 min to 1hr one way travel time to the hospital. To get a healthy amount of sleep students on such a rotation likely have to get to bed at 9 or 10 pm. If you're making it so they only get home at 6 pm, then still have to make dinner, you're only leaving like 2 hours a day for studying, some minimal relaxation, etc. That's not fair to the student.

 

[zeppelinpage4]

Pretty sure OP isn't complaining about their day ending at 5pm. They're most likely frustrated with being kept around once all the work and learning opportunities are done, which I definitely understand.

On rare days during surgery, I've stayed in the hospital from 4am-10pm, but I scrubbed in on cases and was actively doing things/learning that time (well most of it). Thus, despite the long hours, I wasn't terribly bothered with it or as frustrated.
On the other hand, if all the patients are seen and there is literally nothing left to do but watch the attending or resident do paperwork, a student should be dismissed, and I get incredibly frustrated too if I'm kept around standing. Standing around for the sake of running the clock benefits no one, and it detracts from study time which is important. And honestly I'm not being payed to work...rather I am the one paying for the educational experience, which is the primary goal. Thus, I would hope that residents and attendings would be understanding about letting med students go once there's nothing left for them to do. I'm usually pretty willing to put in the hours, but those hours shouldn't feel wasted.
Andyes, inpatient, I can see how sticking around allows you to be present when something happens (in those times, the good residents usually let us go study in the library and called us back when we were needed). However, outpatient, once the patients for the day are done and there's just paperwork left, it seems unnecessary to keep the student.

 

[cbrons]

My friends in the "real world" also stay at their 8/9-5 jobs until the end of the day even if they have downtime.

Oh... are your friends also playing $40,000 per year to be there?

 

[cbrons]

Pretty sure OP isn't complaining about their day ending at 5pm. They're most likely frustrated with being kept around once all the work and learning opportunities are done, which I can relate to.

What about those situations where the entire rotation has absolutely no work or learning opportunities and all you do is shadow?
Should such rotations be evaluated and the school sponsoring them be placed on probation by the LCME?
If there was a just system they would.

 

[PL198]

A lot of the people against me are tools. Today, we did patient presentations, rounded, went through didactic lectures, and I finished my note. All we had to do in the afternoon was do a quiz packet while we were in hospital which we could have done at home. Luckily our residents which recognized this and were trying to send us home earlier, were finally able to. If there is nothing for med students to do, let us study at home and use materials we have access to there but not the hospital. Luckily, I have had really good residents who recognized this and let us go if we were useless and not learning anything. Honestly, this is really is an attending problem. Its like they forget when they were once medical school students. If there is something for us to help with or learn, I want to to it or learn. But if we are just sitting around and doing nothing, then its not helpful to just be there. And lastly, I'm not a idiot. I have never asked to leave early or implied. I always ask to help.

P.S: I am having a really really hard time accepting that all these people on sdn are perfect shining angelic students that have pure hearts and don't question anything in life.

when you say note, you mean that in the singular? as in 1?

 

[zeppelinpage4]

What about those situations where the entire rotation has absolutely no work or learning opportunities and all you do is shadow?
Should such rotations be evaluated and the school sponsoring them be placed on probation by the LCME?
If there was a just system they would.

Indeed. An evaluation and improvement system that is enforced could save a lot of headaches for future students going into those rotations. Where rotations that have a high number of dissatisfied student evals is placed on temporary probation and expected to fix those issues during that time, otherwise the school pulls it's sponsorship.
They take student evals for each clerkship at my school, and are pretty good about making improvements and making sure students are learning. Our ob/gyn rotation was notorious for keeping people standing around, but the program directors stepped in after getting student feedback and my experience with the rotation was significantly better as a result.
Of course yes, I've still had my fair share of wasted hours (thankfully I would be able to read during that time and make some use of it) and I understand the reality isn't quite as ideal, but hopefully it's something we can keep in mind and strive for, especially if we ever reach a position to make those changes.

