Have we lost perspective, or just evolved with experience?

[Dr.LeoSpaceman]

If anything, this seems to be getting worse, and it's reinforced by the medcial school administration. At our institution, medical students are no longer allowed to take trauma night calls (even if they request to do so) because the admin is afraid some other students may feel "pressured" to do so. The stupidity of this outlook is just mind-numbing. We are actually preventing students from engaging it what can be one of the most exciting/interesting/educational experiences simply because we don't want other students to "feel bad".

---

Members don't see this ad.

 

[MeRLin443]

This was actually perfect timing for a bump, as I was pondering starting a thread about my growing jaded-ness towards medical students.

I think most of the residents can identify with the frustration of dealing with students who very clearly don't give a s**t. My reaction to this, increasingly, has been to basically ignore them when this is the case.

Anyone have suggestions on how to interact with/engage these types of students?

I would suggest telling the student that you feel they aren't performing up to expectations. I had one experience as a clerk on ob-gyn where a resident mentioned to me, in a non-confrontational way, that I looked incredibly bored and unengaged during an AM teaching session. I was post-call and really didn't give a **** about the teaching, but she approached me directly and I appreciated the reminder that people notice these things and my attitude was not appropriate.

Coincidentally there was a talk given at morning rounds that week discussing medical education. Specifically the issue of sub-par residents being surprised with poor end of rotation evals, mainly due to the lack of actionable feedback during a rotation. The moral of the story was that everyone has a responsibility to give feedback and give the student/resident an opportunity to improve by pointing out their deficiencies-i.e. man up, stop being nice, and tell the students that there performance should be better.

 

[SLUser11]

This was actually perfect timing for a bump, as I was pondering starting a thread about my growing jaded-ness towards medical students.

I think most of the residents can identify with the frustration of dealing with students who very clearly don't give a s**t. My reaction to this, increasingly, has been to basically ignore them when this is the case.

Anyone have suggestions on how to interact with/engage these types of students?

My suggestion hasn't changed:

1. Sit them down at the beginning of the rotation and lay out your expectations.

2. Give frequent feedback, both positive and negative. If they're not meeting your expectations, tell them. Then, tell them what you would like for them to do differently, and offer some resources. Remind them that they don't want to become the future weak intern.

3. If they've been warned, and continue to underperform, then it goes in the evaluation. There has to be accountability for bad behavior. If their behavior is unacceptable (beyond general disinterest), then you take your case to the clerkship director.

 

[Thanatos]

Bunch of wizards in this forum....I was going to start a thread on this very topic centered around a recent experience I had with a group of students.

I'm not that old and have vowed to not be one of those "i walked up hill both ways in the snow" type of people. And we all know that as generations age they tend to think those that follow them are a bunch of lazy ass mofos, I think thats a given.

But what about evidence. When I was a medical student we were q4 on medicine, peds, and surgery. We were q5 on obgyn, had to take a few psych calls but none for family med. As students on all inpatient services (IM, peds, ob, surgery) we were assigned 2 patients, we pre-rounded on them and wrote our little (or long) note. We presented these patients on rounds, and god help you if that note was not in the chart before rounds. On many services (surgery and ob) we had to update the census list and write all the vitals/labs and make copies for the residents. These were our expectations laid out on the first day, and we just kind of dealt with it.

Currently the med students where I'm at have successfully protested that because the interns are no longer allowed to take overnight call that they should not be forced to either. All services have caved except surgery.....the only service students actually take call on is surgery, and its q7. Knowing that our clerkship director won't give in, they went to the dean of the medical school and complained that when they are post call they miss out on cases and should not have to take call during the week because they miss out on learning stuff, so we are changing up all the call schedules again. Basically students will take call like twice during their 8 week rotation.

We also can't make them come in before the interns....so no pre-rounding and no list. They kind of just follow me around on rounds, scrub one case, then hide from the interns in the library all day. Its kind of sad really....

I had a case going in the early am on call last week and approached a group of them to see who wanted to scrub the case. They told me that because they had conference that morning (about 2 hours from the case starting, a lap appy btw) they could not go. I said it should be fine, and if it ran late I would let them scrub out and go to conference. The response I got (and I'm not kidding) was something along the lines of "the dean says we can't miss conference for any reason and you can't make us go to this case, so no we're not going, and we'll tell on you if you try to make us."

