end-of-rotation ettiquete

[BigPimpin]

Hey, maybe I'm revealing myself as a social cretin for even asking, but I've heard of people giving their preceptors gifts or trinkets at the end of the rotation to say thanks for teaching them. Is this a must, a judgment call, or simply NOT to be done? I know the arguments against it, i.e. most students can't afford a bag of doritos, let alone a low-priced something-or-other for a well-paid doc. And of course as students we don't get monetary payment. I could see the advantages, too -- they might remember you if you end up needing a letter or something, etc.

My point is that I'm just ending my first rotation and I don't want to NOT do it if it's something that's usually done. Opinions? Thanks.

BigP

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[Noelle]

I've never heard of students buying gifts for attendings although I wouldn't doubt it with some of the brown-nosers out there. . I have, and have heard of other students writing thank you cards/letters to their preceptors/attendings. I have primarily done this for preceptors that have hosted me for 6 weeks in THEIR clinic. I think gift giving is inappropriate. But I think you should definitely let a preceptor know if you've had a great experience and if not pretend like you did and thank them for their time and teaching.

 

[ckent]

Don't buy a gift for your attending. It's poor tact in my opinion, particularly if you buy the gift before the attending has had the opportunity to write you a letter/evaluation. I doubt that you will impress any attending with a gift, you are probably much more likely to turn them off if you give them a gift while they are working on your eval. If you *must* to buy your attending a gift, I'd recc doing so after you have collected a completed LOR and your grade and eval have been turned in.

 

[DrQuinn]

I bought one of my EM attendings a bottle of wine. He really encouraged me to do EM (not that I neede dencouragement) and really took me in under his wing (i.e. he called Program Directors without me asking)... he also wrote a great LOR and told me to stay in contact with him. That was the only time I ever did that though.

Q, DO

 

[huktonfonix]

Yeah, I bought lunch for my preceptor and his staff after one rotation. Of course, they had fed me everyday for like 6 weeks (great bunch)so I think that one may have been justified.

 

[rubyness]

Rule #1: If you decide to give a gift or card, do it as a group, meaning that it's from all of the students.

It depends on the situation about whether or not giving a gift is tacky or just thoughtful. It depends on the relationship that you have with the preceptor. However, I think it's risky to give gifts to a preceptor if that person is grading you because this can be misconstrued as major brownnosing, etc.

In my experience, on certain rotations we had really great residents or chiefs or attendings who dedicated a lot of time to us and taught us a lot when they could have easily been sleeping or having fun doing something else. For these folks we all agreed as a group to give cards. I think the card is the way to go because it allows you to really express your thanks in writing, and it's not a gift so you don't come off as brownnosing. Plus, there's not a huge money expenditure, so it's not embarrasing that you as a student are spending all this money on someone who actually has a job, and it also doesn't put you out financially.

Interestingly, this month on medicine our attending and several of the other attendings have taken their respective teams out to dinner. Personally, while I really appreciated the gesture, I felt awkward because he spent a lot of money on us and we didn't really have much rapport with him. (Actually we were kind of angry at him for a variety of things.) Plus, we really didn't have much to talk about at dinner and that shot the guilt factor up a few notches.

 

[rubyness]

P.S.

You can never go wrong with bringing in homemade baked goods for the group. Because it's something you made it's especially thoughtful, considering that we have absolutely no time to be sitting around cooking lemon squares!

 

[Winged Scapula]

Although we often tease our students on their last day about ,"Where's our doughnuts?" we (residents and attendings) don't expect ANY sort of gift and would be rather taken aback if it were to happen.

Its a nice touch to bring in some cookies or something and we're always pleasantly suprised or if a special attending really went out of his way to assist you then a small token would be nice, but please don't feel that its expected or even necessary.

 

[southerndoc]

My school requires us to do a rural medicine rotation. I found out that our preceptors for this are NOT paid.

So, I usually buy a small gift at the end of each rotation (total of 3 rotations) to thank him for doing this. First time I bought him a BB King CD. The second time a bottle of wine. Doing a rotation now, so I'm not sure what I'll buy him at the end of my month.

As for the rest of my attendings, all I gave them was a verbal thank you and sometimes they didn't even get that.

 

[md03]

I never gave any attending a gift, nor did any of my classmates.

A couple of times, the attending took the team out to lunch on the last day.

Now that I'm a resident, I certainly don't expect students to give me gifts. And if you give a gift before you get your evaluation, it could potentially be misconstrued.

If you are really worried, check with your 4th year students. If it is the tradtion at your school, go with it. If not, I wouldn't.

 

[Flipchick]

I always give handwritten thank-you cards to the attendings/residents with whom I spent the most time with. I think it's nice to show your appreciation to them and the time they took to teach you. However, I do this AFTER the rotation is done (I wait about 1 week) so they don't think I'm doing it to get a good eval.