 

[Merely]

A lot of the people against me are tools. Today, we did patient presentations, rounded, went through didactic lectures, and I finished my note. All we had to do in the afternoon was do a quiz packet while we were in hospital which we could have done at home. Luckily our residents which recognized this and were trying to send us home earlier, were finally able to. If there is nothing for med students to do, let us study at home and use materials we have access to there but not the hospital. Luckily, I have had really good residents who recognized this and let us go if we were useless and not learning anything. Honestly, this is really is an attending problem. Its like they forget when they were once medical school students. If there is something for us to help with or learn, I want to to it or learn. But if we are just sitting around and doing nothing, then its not helpful to just be there. And lastly, I'm not a idiot. I have never asked to leave early or implied. I always ask to help.

P.S: I am having a really really hard time accepting that all these people on sdn are perfect shining angelic students that have pure hearts and don't question anything in life.

OP sounds like a tool

 

[sloop]

Uh, what? 12 hour days are light. I would kiss the ground that my chief walked on if I worked 5-5 every day when I was a student.

We took q3 30+ hour call on surgery when I was a student. Now I regularly have days where I work 4:30a-9p and my call responsibilities will start ramping up real quickly real soon.

The thing that people don't realize about med school is that if you're completely sheltered and work 9-5 banker's hours, your school is actually doing you a disservice. Because even though as a student you're expendable and therefore feel like you should work easy hours, when July 1 of your intern year hits, you suddenly are needed to have the output of a coked up worker bee. And if you've never physically been in the hospital for more than 12 hours at a time, when you're suddenly expected to run around like crazy for 16 straight hours, you're going to feel like you got hit by a truck.

I got worked as a medical student and my transition to intern year was relatively painless because of it. My co-residents who had cushy M3 and 4 years definitely had a much steeper learning curve.

And before I hear the "I'm not going into surgery so why should I have to do this," question, the answer is because no matter what field you go into, you're going to have brutal days as an intern. Yes, derm residency is easy but what about when you're a TY intern cross-covering 20 MICU patients at night? How is that going to feel if you've never had any expectations put on you?

And finally... in regards to this:


If nothing is going on, instead of daydreaming about going home, why not study for the shelf in the hospital? Why not prepare whatever lecture in the hospital? etc. You can easily slip away to a quiet place while still being available if something of value arises. Or you can find a similarly unoccupied resident on your team and ask them to go over stuff with you. We had a quiet night on trauma the other day and I spent an hour talking to my M3 about fluid and blood product resuscitation while I took them through the SICU and pointed out the rationale for various fluid regimens on our patients.

Look, man. Your justification for this bull**** largely amounts to "I had to do it, internship sucks too, etc." We're not surgical interns or surgical residents. The goal of clerkship is not to become technically competent at things, generally speaking. Waiting around in the hospital forever hoping that some surgical case will walk through the door does not help accomplish the goals of a clerkship. We are supposed to learn the conceptual basics of the specialty.

Additionally, being overworked does not help most people learn. Being in the hospital and trying to learn in interrupted short breaks is not efficient.

Regarding call, we take long call as medical students too. It's pointless. Please do enlighten me on how depriving myself of sleep and personal time to help slide some barely injured level 2 into a CT scanner at 4 in the morning is educational. Actually don't. I'm not that interested. Being forced to do this as a medical student in surgery is not an important factor in whether one can handle difficult hours as a resident in a field they're genuinely interested in. Your anecdotal observations are biased and self-serving. Forgive me, but I don't trust that the person saying "I was trained super intensely so I'm awesome and other people suck in comparison" is giving a balanced evaluation of reality.

To be honest, your post is emblematic of a ****ty culture in surgical residents that thinks surgery is some sacred cow of medicine. Other fields tend to think they can get students to achieve clerkship goals without having them basically live at the hospital. Why is surgery so special? The answer is that it's not. Surgery just has a ****ty culture of valuing intensity, regardless of whether it serves a purpose. Surgical residents also have a ****ty tendency to disrespect non-surgical fields and at best see them as "half-trained surgeons." Generalizations of course, but based on talking to many surgical residents.

 

[cbrons]

Grow up. That is seriously one of the most pathetic comments I have ever seen from an adult, much less a future physician.