Pretty bold I think, and maybe I am losing touch with what is was like to be a student. But can we agree that taking 2-3 overnight calls (total) as a 3rd year student, no prerounding, no list, and refusing to scrub cases while hiding behind the administration is a bit different from even a few years ago? Kind of hard to give them all honors for that.

 

[Miami_med]

In line with Thanatos (and at a similar point in training). These things do seem very different today than they used to. That being said, I don't think that the students are all that different than I was a few years ago. I think the system is incredibly different. In my training, I straddled the systems. We had call on surgery and Ob/Gyn, but it was "optional." I never missed "optional" call. Medicine had eliminated student call, but we were still required to pre-round, write notes, update the list, etc...

If you ask the people who came five years before me, they were mandatory q3 for surgery and q4-q6 on most other things. I'm sure I looked lazy. Today, I usually think any student who stays past 10:00 pm on the weeked appears motivated. As the work hour restrictions tighten on residents, expect the changes to be doubly so for students. They may not be mandated by the ACGME, but the school works for them.

As a student, residents would write"80 hours" on a piece of paper and keep the same q3 schedule that they had for years. As I started residency, we started a night float, and the game changed to more of a write 80, work 90. Now, I essentially comply with all of these restrictions. To be fair, it really wouldn't be reasonable to expect my students to work a call schedule that I don't have to work. Also, the reality is that work schedule doesn't really jive with what most residents do any more. A strong argument could be made that this is all really maladaptive to life on the other side of training, but its hard to point to the students when our own house is out of order.

 

[Miami_med]

I will say that last year, I had a medical student all out refuse to come scrub a case, because she'd "already seen one." This is from someone who claimed to want to go into surgery. I had another student who failed to show up to work over half the days of the rotation because he was "sick, car broke down, slipped in the shower, etc..." He failed the rotation. He then showed up for a sub-I, where he missed the first day due to "car trouble," claiming that he wanted to redeem himself and go into surgery. I'm sure these students were around when I was in school, but it does get a little scary.

 

[DoctwoB]

I'd like to think that the residents saying "medstudents are so lazy these days" and the medstudents talking about jerk residents are the exception, not the rule. Most of my classmates are extremely hard working and don't have the entitled mentality you speak off, and I'm sure most residents aren't evil and legitimately want to help medstudents learn.

However, I do think a lot of the problem is the shift back towards objective evaluations for rotations, meaning your shelf matters a lot more then evaluations. Clinical grades are essential for the residency app, so students tear off for the library which is higher yield for the shelf but not for actual practice.

 

[45408]

Most of our students are decent, but it's both indifference and fear that really limits a lot of them. I haven't really seen the "I don't care, and you can't make me" attitude. I wasn't indifferent on surgery, but I was often probably more scared than I should have been to try things. So I try to encourage the students into doing things that I know I was reluctant to initiate, like writing admission/post-op orders, coming up with a treatment plan for a given condition, having them present the patient to the attending, etc. They only ever take short call, which limits their experience, but unless they're the one holding the pager and taking floor calls (not going to happen here), then I don't think that keeping them the rest of the night is going to add a whole lot, especially since they would then leave early when post-call. I definitely teach more when they're clearly interested, but I honestly try to tailor my teaching points to their given profession (same for the prelims/TYs that rotate with us).

I don't have a student every month though, so my exposure is more limited to them now. Sometimes I wish we had them all the time, and other times it's nice to just do your work and not try to teach someone else. Although they do make me feel like I've learned something along the way

 

[SLUser11]

They told me that because they had conference that morning (about 2 hours from the case starting, a lap appy btw) they could not go. I said it should be fine, and if it ran late I would let them scrub out and go to conference. The response I got (and I'm not kidding) was something along the lines of "the dean says we can't miss conference for any reason and you can't make us go to this case, so no we're not going, and we'll tell on you if you try to make us."

That is completely unacceptable behavior by the medical students.

I'd like to think that the residents saying "medstudents are so lazy these days" and the medstudents talking about jerk residents are the exception, not the rule.

What you will find interesting is that often, the above-mentioned students evolve into the above-mentioned residents. Some people just complain a lot, regardless of their level of training.

