Attendings who keep their medical school students until 5pm

[jdh71]

It's not because we're all such high achievers, though, it just isn't that good of a score these days. Slightly above average, which is another point lost on you, namely that things like shelf exams and steps have been massively up-curved in the past few years. And this is only continuing. Studying for us means something very different than what it meant for you.

That point isn't lost on me. You guys don't study more. Arguably you study better with all the test prep. It's not like we were all just fooking around while you guys spend every waking moment. You probably need to get over your clear sense of special snowflake status. You're just another bozo on the bus. Not special. Not worse off. Not working more hours. Not getting fewer procedures. You didn't miss a golden age because there never really was one.

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[Wordead]

He didn't answer the question about how many lines he did, but even assuming he's telling the truth and not downplaying things for the sake of making a point that's still way more than I and many others have done. Think about every fun, exciting or just useful thing you got to do as a third year, and then take it all away: that's been the experience of many of us.

I did ~15 intubations 3 central lines 1 para and 5 a-lines as a med student.

I use all my med students notes (I look them over of course) and once they're trusted to not be ****ty I just sign them under my name.

And the fact that you think you need to be doing these as a part of of med school completely misses the point. Do you know how to work up common problems on the floor? Deliver a concise history to your attending or when you call a consult? Can you keep track of 10-20 patients at once?

 

[Señor S]

I did ~15 intubations 3 central lines 1 para and 5 a-lines as a med student.

I use all my med students notes (I look them over of course) and once they're trusted to not be ****ty I just sign them under my name.

And the fact that you think you need to be doing these as a part of of med school completely misses the point. Do you know how to work up common problems on the floor? Deliver a concise history to your attending or when you call a consult? Can you keep track of 10-20 patients at once?

Nobody uses our notes here; they can't, the computer won't let them. I've done 0 lines or any kind of -centesis. No intubations. Never got to deliver a baby or even a placenta. All the feedback I've gotten (and the only feedback I've gotten) is along the lines of "this looks good" and "nice job" so presumably I must be doing OK? Mostly we just follow the residents or attendings around. Maybe you think there's a lot of value in that, but at this point I don't.

 

[Señor S]

That point isn't lost on me. You guys don't study more. Arguably you study better with all the test prep. It's not like we were all just fooking around while you guys spend every waking moment. You probably need to get over your clear sense of special snowflake status. You're just another bozo on the bus. Not special. Not worse off. Not working more hours. Not getting fewer procedures. You didn't miss a golden age because there never really was one.

We do study more, medical school is more competitive now and we beat you by all objective measures. Those are just the numbers. As for the rest of it, I don't have any data but it wouldn't be physically possible to do less than I've done. Maybe there was no "golden age" but I'd feel a lot better without 250k in non-dischargeable debt hanging over my head (for a state school, mind you) due to tuition far outpacing inflation, and without a small army of PAs, NPs, CRNAs etc etc. constantly pushing for (and winning) more and more autonomy for themselves.

 

[jdh71]

We do study more, medical school is more competitive now and we beat you by all objective measures. Those are just the numbers. As for the rest of it, I don't have any data but it wouldn't be physically possible to do less than I've done. Maybe there was no "golden age" but I'd feel a lot better without 250k in non-dischargeable debt hanging over my head (for a state school, mind you) due to tuition far outpacing inflation, and without a small army of PAs, NPs, CRNAs etc etc. constantly pushing for (and winning) more and more autonomy for themselves.

If you beat us by all objective measure then why are you crying so much?

 

[Señor S]

If you beat us by all objective measure then why are you crying so much?

It's lonely at the top man.

 

[jdh71]

It's lonely at the top man.

Must be hard.

 

[sloop]

Must be hard.

Your wife can attest to that.

 

[ProfMD]

I am sure this will generate a flurry of defensive replies, but here it goes.

We have students are content to be wallflowers. They stand around and wait to be told what to do. They pick up a patient to follow if told to. If not, they just follow the team around, maybe ask a few questions.

Then there are other students who are always there, always asking to be involved. When a case comes, the come up and ask to scrub in. When there are procedures, they ask if they can watch. If they have seen a few, they may ask to do one. They develop a rapport with the residents and faculty. They show enthusiasm.

Guess which student does more. Guess which student gets the better evaluation.

There is strategy to clerkships just as there is to shelf exams and the USMLE. I want to see that the student is enthusiastic. I want to see that they want to be there. I want to see that they want to learn something. Those are the students that I go out of my way to make sure get involved as much as possible. The students who stand around wondering why they are there and if they can leave at 5 - they can leave at 5 (or 4 or 3 if they want) but they will miss out on opportunities.

The way I see it, medical students are adults. They can make their own decisions. Their evaluations, however, will reflect these decisions.

 

[jdh71]

Your wife can attest to that.

Classy.

 

[IlDestriero]

If you beat us by all objective measure then why are you crying so much?

All except for net worth apparently.
That golden age they did miss.
8-0


--
Il Destriero

 

[jdh71]

All except for net worth apparently.
That golden age they did miss.
8-0


--
Il Destriero

Hard to fight against the inflation.