 

[rrreagan]

That's a waste of money, then.

Why else would you be giving a gift if not to get a good eval or a good letter of recommendation?

<b>Always</b> give the gift along with a well-worded letter of thanks <b>before</b> the letter and/or evaluation is sent out.

Use some common sense here.

I guess if you're confident of getting good marks or good letters, then don't give a gift. Otherwise, do give a gift. Doctors are under pretty severe time constraints and the gift represents a thoughtful gesture on your part that will likely be reciprocated with a favorable letter.

I only gave these gifts to letter writers, not to every attending I interacted with.

I personally don't think it's worth it to suck up for a good eval, but it's definitely worthwhile to "bribe" a letter writer.

 

[Flipchick]

I disagree with rrreagan's post above. Don't you think attendings and residents are smart enough to figure out that you're trying to suck up? They were students once, too. When I become a resident/attending, I for sure will be able to figure out which students deserve a good eval, and give them that eval regardless of any gifts they give me.

 

[DOtobe]

My two cents...

I feel that giving an attending a gift would be seen as brown-nosing. I think the best thing to do would be, as others have said, just a sincere verbal "thank you" or, if you want, a card telling them thank you for offering their time.

I've done fine on my evaluations so far on my rotations without giving gifts, just a verbal "thank you, you taught me a lot."

 

[rrreagan]

I never said give every attending a gift for a good eval---I said that's a waste of effort.

I did say that sending a gift <b>after</b> an eval is in is idiotic.

On the other hand, sending a gift to a letter writer <b>may</b> be worthwhile.

For example, let's say a letter writer agrees to write a letter with the intention of a writing a bad one. If they have any kind of conscience, they won't write the bad eval <b> and </b> take your gift.

My friend got a bad eval in a college Organic chemistry class despite getting an A+ in that class---the professor, a famous one at Columbia, had concealed his dislike of my friend till letter time.

My friend was able to view the letter surreptitiously after signing the waiver of confidentiality.

what I'm getting at is this---if your attendings harbor a secret dislike of you and are waiting to give you a bad recommendation, then a gift <b>may</b> be a way to <b>insure</b> against this.

 

[rrreagan]

And, in a similar vein to my previous post, a lot of times the attendings are so bloody lazy they won't even send in the recommendation for months.

Rather than prod and nag at them with phone calls, emails and pages, <b> a gift</b> might have the effect of pushing the professor to send the eval in more quickly.

This is what I have found, and I dare any to take exception to these reasoned and cogent post.

Again, I'm not idiotic enough to give every attending I interact with a gift---just the letter writers, for the reasons described.

 

[Galaxian]

The last day of my SICU rotation, one attending gave us students flowers and this really cool pen with glittery stuff inside that lights up when you write with it! And our head attending gave us a pizza party. We felt so special the whole day, unlike a lot of rotations I've been on. They were the best-- friendly, and good teachers.

 

[Starflyr]

I generally just get donuts or something for the whole team on the last day - that way it isnt "brown-nosing" and everybody gets a donut - plus, at least here, our evals are already done and gone over with us before the last day.

Star

 

[rrreagan]

Well, I've <b>never</b> gotten the whole team anything.

Again, I just give the letter writers' gifts to accelerate the letter-writing process.

Does anyone else have any experience with letter writers who are slow to send in their letters?

 

[Daiphon]

my group of med students got a small gift for our clerkship director, but it was his first time as director and he really went out of his way to make things as painless as possible for the clerkship (no call before the exam, lots of 'pimp' sessions, good mediation between us & the attendings, etc.).

I agree with the earlier post that you should say thank you first, and wait until AFTER the grades are in as to avoid the veil of impropriety (e.g. bribing for grades)... but if you had a great preceptor, and gifting is your thing, then go ahead. 2 caveats: 1) don't spend a ridiculous amount of money. you don't have it. they know you don't have it. plus, it's the thought that counts (to be extremely cliched). 2) if you shared your preceptor with another student, don't do anything that might make them look bad... that is very bad form.

2cents... take 'em for what it's worth.
-tim

 

[double elle]

I've completed 2 rotations so far, and on both - the office staff made me feel SO welcome and comfortable. So - for the first one, I bought the office ladies/nurses an assortment of teas, coffees, and hot chocolates. Cost me all of 6 bucks. As for the "thanks for the hospitality" card I gave to them - I addressed it to everyone, including the doc.

My second rotation was psych and there were all of 3 people employeed there - two office ladies and the doc. I make my own greeting cards, so one weekend I went on a crafting spree and made about fifty of them. I packaged up 5 cards for each person and gave that to the ladies and the doc on my last day.