 

[cpants]

I've been trying to lower expectations a bit because I came from a very old school medical school system. We were Q3 on surgery and were expected to round on 4-5 patients daily with notes in the chart BEFORE the intern saw the patient. As sub-i's we were expected to perform at the level of an intern, seeing all consults first, maintaining the list, knowing all labs and vitals for the service, stay til the team leaves, topic presentations several times per week, etc. Well, that's just not the culture here. I try and teach the interested ones and set high expectations, but if you are going to be lazy, disappear, etc...well, I frankly don't care that much. I'm not going to come looking for you and force you to learn, because frankly I have too much on my own plate to worry about.

As a student, I resented some of the scut work and long hours expected of me, but I thanked God for it the first month of internship. Some of my colleagues had no idea how to do the simplest things like replete electrolytes or put in a Foley or NG tube. I was scrubbed with a fourth year subI today who had never done a skin closure... I was happy I had done basically all intern-level tasks under supervision as a medical student dozens of times.

 

[SLUser11]

I've been trying to lower expectations a bit because I came from a very old school medical school system. We were Q3 on surgery and were expected to round on 4-5 patients daily with notes in the chart BEFORE the intern saw the patient. As sub-i's we were expected to perform at the level of an intern, seeing all consults first, maintaining the list, knowing all labs and vitals for the service, stay til the team leaves, topic presentations several times per week, etc. Well, that's just not the culture here. I try and teach the interested ones and set high expectations, but if you are going to be lazy, disappear, etc...well, I frankly don't care that much. I'm not going to come looking for you and force you to learn, because frankly I have too much on my own plate to worry about.

As a student, I resented some of the scut work and long hours expected of me, but I thanked God for it the first month of internship. Some of my colleagues had no idea how to do the simplest things like replete electrolytes or put in a Foley or NG tube. I was scrubbed with a fourth year subI today who had never done a skin closure... I was happy I had done basically all intern-level tasks under supervision as a medical student dozens of times.

Since the thread's resurrection, 6 surgical residents have commented that they feel some students to be lazy/entitled/disinterested, or possibly limited by new rules that ultimately harm the educational process. Most of you are junior residents who are not too far removed from being a student, and surely you remember similar complaints from the surgical residents when you were students.....

Still, students often perceive our behavior as unfair, low-yield, and abusive, and then accuse us of "losing touch" with the plight of the poor med student since our graduation to the next level.

So my question to you guys: Did we lose touch? Should we be easier on our medical students? Or, are students just blind to their bratty, entitled behavior, and too green to appreciate the things we do for their benefit?

So are we getting better, or are we getting meaner?

 

[cpants]

Since the thread's resurrection, 6 surgical residents have commented that they feel some students to be lazy/entitled/disinterested, or possibly limited by new rules that ultimately harm the educational process. Most of you are junior residents who are not too far removed from being a student, and surely you remember similar complaints from the surgical residents when you were students.....



So are we getting better, or are we getting meaner?

Well, I really don't remember a lot of similar complaints, at least not directed toward me, during my med school days. I think those enthused students who do a great job on surgical rotation are probably overrepresented in the surgical resident population, and it's probably why we all bitch about the lazy student. The reality is that most students dread surgery, don't care, and look forward to managing CHF and COPD for the rest of their careers (vommed in my mouth a little while typing that). I guess to a certain extent we have to know our audience.

 

[Buzz Me]

The response I got (and I'm not kidding) was something along the lines of "the dean says we can't miss conference for any reason and you can't make us go to this case, so no we're not going, and we'll tell on you if you try to make us."

They were probably looking forward to some free time before conference.

I also try hard to not go down the "when I was a med student..." path, but things were very different when I was an MS3 (2003). On our surgery rotation, we took Q3 call with the residents, no post-call. 2 days off per month. Q4 call on Medicine and OB/GYN with post-call rules. Q4 call on Peds with 4 days off a month. Things are very different now.

 

[igap]

I was a medical student in the pre-80 hour era so I remember things like:

-Pre-rounding on the entire census, and writing notes before 6:00 am rounds.
-q2 in-house call
-Scrubbing on every case available.
-Presenting patients on rounds whenver asked (ie. - there wasn't a set time to present, we just had to be ready at any time to present)
-Knowing every iota of information about any patient.
Etc...

In residency (for the most part during the 80 hour era), none of the residents cared about the restrictions and we worked as hard as necessary to get our education, and to get the work done.

The students on plastic surgery rotations all tended to be first-rate since the 4th years were all on sub-I audition rotations, and the 3rd years were mostly interested in going in to plastic surgery as well. However in my intern year on general surgery, I noticed a great variation in quality of medical students. I think that is probably because general surgery is a required rotation at most institutions and so the student rotators represent a cross section of the entire student body and not just those interested in surgery.