 

[qwerty89]

I am sure this will generate a flurry of defensive replies, but here it goes.

We have students are content to be wallflowers. They stand around and wait to be told what to do. They pick up a patient to follow if told to. If not, they just follow the team around, maybe ask a few questions.

Then there are other students who are always there, always asking to be involved. When a case comes, the come up and ask to scrub in. When there are procedures, they ask if they can watch. If they have seen a few, they may ask to do one. They develop a rapport with the residents and faculty. They show enthusiasm.

Guess which student does more. Guess which student gets the better evaluation.

There is strategy to clerkships just as there is to shelf exams and the USMLE. I want to see that the student is enthusiastic. I want to see that they want to be there. I want to see that they want to learn something. Those are the students that I go out of my way to make sure get involved as much as possible. The students who stand around wondering why they are there and if they can leave at 5 - they can leave at 5 (or 4 or 3 if they want) but they will miss out on opportunities.

The way I see it, medical students are adults. They can make their own decisions. Their evaluations, however, will reflect these decisions.

As a current resident that has seen the full gamut of students rotating through I'd just like to add my two cents...

I was the former type of student. I always felt stupid and useless. Therefore I never really asked to do extra and just did what I was told. Surprise surprise, I got mainly passes with the occasional high pass.

As a resident I have seen those types of students as well as those that are very enthusiastic and read up preemptively on topics to present on rounds. Those that pick up extra patients when another patient that they are following becomes a "rock". This is looked upon favorably and these students are much more pleasant to be around.

Guess who gets better evals?

The funny thing is that the first type of student probably sees the second type as a "gunner" or a suck up. The second type usually aren't kissing anyone's ass. They are doing their job and doing it well.

The intern me would have really hated having the MS3 me on wards.

That being said being a medical student does suck. Even with worse hours the day to day work is much more enjoyable as a resident. Every day on rounds isn't the "performance" that it felt like as a MS3.

 

[Mountaineer12]

As a current resident that has seen the full gamut of students rotating through I'd just like to add my two cents...

I was the former type of student. I always felt stupid and useless. Therefore I never really asked to do extra and just did what I was told. Surprise surprise, I got mainly passes with the occasional high pass.

As a resident I have seen those types of students as well as those that are very enthusiastic and read up preemptively on topics to present on rounds. Those that pick up extra patients when another patient that they are following becomes a "rock". This is looked upon favorably and these students are much more pleasant to be around.

Guess who gets better evals?

The funny thing is that the first type of student probably sees the second type as a "gunner" or a suck up. The second type usually aren't kissing anyone's ass. They are doing their job and doing it well.

The intern me would have really hated having the MS3 me on wards.

That being said being a medical student does suck. Even with worse hours the day to day work is much more enjoyable as a resident. Every day on rounds isn't the "performance" that it felt like as a MS3.

Yeah, I would definitely think that person was being a gunner. I think this is more about personality than work ethic though. I'm not one of those students that will assume responsibility without being told to do so because I don't want to step on anyone's toes or do something I'm not supposed to. I'm definitely more of a "wallflower" student, but I don't necessarily think that's my fault, it's just my personality. I want to work hard, but I don't feel comfortable preemptively doing things. If someone tells me to do something, I'll do it or if I know in advance that I'm responsible for X, Y, and Z, I'll get it done. But especially when it comes to wards or surgery where everything is still a bit foreign, I'm not going to just start doing things without being told to or at least asking (though when I ask to do things I feel like I'm annoying the residents so that's not a great route either). This just further highlights how subjective third year is and how you luck out if you have the right personality.


Sent from my iPhone using SDN mobile app

 

[dadaddadaBATMAN]

As a current resident that has seen the full gamut of students rotating through I'd just like to add my two cents...

I was the former type of student. I always felt stupid and useless. Therefore I never really asked to do extra and just did what I was told. Surprise surprise, I got mainly passes with the occasional high pass.

As a resident I have seen those types of students as well as those that are very enthusiastic and read up preemptively on topics to present on rounds. Those that pick up extra patients when another patient that they are following becomes a "rock". This is looked upon favorably and these students are much more pleasant to be around.

Guess who gets better evals?

The funny thing is that the first type of student probably sees the second type as a "gunner" or a suck up. The second type usually aren't kissing anyone's ass. They are doing their job and doing it well.

The intern me would have really hated having the MS3 me on wards.

That being said being a medical student does suck. Even with worse hours the day to day work is much more enjoyable as a resident. Every day on rounds isn't the "performance" that it felt like as a MS3.

I would point out that this is an acquired skill, and that it takes time to realize what's overbearing/weird and what's helpful.

If you don't get this instantly when you step onto the wards, it's cool, just make sure it's obvious you care about learning and try as hard as you can.

 

[MediCane2006]

I was wondering when @jdh71 would find this thread....

 

[jdh71]

I was wondering when @jdh71 would find this thread....