You aren't even in med school yet, so you have no idea what 3rd year is like. I think Burnett’s Law should be changed from, "The longer a thread goes, the probability of someone telling or implying that you will be a bad doctor approaches 1" to "The more inexperienced/useless and self-righteous a poster is, the higher the probability of them telling or implying that someone will be a bad doctor approaches 1."

 

[hallowmann]

I get the idea of OP in spirit, if you're not doing or learning anything, why stay? That said, leaving at 5pm is amazing even if it means having to sit for a while doing questions on your phone. Be thankful for it. Having surgery as some of my first rotations with a regular 12-14 hr daily schedule followed by an IM elective with consecutive 10 hr short and 12 hr long days made me really appreciate the subspecialty electives where I had normal 7am to 5pm hours. Right now its 8-5 and I love it. Actually have time to study, sleep, and relax everyday.

 

[CherryRedDracul]

I also get OP's sentiment. I prefer being busy and doing clinical things rather than just sit around until we're dismissed. Sure, I could study, but that's why I have a study space at home.

My favorite moments during clerkships were when I got to do things and felt like I had an impact on patient care.

 

[jw3600]

Oh... are your friends also playing $40,000 per year to be there?

40? Lucky bastard.

 

[themockjock]

Ok, since I'm just chilling at work and have nothing better to do at the moment, let's break this down point by point.

Look, man. Your justification for this bull**** largely amounts to "I had to do it, internship sucks too, etc." We're not surgical interns or surgical residents. The goal of clerkship is not to become technically competent at things, generally speaking

So then what is the goal? No of course you're not expected to sew coronaries as an M3. But you should learn how to close at least subq tissue and skin. You should become proficient at knot tying. You should generally have an idea as to when you need to call surgery, how to recognize an acute abdomen, and be able to recognize urgent from not urgent; what needs a surgeon at 3am, what needs a surgeon at 9am, and what never needs a surgeon. Being able to accomplish those basic things will serve you well regardless of the specialty.

Additionally, being overworked does not help most people learn. Being in the hospital and trying to learn in interrupted short breaks is not efficient

So continuing the reductio ad absurdum that you seem so fond of, by this logic why even have a clerkship at all? Why not give M3s 2 months of uninterrupted time to read Sabiston cover to cover? Just because I feel like pretentiously quoting Osler: He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.

Plus, learning in interrupted short breaks is pretty much all you're going to have from here on out. I have a vastly worse schedule than I did when I was a medical student, but I still had to study for step 3, and will perpetually be studying for the ABSITE and/or TSDA ITE, to say nothing about my boards when I'm a chief. You find time and make it work. I do occasionally manage to have some down time at work and will always work to get a little bit of reading done or work a bit on a manuscript despite getting interrupted occasionally by my pager.

Regarding call, we take long call as medical students too. It's pointless. Please do enlighten me on how depriving myself of sleep and personal time to help slide some barely injured level 2 into a CT scanner at 4 in the morning is educational. Actually don't. I'm not that interested.

This is spectacularly entitled and arrogant. No, you're right. I'm not improving your education by asking you to help me slide a patient into the scanner. But if you just shift your attitude from being a special little medical student snowflake to being a member of a team that is taking care of a patient, then even this has value. That value is just for someone else, not you. Because even as an attending, son, you aren't the star of the show. It's the patient.

To use your example of the "barely injured level 2," there are a lot of these patents that - surprise - actually have a serious injury. And maybe if you were present from the time that patient rolled into the trauma bay to the time that patient went to the OR, I'll probably work to get you involved in the case in some small way. But if you're one of those medical students that says "cya, please page me if something good happens," then no I am not going to go out of my way to help you learn in spite of yourself.

Also, from your degree of bitterness, it sounds like you had a ****ty surgical clerkship, whether of your own doing or not. But a lot of the best students I've worked with have managed to turn even slow, boring days into something useful. That may be hanging out with the SICU resident and asking about management of critically ill surgical patients. Or finding another team that has a case going and asking to scrub that case. There are all ways to get involved during the clerkship without just waiting for someone to stand there and hand you an educational opportunity.