As far as the work-hours rules affecting surgical culture, I absolutely agree that students and residents alike will work as little as possible to meet expectations. When I was a resident, the expectations were very different from what everyone here is describing. If I was an intern today, and was told that I could not take overnight call, or that as a resident I had to leave after 24 hours, I probably would have quickly adapted to that, and expected that level of work. The fact is, the surgical raw material, and the surgical end-product, are very different today under the work hours rules than the raw material and product of years past. Whether you feel that the product is worse or better is a totally different topic, but the difference is real.

 

[SLUser11]

And I'm sure you're mentor thought the same thing about your training. And Harvey Cushing would have scoffed at both of you.

The sentiment has been around for a while.

Homer (Iliad): "For rarely are sons similar to their fathers: most are worse, and few are better "

As far as the work-hours rules affecting surgical culture, I absolutely agree that students and residents alike will work as little as possible to meet expectations. When I was a resident, the expectations were very different from what everyone here is describing.....

I think Beaverfetus hit this one on the nose.

How many of our posts in this thread have just been "when I was a student" stories recounting how difficult the work was, and how we never complained about it?

When tell these uphill-both-ways-barefoot-in-the-snow stories, we are definitely reinforcing the student sentiment that we've lost touch. I know that I always found those stories redundant and self-aggrandizing when I was a student and junior resident.

The 80 hour work week didn't ruin surgical education. If anything, we should blame the pre-existing @$$-backwards training model that mandated reform. We should also blame our inability as a surgical community to adapt and adjust to the changes...instead condemning them, ignoring them, and initiating an unreasonable amount of guilt and self-hate for anyone trying to comply with them.

I also disagree with the suggestion that the "surgical end-product" is somehow inferior to years past. I trained in an 80-hour compliant program, and I feel competent and well-prepared for surgical practice. I've met plenty of surgeons who trained before 2003 and after 2003, and there's no significant difference in skill set or work ethic.

 

[filter07]

Back before my time there was no 80 hour work week and even the decent ones got routinely fired due to the pyramidal system. Nowadays we get to evaluate rotations, and the ones that push 80 hours get low evals and the rotations get a verbal slapdown from the program director. And crappy residents with just good enough demeanor get advanced along only to fail their boards.

Third year clerkships were changing rapidly even when I was a student. The year before me used to take overnight call on certain rotations. In my year that switched to midnight at the latest on the same rotation. In surgery we had trauma shifts but the unwritten rule was that you would ask the intern to "page me when the interesting cases come up" and you would never actually get paged. Nowadays my students usually don't pre-round... the enterprising ones take on 1, and the gunners take 2. My last student wrote 1 post op note over an entire month, and that is after prodding multiple times. I bet that prodding will earn me a low evaluation in a few weeks, for actually caring about their education. (Post op notes from med students don't count, and therefore I wasn't just scutting them out). I don't know the last student that read about a patient's case before scrubbing in the OR. Students have not written a single order and I doubt any of them know what ADC VAANDIML is. Things are changing and let's face it, not all of it is for the better. Most people will do the minimum possible for whatever grade they think they can get (A/B/C, Honors/Pass, etc). The more we lower the bar, the lazier the students will get, and it's not all their fault. We have to, at some point, stop coddling everyone like they are fragile little children, because once you keep removing the "less educational" things, you will eventually end up with no education at all outside of reading a textbook and taking the shelf... in which case why even have 3rd year?

 

[Substance]

Back before my time there was no 80 hour work week and even the decent ones got routinely fired due to the pyramidal system. Nowadays we get to evaluate rotations, and the ones that push 80 hours get low evals and the rotations get a verbal slapdown from the program director. And crappy residents with just good enough demeanor get advanced along only to fail their boards.