As noted above was working on my day off. Two cancer diagnoses. Two to three weeks before it was convenient for me. Also staged the mediastinum. Both can have surgery (assuming PET/CT shows no other distance spread) next week.

I didn't do that for me. I did that for them.

 

[MediCane2006]

As noted above was working on my day off. Two cancer diagnoses. Two to three weeks before it was convenient for me. Also staged the mediastinum. Both can have surgery (assuming PET/CT shows no other distance spread) next week.

I didn't do that for me. I did that for them.

But what about your hobbies....and your FREE TIME...

 

[jdh71]

But what about your hobbies....and your FREE TIME...

I missed my normal time with my trainer (because of some post-procedure bleeding I ended up putting one guy in for obs afterwards), but he left me a brutal workout to do for later. I did it LATER. I mean I still have hobbies. I work hard and I play hard.

 

[prettylittlebird]

As noted above was working on my day off. Two cancer diagnoses. Two to three weeks before it was convenient for me. Also staged the mediastinum. Both can have surgery (assuming PET/CT shows no other distance spread) next week.

I didn't do that for me. I did that for them.

 

[Amygdarya]

Not cool. Not cool at all.

And I bet the students who are now so protective about their work-life balance and denigrate physicians actually taking care of patients (!!!) waxed poetic about how much they wanted to serve the sick in their medical school personal statements and interviews.

 

[psychMDhopefully]

OP, I feel you dude there is so much wasted time, effort, years, in medical education, no wonder NPs think they can do whatever family medicine docs do , they probably can. Its not their education is too short, its that MD training in this country is overly long and wasteful. The length of most training obviously serves are a filter to keep most sensible people out of medicine.

 

[sliceofbread136]

I am sure this will generate a flurry of defensive replies, but here it goes.

We have students are content to be wallflowers. They stand around and wait to be told what to do. They pick up a patient to follow if told to. If not, they just follow the team around, maybe ask a few questions.

Then there are other students who are always there, always asking to be involved. When a case comes, the come up and ask to scrub in. When there are procedures, they ask if they can watch. If they have seen a few, they may ask to do one. They develop a rapport with the residents and faculty. They show enthusiasm.

Guess which student does more. Guess which student gets the better evaluation.

There is strategy to clerkships just as there is to shelf exams and the USMLE. I want to see that the student is enthusiastic. I want to see that they want to be there. I want to see that they want to learn something. Those are the students that I go out of my way to make sure get involved as much as possible. The students who stand around wondering why they are there and if they can leave at 5 - they can leave at 5 (or 4 or 3 if they want) but they will miss out on opportunities.

The way I see it, medical students are adults. They can make their own decisions. Their evaluations, however, will reflect these decisions.

Try making your expectations clear and then maybe you'll find more people will be meeting them. Attendings seem to think we can all read their minds about what nuances/skut/random crap you want us to do. I can count on 1 hand the amount of attendings who clearly laid what they expect for you to do well.

 

[sliceofbread136]

OP, I feel you dude there is so much wasted time, effort, years, in medical education, no wonder NPs think they can do whatever family medicine docs do , they probably can. Its not their education is too short, its that MD training in this country is overly long and wasteful. The length of most training obviously serves are a filter to keep most sensible people out of medicine.

This. Putting 100 hour weeks into surgery to retract and drive cameras in surgeries that I will never care about during the rest of my career. Could've learned how to suture and place IVs in a morning class instead of this huge waste of time

 

[ProfMD]

Try making your expectations clear and then maybe you'll find more people will be meeting them. Attendings seem to think we can all read their minds about what nuances/skut/random crap you want us to do. I can count on 1 hand the amount of attendings who clearly laid what they expect for you to do well.

First off, in surgery it is usually the residents who have the most interaction with the students.

Second, as I mentioned in my post, you are all adults. I should not have to tell you to come to rounds, come to surgery, come to clinic, follow patients, take ownership of patients, etc. This was fairly common knowledge when I was a med student. By the time we got to third year, my classmates and I all knew the drill. Maybe it is different now.

And, I am not suggesting that you be scutted out. I am just asking you show show some interest in being at the hospital. That's all. If you need to be told to be interested in being at the hospital, maybe you chose the wrong career.

Sorry if that is harsh, but the days of hand holding are over.

 

[ProfMD]

This. Putting 100 hour weeks into surgery to retract and drive cameras in surgeries that I will never care about during the rest of my career. Could've learned how to suture and place IVs in a morning class instead of this huge waste of time

I did medicine, pediatrics, OB/GYN, psych, and family medicine - now I am a surgeon, but I still learned stuff from those other rotations. Basic knowledge and exposure to a wide variety of patients and specialties is what the clinical years of medical school are about.

How about taking the opportunity in surgery to refresh anatomy and figure out what is important to know. Maybe you can learn about what surgeons do with gallbladder disease or appendicitis so that when you see these patients in your practice, you have some idea what they are in for. Maybe you can learn how to identify an acute abdomen, this might help inform when a surgical consult is and is not needed. How about learning sterile technique so that you do not cause a bunch of central line infections when you start residency. And suturing and tying takes practice to do well and efficiently - more than just a morning course.