Forgive me, but I don't trust that the person saying "I was trained super intensely so I'm awesome and other people suck in comparison" is giving a balanced evaluation of reality

I just want to call this out because that is not at all what I said. I said that I got worked as a medical student and had an easier learning curve as an intern. That does NOT mean that I'm awesome (I feel like an idiot on a daily basis) and it does not mean that I think that other people suck (I feel like an idiot on a daily basis).

Surgery just has a ****ty culture of valuing intensity, regardless of whether it serves a purpose

What the hell is wrong with working your ass off for the service of others? This is an incredibly spoiled kind of thing to say and really shows your lack of maturity and insight into what surgeons do. And lest you continue in your delusion that I think surgeons **** doesn't stink, this is true of what physicians of all specialties do. One of my closest med school friends is a derm resident. And while he has nice hours in clinic, he still has to come home and put in 3-4 hours of reading every night just to stay on top of the incredible minutiae (how many kilodaltons is desmoglein?) he needs to know for his boards. To say nothing of research, charting, etc. So he ends up working pretty damn close to surgical resident hours when all of the ancillary work is factored in. So he values the intensity the same as I do, just in a different way.

Surgical residents also have a ****ty tendency to disrespect non-surgical fields and at best see them as "half-trained surgeons."

No, the problem is that many of the medical students who have your attitude and get nothing out of their surgical clerkship other than an inchoate hatred of the operating room become residents that consult me. And when they do consult me, they don't have the first clue about the evaluation of a surgical patient. So please, if you get nothing else out of your surgical clerkship, please know that asymptomatic cholelithiasis does not need a 3am acute care surgery consultation. Your friendly, beaten-down surgical intern will thank you for it.

 

[Tenk]

I usually dismiss my ED students if there is nothing going on in the ED overnight.

My advice: Read a book. Do questions. Ask if there is anything you can do to be helpful (this can backfire sometimes). Beg residents to dismiss you. Smile a lot. Talk about non medical crap (I once had an hour long discussion with an old school trauma surgeon about WWII).

All I can think of right now. Suck it up for now and just don't do the same when you're an attending.

 

[Goro]

I expected better from you, spadz!

I am really frustrated with this. If we aren't doing anything, why make us stay? Opinions?

 

[TheFutureFatMan]

You're a pre-med. With all due respect, your opinion on this carries no weight whatsoever. There have been times where attendings and residents demand far more time than is reasonable from students. There's a difference between being kept a few hours later than necessary (O.P.'s situation) and being ignored and forgotten in a call room for 18 hours despite offering to help out/see patients/witness procedures throughout the shift (as happened to me). I'd absolutely encourage a student to say something in such a situation. it's justified.

No one ever uttered the phrase "with all due respect" and had anything but disrespect intended. Bring a book. Study. It's not that complex. You're scheduled. Stay until the end of your shift. Quit complaining. That's ridiculous. In the real world, that's how you get a pink slip.

 

[sloop]

Ok, since I'm just chilling at work and have nothing better to do at the moment, let's break this down point by point.



So then what is the goal? No of course you're not expected to sew coronaries as an M3. But you should learn how to close at least subq tissue and skin. You should become proficient at knot tying. You should generally have an idea as to when you need to call surgery, how to recognize an acute abdomen, and be able to recognize urgent from not urgent; what needs a surgeon at 3am, what needs a surgeon at 9am, and what never needs a surgeon. Being able to accomplish those basic things will serve you well regardless of the specialty.

I know how to do basic suturing and tying (simple interrupted, running, buried, vertical mattress, two handed ties, one-handed ties, instrument ties, closing subq and skin, etc.) These are not difficult and after closing a few incisions and maybe doing a few skin grafts, the skill is there. I may not be as facile as a trained surgeon, but I can do it.

Still, so what? Honestly, again, this is not what clerkship is for. I am going into psychiatry, so I don't expect to be sewing up my patients any time soon. It's a cool skill to have and maybe I can save somebody a trip to the ER one day for some minor laceration, but it's not important for my career. The goal of a clerkship is not to make students technically competent or even competent managing surgical patients. It is to give students an understanding of what surgical management for different patients entails. If you want to expect technical or in-practice surgical management competencies of your sub-Is, that makes at least some sense. It doesn't make sense to expect this of clerkship students.