Both of those were hospital based rotations and both were situations where the docs/offices really were kind and generous with their time.

Currently, I am on surgery. I don't plan on doing anything but saying a bunch of 'thank yous' at the end of this one. It's definately not as personal of a rotation, although it's been great. So, not being as personal - I wouldn't feel comfortable doing something so personal as giving a thank you gesture. Saying it is good enough.

As for sucking up - You know what - only the people who aren't kind enough to really like doing nice little things for people say that. Whether it's baking, or making cards, or bringing wine - those are small, nice things that people appreciate. Especially people whose practice gets turned upside down every month with a new student coming in. Also, some preceptors go above and beyond just teaching the subject matter and make sure you are aware of professional issues, business stuff, etc.

Maybe it's because I am female, or because I'm a mom - but I feel that if you even CONSIDER giving a small token of thanks - then you probably should - it means that preceptor did something right. Certainly, don't feel obligated. And, if the thought has never crossed your mind - then don't. Heck - I even made and sent out thank you cards for all the people who gave my daughter gifts for her birthday.

Remember - we all like to know we are appreciated.

 

[doc05]

why would you do this? whether it's bringing in a card, food, or wine, it's all completely unnecessary. remember that in the world of academic medicine, it is the physicians JOB to teach the medical students.

Don't forget to wipe your nose.

Originally posted by double elle
I've completed 2 rotations so far, and on both - the office staff made me feel SO welcome and comfortable. So - for the first one, I bought the office ladies/nurses an assortment of teas, coffees, and hot chocolates. Cost me all of 6 bucks. As for the "thanks for the hospitality" card I gave to them - I addressed it to everyone, including the doc.

My second rotation was psych and there were all of 3 people employeed there - two office ladies and the doc. I make my own greeting cards, so one weekend I went on a crafting spree and made about fifty of them. I packaged up 5 cards for each person and gave that to the ladies and the doc on my last day.

Both of those were hospital based rotations and both were situations where the docs/offices really were kind and generous with their time.

Currently, I am on surgery. I don't plan on doing anything but saying a bunch of 'thank yous' at the end of this one. It's definately not as personal of a rotation, although it's been great. So, not being as personal - I wouldn't feel comfortable doing something so personal as giving a thank you gesture. Saying it is good enough.

As for sucking up - You know what - only the people who aren't kind enough to really like doing nice little things for people say that. Whether it's baking, or making cards, or bringing wine - those are small, nice things that people appreciate. Especially people whose practice gets turned upside down every month with a new student coming in. Also, some preceptors go above and beyond just teaching the subject matter and make sure you are aware of professional issues, business stuff, etc.

Maybe it's because I am female, or because I'm a mom - but I feel that if you even CONSIDER giving a small token of thanks - then you probably should - it means that preceptor did something right. Certainly, don't feel obligated. And, if the thought has never crossed your mind - then don't. Heck - I even made and sent out thank you cards for all the people who gave my daughter gifts for her birthday.

Remember - we all like to know we are appreciated.

 

[ckent]

yes, i agree. Some of the things that you are doing border on being (rightfully) interpreted as "gunner" behavior by your classmates. By bringing in gifts and thank you notes for every staff member of every rotation that you go through, you are setting yourself apart from your classmates who did not and raising the bar for them by requiring them to show some token of appreciation so that they won't be graded down for being "ungrateful". I can't imagine that your classmates approve of your behavior; and even if they don't say it to your face, I suspect that they are talking about you behind your back.

 

[DOtobe]

Originally posted by doc05
why would you do this? whether it's bringing in a card, food, or wine, it's all completely unnecessary. remember that in the world of academic medicine, it is the physicians JOB to teach the medical students.

Don't forget to wipe your nose.

I agree completely.

I am a female, and I still agree completely.

 

[Christiangirl]

I don't think it is inappropriate at all to give a small token of appreciation at the end of a rotation. I don't mean to be rude, but I think "it's their job to teach us" is the obnoxious attitude that makes med students hated by residents, attendings, nurses, etc. It is their job to teach us, but some people really do go above and beyond to make the student an active participant of the team, take their time to teach more than they have to when they could be sleeping, and to encourage the student despite our mistakes. I think there is nothing wrong with being a little grateful. Perhaps my life experiences have just taught me not think anyone owes me anything unlike some other posters. Also, perhaps after you are on teams with staff, residents, nurses, etc who literally do only what is required of them (and nothing else) by the med school, you will understand why some of us are appreciative of those who do more.