Attitude and enthusiasm during rotations are what separates great medical students from mediocre ones. We can all spot a suck up a mile away and cannot stand it. But we like it when students show that they are actually interested in learning how to be doctors. And, if you have this attitude, you will be a better doctor for it.

 

[sliceofbread136]

First off, in surgery it is usually the residents who have the most interaction with the students.

Second, as I mentioned in my post, you are all adults. I should not have to tell you to come to rounds, come to surgery, come to clinic, follow patients, take ownership of patients, etc. This was fairly common knowledge when I was a med student. By the time we got to third year, my classmates and I all knew the drill. Maybe it is different now.

And, I am not suggesting that you be scutted out. I am just asking you show show some interest in being at the hospital. That's all. If you need to be told to be interested in being at the hospital, maybe you chose the wrong career.

Sorry if that is harsh, but the days of hand holding are over.

Yes me being an adult should make my expectations nebulous. Makes sense thank you for clearing that up

 

[sliceofbread136]

I did medicine, pediatrics, OB/GYN, psych, and family medicine - now I am a surgeon, but I still learned stuff from those other rotations. Basic knowledge and exposure to a wide variety of patients and specialties is what the clinical years of medical school are about.

How about taking the opportunity in surgery to refresh anatomy and figure out what is important to know. Maybe you can learn about what surgeons do with gallbladder disease or appendicitis so that when you see these patients in your practice, you have some idea what they are in for. Maybe you can learn how to identify an acute abdomen, this might help inform when a surgical consult is and is not needed. How about learning sterile technique so that you do not cause a bunch of central line infections when you start residency. And suturing and tying takes practice to do well and efficiently - more than just a morning course.

Attitude and enthusiasm during rotations are what separates great medical students from mediocre ones. We can all spot a suck up a mile away and cannot stand it. But we like it when students show that they are actually interested in learning how to be doctors. And, if you have this attitude, you will be a better doctor for it.

Yes driving the camera and retracting have taught me many things and have totally been worth the ridiculous hours in the OR, thanks for clearing this up once again.

Seeing consults and working in the trauma bay were good experiences but standing there in the surgery is a waste of time for anyone not going into surgery.

 

[ProfMD]

Yes me being an adult should make my expectations nebulous. Makes sense thank you for clearing that up

As I mentioned, all the expectations on that list are common knowledge among medical students. At least they were when I was a medical student. Maybe things have changed, but by the end of second year I knew from talking to those senior to me that on clerkships you would be expected to pick up patients, follow them, write notes for them, write orders, etc. I realize that some of this is not done anymore, but certainly people talk.

Showing enthusiasm, being interested in learning - I would hope that is inherent. I can't teach that. I should not have to take a medical student aside and say "It would really be great if you were interested in learning medicine during medical school."

 

[ProfMD]

Yes driving the camera and retracting have taught me many things and have totally been worth the ridiculous hours in the OR, thanks for clearing this up once again.

Seeing consults and working in the trauma bay were good experiences but standing there in the surgery is a waste of time for anyone not going into surgery.

I could say that hours in family medicine clinic was worthless. I could say group sessions on my psych rotations were worthless. I could say that delivering babies was worthless. I could say a lot of things about non-surgery rotations. But it is not true. I don't say these things because exposure to the nuts and bolts of a variety of disciplines is part of becoming a good doctor.

I am not sure where you are in you training since you have not indicated, but if you have not started residency, you will soon have more months that you see as "worthless" since you will certainly have rotations that are not exactly what you plan to do with the rest of your life.

 

[sliceofbread136]

As I mentioned, all the expectations on that list are common knowledge among medical students. At least they were when I was a medical student. Maybe things have changed, but by the end of second year I knew from talking to those senior to me that on clerkships you would be expected to pick up patients, follow them, write notes for them, write orders, etc. I realize that some of this is not done anymore, but certainly people talk.

Showing enthusiasm, being interested in learning - I would hope that is inherent. I can't teach that. I should not have to take a medical student aside and say "It would really be great if you were interested in learning medicine during medical school."

"Show enthusiasm" is about as specific an expectation as "do well", useless. How exactly do you want me to show enthusiasm? Different attendings have different things. Some want involved S and O, some focus more on A and P, some emphasize citing research papers and guidelines on rounds, some want you to write orders, some don't, some want you to write long detailed notes, some none at all. Some want you to get in there and do procedures, some want those to residents. The possibilities are literally endless. If you don't want to take the 2 minutes it takes to outline what you think should be getting done, well then don't be suprised when it doesn't happen.

I could say that hours in family medicine clinic was worthless. I could say group sessions on my psych rotations were worthless. I could say that delivering babies was worthless. I could say a lot of things about non-surgery rotations. But it is not true. I don't say these things because exposure to the nuts and bolts of a variety of disciplines is part of becoming a good doctor.