I don't think being in the hospital all day is the best way to learn when a surgeon is needed. This is mostly book learning of indications for surgery coupled with some exposure to actual surgical patients, not the other way around.

So continuing the reductio ad absurdum that you seem so fond of, by this logic why even have a clerkship at all? Why not give M3s 2 months of uninterrupted time to read Sabiston cover to cover? Just because I feel like pretentiously quoting Osler: He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.

Some patient contact is surely required. I don't think 12 hours of hospital work a day for 8 to 12 weeks is required.

Plus, learning in interrupted short breaks is pretty much all you're going to have from here on out. I have a vastly worse schedule than I did when I was a medical student, but I still had to study for step 3, and will perpetually be studying for the ABSITE and/or TSDA ITE, to say nothing about my boards when I'm a chief. You find time and make it work. I do occasionally manage to have some down time at work and will always work to get a little bit of reading done or work a bit on a manuscript despite getting interrupted occasionally by my pager.

Why should I pay $50K/yr to be told that I have to learn in an inefficient way? When you're a resident, that's your job, so it's different. When you're in medical school, you are paying a lot of money to learn medicine, so you should be learning medicine in the most efficient way that gives you the most value.

This is spectacularly entitled and arrogant. No, you're right. I'm not improving your education by asking you to help me slide a patient into the scanner. But if you just shift your attitude from being a special little medical student snowflake to being a member of a team that is taking care of a patient, then even this has value. That value is just for someone else, not you. Because even as an attending, son, you aren't the star of the show. It's the patient.

You're deliberately misconstruing what I'm saying. I obviously don't have a problem helping out. I don't mind helping the patient onto the CT scanner. I'm just saying it's not educational. Besides, it's not like there aren't people around to get the patient up there if I wasn't around. They pay people to assist with patient transport in hospitals.

I'm not being compensated for my time. I'm paying a lot of money in order to learn. The only justifiable reason to have me there in the middle of the night is if it substantially contributes to my learning. Honestly, call is rarely educational for med students.

To use your example of the "barely injured level 2," there are a lot of these patents that - surprise - actually have a serious injury. And maybe if you were present from the time that patient rolled into the trauma bay to the time that patient went to the OR, I'll probably work to get you involved in the case in some small way. But if you're one of those medical students that says "cya, please page me if something good happens," then no I am not going to go out of my way to help you learn in spite of yourself.

We get the same automatic page that the residents get, and we're there at the same time as the residents, typically. I don't know why you're implying that I'm a bad student who just ignores trauma pagers. Most of these patients are not seriously injured. I never denied that some are. It's just that it's not worth the time commitment required to catch one educational trauma if you're a medical student not interested in surgery.

Also, from your degree of bitterness, it sounds like you had a ****ty surgical clerkship, whether of your own doing or not. But a lot of the best students I've worked with have managed to turn even slow, boring days into something useful. That may be hanging out with the SICU resident and asking about management of critically ill surgical patients. Or finding another team that has a case going and asking to scrub that case. There are all ways to get involved during the clerkship without just waiting for someone to stand there and hand you an educational opportunity.

Yeah, I believe that paying tens of thousands of dollars a year to go to school entitles me to have educational opportunities fall into my lap. I don't understand why this is even a controversial position to you . . .

I just want to call this out because that is not at all what I said. I said that I got worked as a medical student and had an easier learning curve as an intern. That does NOT mean that I'm awesome (I feel like an idiot on a daily basis) and it does not mean that I think that other people suck (I feel like an idiot on a daily basis).

Well, you made it sound like you think your training made things come easy to you while others had trouble. I just don't believe that how your surgery clerkship was structured makes much of a difference past the first month or two. I especially don't think it matters in the context of the fact that resident aptitude is going to vary far more on an individual basis than it does based on clerkship structure.