 

[ckent]

Originally posted by Christiangirl
I don't think it is inappropriate at all to give a small token of appreciation at the end of a rotation. I don't mean to be rude, but I think "it's their job to teach us" is the obnoxious attitude that makes med students hated by residents, attendings, nurses, etc. It is their job to teach us, but some people really do go above and beyond to make the student an active participant of the team, take their time to teach more than they have to when they could be sleeping, and to encourage the student despite our mistakes. I think there is nothing wrong with being a little grateful. Perhaps my life experiences have just taught me not think anyone owes me anything unlike some other posters. Also, perhaps after you are on teams with staff, residents, nurses, etc who literally do only what is required of them (and nothing else) by the med school, you will understand why some of us are appreciative of those who do more.

I actually tend to get upset if I encounter an attending or even a resident or fellow who is not willing to teach, as opposed to being eternally grateful for those that are willing to teach. If you don't want to teach-->don't work in an academic center. There are certainly some who put in the extra effort in teaching, while others who seem to go out of their way to avoid teaching, but I still think that it is wrong for students to purchase gifts for their preceptors because it raises the bar for other students doing the rotation. You can verbally express your gratitude, but I don't think that you should be going out and baking the attending cookies or purchasing him or her chocolates. Why risk having an attending swayed by your "generosity" in determining what grade to give you or how strong to make your LOR? Studies have shown that gifts (most of the studies are done on pharmaceutical gifts of course) do have a subconscious effects on physician behaviors. Even if you give your gift after the attending has already graded you, your classmates who do the rotation after you will be held to the standard that you set by giving the attending a gift. You should play on the same playing field as your classmates.

 

[Christiangirl]

ckent. I understand your point, but my point is why do I have to demonstrate what I think (and it is my opinion not fact) are bad manners just because my classmates don't agree. No one is forcing them not to give anything. If they feel like you, they shouldn't give but I don't think it is fair to assert that we all should act the same way. If we take your argument, then I should never do anything "extra" because my classmate will suffer. So, should I perform poorly on a shelf just to keep the class average low so other students don't look poorly? If the attending for some random reason dislikes my classmate, should I be evil to the attending so that we are even? Do you see my point? I think there are definite behaviors to avoid that blatently demonstrate your trying to make other students look poorly, but somewhere you have to draw the line.

 

[double elle]

I guess my thinking is - our preceptors are PEOPLE before they are DOCTORS - and I am a PERSON before I am a student. So - given that, I give tokens of thanks to the PERSON - not just because they are a doc.

Yes - it is their responsibility to teach me if they signed on to be a preceptor - BUT - I have found that almost all of the docs I have worked with do NOT get paid for this - yes, the ones that teach in the classroom do, but not the ones who do it in clinicals.

Also - as I stated above, there is a difference between hospital based rotations and office-based rotations. I'm not going to do anything but say 'thank you' after my hospital based rotations. However, when you spend a month with someone 8-9 hours a day in their office and with their office staff - (perhaps it's only me) - but I feel a strong sense of gratitude if they have gone above and beyond to make sure I feel welcome. I even had one preceptor make sure the drug reps treated me with respect, made sure I was aware of all the drug rep meals, took me out to lunch when we were traveling to nursing homes together, etc.

Anyone can say it's brown-nosing - and that's fine - But, as a 29 year-old mother whose been through things in life that were a LOT tougher than medical school - I KNOW that small tokens of appreciation are nice once in a while. However, like I said in my first post regarding this subject - if you don't FEEL it - then don't do it. It doesn't say anything BAD about a student if he/she doesn't do this. I am sure preceptors are professional enough that they don't look down on a student who doesn't do this - and the same goes for the opposite - the professional preceptors won't give any special treatment to those who do.

 

[YellowRose]

I personally don't think it's appropriate to give gifts to attendings/residents that have a direct impact on your grade. I think its twice as wrong to give a gift to the docs when you are on rotation with another student. Imagine if you were working in a group of 4 students, and 1 of the 4 students brings a gift to the attending. I think you would be undermining the other 3 students.

I do however think its perfectly fine to bring cookies or small gifts to the nurses or med assistants if they helped you out tremendously. They have no bearing on your grade, and deserve more gratitude from doctors and medical students.

 

[MacTavish]

Far as I'm concerned, the only gift-giving should be done on the part of the attending to the residents, interns, & students that have made his or her life easier over the past month. Five months into the 3rd year, I have yet to have an attending that hasn't taken the whole team out to lunch at a nice restaurant to say "thanks" for the working their fannies off. It is, and should be, standard practice.

Now, about giving your attending a gift, that is just silly, unless there is some sort of tradition at your school that states otherwise. A firm handshake and a sincere (or not so sincere) thank-you is enough. Let you work ethic be your gift to your team.

 

[YellowRose]

"Let you work ethic be your gift to your team".

I agree....although i wish it were the first thing taught to MS3's.