I am not sure where you are in you training since you have not indicated, but if you have not started residency, you will soon have more months that you see as "worthless" since you will certainly have rotations that are not exactly what you plan to do with the rest of your life.

You can encounter patients with psych and medical disease on anything, you will not be going into the OR for every specialty. Sure make me see consults and maybe a couple of surgeries, other than that should be put in an elective.

 

[ProfMD]

"Show enthusiasm" is about as specific an expectation as "do well", useless. How exactly do you want me to show enthusiasm? Different attendings have different things. Some want involved S and O, some focus more on A and P, some emphasize citing research papers and guidelines on rounds, some want you to write orders, some don't, some want you to write long detailed notes, some none at all. Some want you to get in there and do procedures, some want those to residents. The possibilities are literally endless. If you don't want to take the 2 minutes it takes to outline what you think should be getting done, well then don't be suprised when it doesn't happen.



You can encounter patients with psych and medical disease on anything, you will not be going into the OR for every specialty. Sure make me see consults and maybe a couple of surgeries, other than that should be put in an elective.

I guess you are missing my point about "broad exposure." So I will not longer try to convince you.

As for showing enthusiasm and interest. At least be there, try and contribute, try and ask questions and I will guide you. I am not going to spend a bunch of time holding the hand of someone who cannot be bothered to take the first step. You can also seek guidance from students who have been there before you.

As I said, I cannot teach interest and enthusiasm. I cannot tell you exactly how to show interest and enthusiasm because this is an overall attitude. Everyone expresses them differently. You either have them, or you don't. You are in medical school, you need to take some initiative.

I am happy to take time with students who want to be there. If you do not want to be there, so be it, I have other stuff I can do. You are an adult. Make your own decisions.

 

[sliceofbread136]

I guess you are missing my point about "broad exposure." So I will not longer try to convince you.

As for showing enthusiasm and interest. At least be there, try and contribute, try and ask questions and I will guide you. I am not going to spend a bunch of time holding the hand of someone who cannot be bothered to take the first step. You can also seek guidance from students who have been there before you.

As I said, I cannot teach interest and enthusiasm. I cannot tell you exactly how to show interest and enthusiasm because this is an overall attitude. Everyone expresses them differently. You either have them, or you don't. You are in medical school, you need to take some initiative.

I am happy to take time with students who want to be there. If you do not want to be there, so be it, I have other stuff I can do. You are an adult. Make your own decisions.

Thank you for reiterating that I am an adult. I'll close with my own reiteration, not setting your expectations at the beginning of a rotation is limiting your effectiveness as an educator. I implore you to take the extra 3.5 minutes to make them clear

 

[ProfMD]

Thank you for reiterating that I am an adult. I'll close with my own reiteration, not setting your expectations at the beginning of a rotation is limiting your effectiveness as an educator. I implore you to take the extra 3.5 minutes to make them clear

I think most attending surgeons and surgical residents would agree with the following, so here is some free advice:
1) Be on time for rounds.
2) Ask the residents if you can follow a patient or two. Generally, if you were involved in an operation, that is a good patient to follow for the duration of his/her hospital stay. See and examine the patient before rounds, check labs and vitals and report on them to the team.
3) Find out the surgery schedule for the following day. Find out from the senior resident what case(s) you will be attending. Read about that condition and the surgery.
4) Show up to the operation on time. Introduce yourself to the attending. Ask if you can scrub in. If the answer is yes, get your gown and gloves for the scrub tech.
5) During the operation help when you are asked (retraction, camera driving, etc). Ask questions, but only when appropriate (i.e., if things look like they are going south - not a good time to interrupt). At the end of the case, when the attending scrubs out, stick around and see if you can help close.
6) When your team is on-call, and a consult request comes in, offer to see the consult.
7) Take call at whatever interval is required by your program. When you are on-call, follow the intern around and find ways to help him or her.

Nobody told me this stuff on my surgery rotation. Much of it was knowledge handed down from medical students senior to me. Some of it is just common sense, or perhaps inherent enthusiasm.

And, I realize we do not know each other, so you have no idea if I am a good or bad educator. However, I do tend to get positive feedback. Of course, they could all be blowing smoke ...

 

[Wordead]

"Show enthusiasm" is about as specific an expectation as "do well", useless. How exactly do you want me to show enthusiasm? Different attendings have different things. Some want involved S and O, some focus more on A and P, some emphasize citing research papers and guidelines on rounds, some want you to write orders, some don't, some want you to write long detailed notes, some none at all. Some want you to get in there and do procedures, some want those to residents. The possibilities are literally endless. If you don't want to take the 2 minutes it takes to outline what you think should be getting done, well then don't be suprised when it doesn't happen.



You can encounter patients with psych and medical disease on anything, you will not be going into the OR for every specialty. Sure make me see consults and maybe a couple of surgeries, other than that should be put in an elective.

Why should a psychiatrist do any other rotation then? By your logic pretty much every other rotation is worthless.

 

[dadaddadaBATMAN]

Why should a psychiatrist do any other rotation then? By your logic pretty much every other rotation is worthless.