Third year clerkships were changing rapidly even when I was a student. The year before me used to take overnight call on certain rotations. In my year that switched to midnight at the latest on the same rotation. In surgery we had trauma shifts but the unwritten rule was that you would ask the intern to "page me when the interesting cases come up" and you would never actually get paged. Nowadays my students usually don't pre-round... the enterprising ones take on 1, and the gunners take 2. My last student wrote 1 post op note over an entire month, and that is after prodding multiple times. I bet that prodding will earn me a low evaluation in a few weeks, for actually caring about their education. (Post op notes from med students don't count, and therefore I wasn't just scutting them out). I don't know the last student that read about a patient's case before scrubbing in the OR. Students have not written a single order and I doubt any of them know what ADC VAANDIML is. Things are changing and let's face it, not all of it is for the better. Most people will do the minimum possible for whatever grade they think they can get (A/B/C, Honors/Pass, etc). The more we lower the bar, the lazier the students will get, and it's not all their fault. We have to, at some point, stop coddling everyone like they are fragile little children, because once you keep removing the "less educational" things, you will eventually end up with no education at all outside of reading a textbook and taking the shelf... in which case why even have 3rd year?

I agree. Third year as it stands now is basically useless. But that's the way it has evolved. Residency selection criteria hinge greatly on step scores, research and grades, and if your grades are determined primarily by your shelf, then it is actually in the students' best interest to do as little as possible on the wards so that they have more time to study for the shelfs(shelves?)

In Canada, residency selection criteria are exceedingly subjective since we have no standardized exams for that purpose. But students still tend to do as little work as possible in fields that are completely unrelated to their final goals (obgyn and psych tend to be the most affected rotations). Can you blame them? When is the radiology gunner going to ever need to know anything about psychiatry, or the internal medicine gunner about obstetrics?

The only way to fix all of this from happening anymore is to make the practical information useful, and it will only be useful if the students, once graduated, can use it in their careers. This is why the rotating internship and general licensure should be the final standard for primary care, and not the lame "family medicine" residency.

 

[JackShephard MD]

I agree. Third year as it stands now is basically useless.

So far I've learned this from SDN:

Bachelor's - useless (not medically relevant)
Pre-clinicals - useless (just cram and forget)
Clinicals - useless (just passing tests, little skills built)

Well, good thing we do residency.

 

[filter07]

So far I've learned this from SDN:

Bachelor's - useless (not medically relevant)
Pre-clinicals - useless (just cram and forget)
Clinicals - useless (just passing tests, little skills built)

Well, good thing we do fellowship

Fixed that for you...

 

[DoctwoB]

I'm all for the idea of axing a year off med school and adding a traditional rotating internship year to residencies.

The way things stand currently, a graduating fourth year isn't much better prepared then a student after 3rd year (so much of 4th year is random electives and time off). Everyone would get a broader base of practical medical knowledge, and pay less tuition to boot.

 

[SLUser11]

I bet that prodding will earn me a low evaluation in a few weeks, for actually caring about their education. (Post op notes from med students don't count, and therefore I wasn't just scutting them out). I don't know the last student that read about a patient's case before scrubbing in the OR. Students have not written a single order and I doubt any of them know what ADC VAANDIML is. Things are changing and let's face it, not all of it is for the better. Most people will do the minimum possible for whatever grade they think they can get (A/B/C, Honors/Pass, etc). The more we lower the bar, the lazier the students will get, and it's not all their fault. We have to, at some point, stop coddling everyone like they are fragile little children, because once you keep removing the "less educational" things, you will eventually end up with no education at all outside of reading a textbook and taking the shelf... in which case why even have 3rd year?

In most cases, I believe med students suck because we allow them to suck. High-functioning people will quickly learn what is necessary, and what doesn't matter in regards to their grades and future. The only way to fix that, which you've mentioned near the end of your post, is to hold them accountable for their actions, even if that means you may get a negative evaluation. You're not there to be likable and buddy-buddy with all the students. You're there to teach them something, even if they're too naive or self-involved to understand the utility of your approach.

I have a relatively strict approach to students, and students on SDN without intimate knowledge of how that plays out have previously chastised me for that. However, I will say that after five years of teaching students with that approach, I've received almost universally positive evaluations (despite the occasional ego-bruised crybaby), and I've received awards, etc for my teaching.

I agree. Third year as it stands now is basically useless.

I think that's going too far. Obviously there's a disparity of talent and work ethic among students, and we're all going to have horrible ones and good ones over time...but it's quite easy for me to differentiate between a newly-minted MSIII and ones toward the end of the year, or during their 4th year...so they must be learning something.

Would you let a new MSIII manage patients independently? Of course not. However, we routinely let interns do that. It's sort of ridiculous to insinuate that people don't gain clinical knowledge and experience during the two-year gap between those titles.

So far I've learned this from SDN:

Bachelor's - useless (not medically relevant)
Pre-clinicals - useless (just cram and forget)
Clinicals - useless (just passing tests, little skills built)

Well, good thing we do residency.