What the hell is wrong with working your ass off for the service of others? This is an incredibly spoiled kind of thing to say and really shows your lack of maturity and insight into what surgeons do. And lest you continue in your delusion that I think surgeons **** doesn't stink, this is true of what physicians of all specialties do. One of my closest med school friends is a derm resident. And while he has nice hours in clinic, he still has to come home and put in 3-4 hours of reading every night just to stay on top of the incredible minutiae (how many kilodaltons is desmoglein?) he needs to know for his boards. To say nothing of research, charting, etc. So he ends up working pretty damn close to surgical resident hours when all of the ancillary work is factored in. So he values the intensity the same as I do, just in a different way.

Dude, there's more to life than patient care. I care deeply about patients but I also don't think I need to be in the hospital my whole life. I work hard, but I have no desire for a life where all I ever do is work hard. I value balance. You can look down at people for valuing that over intensity, but I don't think it's unreasonable.

Of course intern year will have bad hours, but it will end and hours will get better. Again, I'm going into psych, and I want to be the best damn shrink I can be. Still, I've seen what the lives of 3rd and 4th year psych residents are like. They have free time—often a decent amount of it. Not everybody in medicine is staring down the barrel of years of terrible hours. Again, get over yourself and your surgical myopia.

No, the problem is that many of the medical students who have your attitude and get nothing out of their surgical clerkship other than an inchoate hatred of the operating room become residents that consult me. And when they do consult me, they don't have the first clue about the evaluation of a surgical patient. So please, if you get nothing else out of your surgical clerkship, please know that asymptomatic cholelithiasis does not need a 3am acute care surgery consultation. Your friendly, beaten-down surgical intern will thank you for it.

And I've seen surgeons consult psych residents because, quite literally, "Pt is sad, so you need to talk to pt." I've literally done a consult from surgery that went along the lines of "we have a patient here POD2 s/p BKA" "what is the reason for consult?" "well, she just seems really upset that she just had a BKA" "sorry, just trying to understand—what is the question you have about this that you want the consult team to answer?" " we're concerned she might be depressed."

This **** happens in a hospital, especially a teaching one. People specialize in medicine and wind up forgetting even basic **** they should know. It happens. You correct them, and they learn.

 

[WilliamofOckham]

No one ever uttered the phrase "with all due respect" and had anything but disrespect intended. Bring a book. Study. It's not that complex. You're scheduled. Stay until the end of your shift. Quit complaining. That's ridiculous. In the real world, that's how you get a pink slip.

Thanks for your input, premed, but you have no idea what you're talking about.

"You're scheduled"? "Stay until the end of your shift"? You clearly have no clue how clinical rotations work. Apart from EM and a few others, med students are not on "shifts." They are expected to do certain tasks - for instance, on IM, they are generally expected to see their patients in the morning, present them, write notes, and help out with things that need to be done on the floor. In the afternoons, there generally isn't all that much to do, particularly if a student has efficiently finished his work in the morning. And believe it or not, reading textbooks or going over UWorld on your phone is not as convenient as doing so from a laptop... without constant beeping from the monitors and announcements from the overhead speakers.

Staying until 5 is hardly a nightmare, but it is irritating if there's no good reason to do so.

 

[Amygdarya]

A lot of the people against me are tools. Today, we did patient presentations, rounded, went through didactic lectures, and I finished my note.

I will second this question: just one note???

Based on the quoted above I'd say the problem you have is not as much with attendings who keep you till 5 pm as with the fact that you're not really involved in patient care. Where I'm at, students typically have *at least* 2 patients at any given time (usually at the beginning of a rotation, but can happen at other times with discharges etc), with the goal of having a total of 4 by the end of a rotation. And, importantly, not only do we preround, present on rounds and write notes on these patients, but we also do many of the things interns do, such as placing orders (interns/residents have to approve student orders, so it doesn't really save them much work but it's good practice for students), calling consults/communicating with other teams involved in patient's care, calling radiology for a quick read if necessary and the official read is taking too long, communicating with patients and families (mostly updates and clarifications, not DNR/DNI discussion kind of things of course), communicating with nurses/social workers/PT/dieticians etc, scheduling procedures with other services and making sure they happen, participating in procedures with interns and residents, participating in rapid responses and codes (not necessarily on one of your patients, though you'll have priority if it's your patient), writing discharge summaries etc - things I've done so far on inpatient floors, off the top of my head). Most of my days are about 12 hours long and *busy* - barely any downtime, sometimes no time for lunch - and I'm *loving* it because I feel like I'm actually part of the team taking care of my patients. Sure, most of the things I listed are not the glorious work of Medicine, don't necessarily have as high educational value as review books and can be classified as scut, but I don't care because: 1) these things are necessary to get my patients the care they need, and 2) these things are what interns do, and I want to be prepared to hit the floor running not for 4 but for 8-9 patients at a time. To put it more succinctly, I love being busy on the floors because I'm actively involved in taking care of my patients and because it helps prepare me for residency. I believe that schools/clerkship sites that don't ensure student involvement in patient care do them a huge disservice.