It's just kind of an odd attitude. I mean, I had an idea of what I wanted to do coming in, but I still tried to convince myself to do other things.

At the very least, I thouroughly convinced myself that I was not a future surgeon within 8 weeks. That's a damn good use of time, it narrows down the residency path considerably. Same thing for ob.

And call me crazy, but I'm happy to have some idea how the hospital works out of my itty bitty corner of it.

 

[kavorca]

I try to get students out when I can but..

Who ever said your time was valuable and too precious to be wasted? You step over the bodies of other premeds to get into your school, and now bitch about wasting your time for a few months. I would argue that sitting around the hospital waiting for something to happen is better than learning 90% of what you learned for Step 1 which is probably about 90% of everything you know about medicine before you start clinicals. Most residents and attendings I have worked with utilized the students. I am sorry if you have a shadowing Med school, but it's only a few months to a year of these long rotations. When you graduate, you will get your fill of action in the specialty of your choice.

 

[Perrotfish]

I could say that hours in family medicine clinic was worthless. I could say group sessions on my psych rotations were worthless. I could say that delivering babies was worthless. I could say a lot of things about non-surgery rotations. But it is not true. I don't say these things because exposure to the nuts and bolts of a variety of disciplines is part of becoming a good doctor.

No, you would be right if you said those things. Those rotations were worthless to you, every bit as worthless as my surgery rotations were to me. While nothing in medical school, or life, is completely without value, the yield of seeing rotations in specialties you're not going into is as close to being worthless as anything in life will every be.

Its not like medical school was designed with the goal of 'exposure'. It was designed, in the late 1800s, to give students the skills they needed to be a doctor in the late 1800s. Everyone needed surgery because every new grad was expected to be able to do the handful of basic surgeries then available, and they were expected to do them unsupervised the day that they graduated. Everyone delivered babies because all doctors delivered babies. They did Internal medicine and Pediatrics because everyone covered clinics and the floors of their cottage hospitals. There were a handful of students that they knew would be specializing in Pediatrics, Surgery, or Venereology, but that percentage was so vanishingly small that they just weren't worth adapting for.

Medicine keeps changing, but every time it change, rather than adapting, the medical-education complex just staples more training onto whatever used to be the end of the training process. This makes sense from their perspective: since the training is legally mandatory and the end goal is lucrative enough to keep attracting eager students educators have no incentive to eliminate the ever increasing layers of vestigial education. So now if you want to do Pediatric heart surgery you need to go through 4 years of utterly worthless undergrad, to be allowed to attend 4 years of largely worthless medical school, to get to spend 5 years dealing with 80% worthless general surgery residency, so that you can be allowed to start a 50% useless Pediatric surgery fellowship, so that you can finally be allowed to spend two years learning to do the thing you actually plan to do for a living in your Pediatric CT surgery sub fellowship

 

[IM88]

the medical-education complex just staples more training onto whatever used to be the end of the training process.

What about the integrated CT, plastics, and vascular surgery residencies? There is a new interventional radiology residency, and there was the old Direct pathway. Medicine doesn't move very quickly, but it seems like some specialties actually do understand the lengthy nature of training, and are taking steps to make it shorter.

I don't agree that rotations are worthless. If you're doing them right, you can develop critical thinking and presentation skills even when you're on a service you're not planning on pursuing. Whether the current setup is the most efficient way of training physicians is debatable. Rather than complaining on an internet forum about being kept until 5pm, though, it would be nice to actually offer up some alternatives. Based on some of the arguments above, it sounds like we should be granting MD's after preclinicals + an extended subinternship?

 

[jdh71]

No, you would be right if you said those things. Those rotations were worthless to you, every bit as worthless as my surgery rotations were to me. While nothing in medical school, or life, is completely without value, the yield of seeing rotations in specialties you're not going into is as close to being worthless as anything in life will every be.

Its not like medical school was designed with the goal of 'exposure'. It was designed, in the late 1800s, to give students the skills they needed to be a doctor in the late 1800s. Everyone needed surgery because every new grad was expected to be able to do the handful of basic surgeries then available, and they were expected to do them unsupervised the day that they graduated. Everyone delivered babies because all doctors delivered babies. They did Internal medicine and Pediatrics because everyone covered clinics and the floors of their cottage hospitals. There were a handful of students that they knew would be specializing in Pediatrics, Surgery, or Venereology, but that percentage was so vanishingly small that they just weren't worth adapting for.

Medicine keeps changing, but every time it change, rather than adapting, the medical-education complex just staples more training onto whatever used to be the end of the training process. This makes sense from their perspective: since the training is legally mandatory and the end goal is lucrative enough to keep attracting eager students educators have no incentive to eliminate the ever increasing layers of vestigial education. So now if you want to do Pediatric heart surgery you need to go through 4 years of utterly worthless undergrad, to be allowed to attend 4 years of largely worthless medical school, to get to spend 5 years dealing with 80% worthless general surgery residency, so that you can be allowed to start a 50% useless Pediatric surgery fellowship, so that you can finally be allowed to spend two years learning to do the thing you actually plan to do for a living in your Pediatric CT surgery sub fellowship

Oh this is all horse**** nonsense. It all builds appropriately on itself.

 

[NWwildcat2013]

My main problem is the disconnect between the clinical work and the shelf exam. Earlier in this thread someone said that you study from your patients and by reading up on them. That alone isn't going to cut it if you want honors at most schools. The actual clinical work is designed to get you comfortable seeing patients and interacting with real people, working in a team, understanding the logistics and flow of modern medicine/hospitals, learning the "language" of medicine (presentations) and how to write about it (notes). Most of all it is about being able to efficiently find, organize, and distill information quickly and from many sources.

MS3 is excellent at the above and I actually enjoy it. What I don't enjoy is that I will never see even a fraction of the stuff that I need to know for the shelf, so I have to fill every waking hour outside of the hospital studying.

 

[ProfMD]

My main problem is the disconnect between the clinical work and the shelf exam. Earlier in this thread someone said that you study from your patients and by reading up on them. That alone isn't going to cut it if you want honors at most schools. The actual clinical work is designed to get you comfortable seeing patients and interacting with real people, working in a team, understanding the logistics and flow of modern medicine/hospitals, learning the "language" of medicine (presentations) and how to write about it (notes). Most of all it is about being able to efficiently find, organize, and distill information quickly and from many sources.

MS3 is excellent at the above and I actually enjoy it. What I don't enjoy is that I will never see even a fraction of the stuff that I need to know for the shelf, so I have to fill every waking hour outside of the hospital studying.

This is all true. Unfortunately, it doesn't stop. My written board exam had very little to do with clinical practice. The oral exam covered esoteric conditions that I have never seen and will likely never see.

However, this is the system of examinations that we have.

 

[Perrotfish]

What about the integrated CT, plastics, and vascular surgery residencies? There is a new interventional radiology residency, and there was the old Direct pathway. Medicine doesn't move very quickly, but it seems like some specialties actually do understand the lengthy nature of training, and are taking steps to make it shorter.

The problem is that that medical education, though it is moving a little, moves at a much slower pace than medicine itself. They're moving in the right direction but the gap keeps getting wider rather than narrower.

I don't agree that rotations are worthless. If you're doing them right, you can develop critical thinking and presentation skills even when you're on a service you're not planning on pursuing. Whether the current setup is the most efficient way of training physicians is debatable. Rather than complaining on an internet forum about being kept until 5pm, though, it would be nice to actually offer up some alternatives. Based on some of the arguments above, it sounds like we should be granting MD's after preclinicals + an extended subinternship?

Rotations aren't worthless. Nothing in life is worthless if you take the time to learn from it. That doesn't mean all of medical training is of equal worth. I think that medical school has become much lower yield than it needs to be.

If I was creating a new medical training pathway I would:

1) Move the classroom based component of medical school to the undergraduate years. Eliminate most of the premedical requirements for medical school to make room. The USMLE Step 1 becomes the entrance exam for medical school.

2) Create two year, entirely clinical rotation based medical schools. Create multiple kinds of schools, each focused on a narrow range of residencies. Basically no more medical school, but instead Internal medicine school, surgery school, pediatrician school, Obstetric school, etc.

3) Eliminate formal residency training. Allow groups of 5 or more board certified physician to hire new graduates and supervise them as they work towards board certification. Residents get credits for working in different enviornments (clinic, nursery, etc) and are certified when they have worked enough hours under someone else's license in enough environments while also passing standardized exams.

 

[thiaeyemd]

The real question is why are you not doing anything? You can read, review patient notes, learn a procedure, ask the nurses to teach you something, ask the residents to teach you something. If you are viewing staying until 5 as a burden it shows you are viewing med school rotations and learning as a burden as opposed to an active opportunity to learn...Not good.

 

[ProfMD]

The problem is that that medical education, though it is moving a little, moves at a much slower pace than medicine itself. They're moving in the right direction but the gap keeps getting wider rather than narrower.



Rotations aren't worthless. Nothing in life is worthless if you take the time to learn from it. That doesn't mean all of medical training is of equal worth. I think that medical school has become much lower yield than it needs to be.

If I was creating a new medical training pathway I would:

1) Move the classroom based component of medical school to the undergraduate years. Eliminate most of the premedical requirements for medical school to make room. The USMLE Step 1 becomes the entrance exam for medical school.

2) Create two year, entirely clinical rotation based medical schools. Create multiple kinds of schools, each focused on a narrow range of residencies. Basically no more medical school, but instead Internal medicine school, surgery school, pediatrician school, Obstetric school, etc.

3) Eliminate formal residency training. Allow groups of 5 or more board certified physician to hire new graduates and supervise them as they work towards board certification. Residents get credits for working in different enviornments (clinic, nursery, etc) and are certified when they have worked enough hours under someone else's license in enough environments while also passing standardized exams.