(Of note, I'm almost 100% set on going into psychiatry, but I want to be as prepared as I can be for my medicine and neurology internship months, and I want to get as much experience in every specialty as I can while in medical school because guess what? This is the only time in my life I get to do/see these things and they're part of my general medical education. Because - and some people, including some psychiatrists, forget about this - psychiatrists are actually medical doctors, too, you know?)

So you're stuck with a rotation that sucks - now what? I second what others have already said: study in your downtime. Bring a review book or an iPad with electronic books or review articles, read some UptoDate articles relevant to your patients or rotation, do/review UWorld questions on your smartphone, for Pete's sake!

 

[qwerty89]

Why should I pay $50K/yr to be told that I have to learn in an inefficient way? When you're a resident, that's your job, so it's different. When you're in medical school, you are paying a lot of money to learn medicine, so you should be learning medicine in the most efficient way that gives you the most value.

You do realize that the world doesn't revolve around you right? Yeah I know you are paying 50K a year but you will soon realize that its chump change compared to the massive opportunity cost of having the attendings go out of your way to teach you. A resident slows down an attending considerably. A med student? An order of magnitude higher.

In the words of the House of God "Show me a medical student that only triples my work and I will kiss his feet".

There is a massive difference in the pace of work between an attending in PP vs one in academics that has to wait in the OR an extra 15 mins to watch a student, or resident, struggle with a vertical mattress suture...

 

[sloop]

You do realize that the world doesn't revolve around you right? Yeah I know you are paying 50K a year but you will soon realize that its chump change compared to the massive opportunity cost of having the attendings go out of your way to teach you. A resident slows down an attending considerably. A med student? An order of magnitude higher.

In the words of the House of God "Show me a medical student that only triples my work and I will kiss his feet".

There is a massive difference in the pace of work between an attending in PP vs one in academics that has to wait in the OR an extra 15 mins to watch a student, or resident, struggle with a vertical mattress suture...

I understand that there are costs associated with teaching medical students, which is part of what justifies tuition costs. What's your point?

My point was that my tuition entitles me to have educational opportunities given to me. The person I was responding to implied that I should have to seek out an education and that I should not simply expect to be educated. I'm sorry, but how is this justifiable?

This is basically akin to going into a restaurant, ordering $20 worth of food, waiting around for hours and hours while the food never comes until you actively go up to the servers and demand that they give you your food. What you and the poster I was replying to are arguing is like saying "what the hell? Are you serious? Do you really expect food to just appear in front of you? Don't you realize that there are lots of costs involved with the raw ingredients for that food?" Yeah, I realize the costs which is why I agreed to the price, and yeah, I expect my damned food.

 

[Señor S]

This is spectacularly entitled and arrogant. No, you're right. I'm not improving your education by asking you to help me slide a patient into the scanner. But if you just shift your attitude from being a special little medical student snowflake to being a member of a team that is taking care of a patient, then even this has value. That value is just for someone else, not you. Because even as an attending, son, you aren't the star of the show. It's the patient.

We're not members of the team. And we don't, in any meaningful sense, take care of patients.

 

[Señor S]

In the words of the House of God "Show me a medical student that only triples my work and I will kiss his feet".

How on earth can a med student in 2016 increase anybody's workload? We don't do anything but write fake notes and give fake presentations that can quickly and easily be cut off.