That sounds like pre-Flexner report days when anyone could set up shop and declare themselves open for business to train doctors.

Who would oversee the groups of five board certified physicians? Who would ensure that they are getting quality training? If there is an overarching body, what you are describing is residency by another name. If not, then woe be unto the future patients.

Your medical school proposal sounds like a mix between the UK system and something else. That is, get students out of high school. Teach them the basic science medicine classes, the stick them on the wards.

As for these "schools" - how are students supposed to pick a field with no exposure?

 

[Perrotfish]

That sounds like pre-Flexner report days when anyone could set up shop and declare themselves open for business to train doctors.

Who would oversee the groups of five board certified physicians? Who would ensure that they are getting quality training? If there is an overarching body, what you are describing is residency by another name. If not, then woe be unto the future patients.

There would be an overseeing body, and periodic standardized tests. It wouldn't completely eliminate the structure of medical training, it would just create a more reasonable power balance between the trainers and trainees. Right now residencies are giant organizations that are allowed to collude with one another, which effectively means that residents have none of the normal free market protections of employees because they can't negotiate with their employers or quit to find a less abusive employer.

This is how engineers are trained and licensed right now, BTW. There is such a thing as a professional engineering license and you get it... while working like a normal employee. Its an amazingling painless system, completely free of all of the angst and depression you see in medical training.

As for these "schools" - how are students supposed to pick a field with no exposure?

A reasonable argument. After all, I was very grateful that my college made me rotate through accounting, law, nursing, marketing, and engineering. Otherwise how could I have settled on healthcare? And of course before that there were my 8 week rotations in high school as a farm hand, lathe operator, gas station attendant, long haul truck driver, and enlisted Marine. Without those, how could I have known I wanted to go to college at all?

 

[sliceofbread136]

I think most attending surgeons and surgical residents would agree with the following, so here is some free advice:
1) Be on time for rounds.
2) Ask the residents if you can follow a patient or two. Generally, if you were involved in an operation, that is a good patient to follow for the duration of his/her hospital stay. See and examine the patient before rounds, check labs and vitals and report on them to the team.
3) Find out the surgery schedule for the following day. Find out from the senior resident what case(s) you will be attending. Read about that condition and the surgery.
4) Show up to the operation on time. Introduce yourself to the attending. Ask if you can scrub in. If the answer is yes, get your gown and gloves for the scrub tech.
5) During the operation help when you are asked (retraction, camera driving, etc). Ask questions, but only when appropriate (i.e., if things look like they are going south - not a good time to interrupt). At the end of the case, when the attending scrubs out, stick around and see if you can help close.
6) When your team is on-call, and a consult request comes in, offer to see the consult.
7) Take call at whatever interval is required by your program. When you are on-call, follow the intern around and find ways to help him or her.

Nobody told me this stuff on my surgery rotation. Much of it was knowledge handed down from medical students senior to me. Some of it is just common sense, or perhaps inherent enthusiasm.

And, I realize we do not know each other, so you have no idea if I am a good or bad educator. However, I do tend to get positive feedback. Of course, they could all be blowing smoke ...

I already won third year, I no longer require any advice for that waste of time.

You are right that I do not know you and am only going off of what you have posted, but I do know that failing to communicate your expectations of your students at all was a huge red flag for a poor teaching attending/communicator. It very rarely failed me, so take that for what you will. Done with the argument

 

[sliceofbread136]

Why should a psychiatrist do any other rotation then? By your logic pretty much every other rotation is worthless.

Psych has to medicine atleast during intern year. What specialty will never do medicine? What specialties will never go to the OR? That comparison is silly

 

[ProfMD]

There would be an overseeing body, and periodic standardized tests. It wouldn't completely eliminate the structure of medical training, it would just create a more reasonable power balance between the trainers and trainees. Right now residencies are giant organizations that are allowed to collude with one another, which effectively means that residents have none of the normal free market protections of employees because they can't negotiate with their employers or quit to find a less abusive employer.

This is how engineers are trained and licensed right now, BTW. There is such a thing as a professional engineering license and you get it... while working like a normal employee. Its an amazingling painless system, completely free of all of the angst and depression you see in medical training.



A reasonable argument. After all, I was very grateful that my college made me rotate through accounting, law, nursing, marketing, and engineering. Otherwise how could I have settled on healthcare? And of course before that there were my 8 week rotations in high school as a farm hand, lathe operator, gas station attendant, long haul truck driver, and enlisted Marine. Without those, how could I have known I wanted to go to college at all?

Your apprenticeship model sounds interesting - limiting factor, as with many things, is money. Who will pay for these trainees/apprentices?

The second point you make, if I may read through the sarcasm, is less convincing. Are you telling me that you do not know anyone who started medical school thinking they wanted to be an internist and then changes their mind after being exposed to each field third year? There were plenty of people in my class for whom third year decided their ultimate specialty - myself included.

 

[ProfMD]

Psych has to medicine atleast during intern year. What specialty will never do medicine? What specialties will never go to the OR? That comparison is silly

Pathology