It's not useless, but some of it is low-yield, meaning you don't get an appropriate benefit for the number of hours you put in. Medical students still build plenty of skills during their clinical years. Often, they are their own roadblock to the process, so students who are motivated to learn have a higher-yield experience.

The way things stand currently, a graduating fourth year isn't much better prepared then a student after 3rd year (so much of 4th year is random electives and time off). Everyone would get a broader base of practical medical knowledge, and pay less tuition to boot.

Not true. MS4s are generally more knowledgeable and experienced than MS3s. This is partially due to the fact that the 4th year allows you to focus your studies on areas of medicine that interest you. It's also because they've just had more reps at that point, and volume is very important.

Overall, since we're all in surgery and relatively high-functioning, we all remember ourselves as bad@$$ med students. We also remember that we could all dunk and had wonderful six-pack abs back in high school. The truth is that we all had imperfections as well, and there's not a single resident or attending in this forum who wasn't considered lazy or dumb at some point during their clerkships, regardless of whether or not it was brought to our attention.


ps: I guarantee that someone will chime in that even though they understand my analogy, they actually can dunk quite well, and have excellent abs. Try to refrain from this, as it adds nothing to the conversation.

 

[illixir]

Not true. MS4s are generally more knowledgeable and experienced than MS3s. This is partially due to the fact that the 4th year allows you to focus your studies on areas of medicine that interest you. It's also because they've just had more reps at that point, and volume is very important.

I somewhat agree with the previous user's sentiment. He isn't comparing an MS3 to an MS4. He's comparing an MS4 in July to an MS4 in May. I did 4 sub-i's(all in a surgical subspecialty) to start my 4th year and then have been doing essentially nothing the rest of the year. I learned a lot during the sub-i's and they were helpful to learning more about that particular surgical field(the material as well as hours, lifestyle, etc) and for improving technical skills(vast majority of time spent in the OR). I don't think I'm that much better prepared for internship due to it, my sewing and tying is tons better but not all residencies are surgical and these are skills I would've picked up in residency regardless. I think a sub-I is valuable but it is probably the only valuable month or two during 4th year for most students. (I only did 4 bc I applied to a competitive specialty) It would not be that difficult to fit that into the 3rd year somehow. Some schools have alotted time during third year, e.g. I had a four month research block to finish 3rd year (mar-june) during which the sub-i's could have been done then. The research time is of course for a different purpose though that might not be fulfilled.

I do not think it's a big stretch then to say a student could start intern year after MS3. But not all students' M3s are the same, especially if not self-motivated and if they have not worked at a sub-I level during their M3. My experience is that M4(outside of the sub-I) is applying and matching not really learning much more.

 

[Dirt]

My experience is that M4(outside of the sub-I) is applying and matching not really learning much more.

Don't forget banging your head against the wall repeatedly during the required medicine sub-I and neurology rotation that you scheduled after match, or is my school the only one that does that?

Truthfully, aside from my three surgery sub-I's, this year has been a total and utter waste of time and money.

 

[illixir]

Don't forget banging your head against the wall repeatedly during the required medicine sub-I

Lots of schools have those. Fortunately, mine doesnt. The only other required M4 rotations I had to do were an EM rotation and a Geriatrics rotation. Neuro is a part of our M3.The EM rotation is just 11 10-hour shifts over a month and in our school's new clinical curriculum is merged into M3 as well.

 

[SLUser11]

I somewhat agree with the previous user's sentiment. He isn't comparing an MS3 to an MS4. He's comparing an MS4 in July to an MS4 in May. I did 4 sub-i's(all in a surgical subspecialty) to start my 4th year and then have been doing essentially nothing the rest of the year. I learned a lot during the sub-i's and they were helpful to learning more about that particular surgical field(the material as well as hours, lifestyle, etc) and for improving technical skills(vast majority of time spent in the OR). I don't think I'm that much better prepared for internship due to it, my sewing and tying is tons better but not all residencies are surgical and these are skills I would've picked up in residency regardless. I think a sub-I is valuable but it is probably the only valuable month or two during 4th year for most students. (I only did 4 bc I applied to a competitive specialty) It would not be that difficult to fit that into the 3rd year somehow. Some schools have alotted time during third year, e.g. I had a four month research block to finish 3rd year (mar-june) during which the sub-i's could have been done then. The research time is of course for a different purpose though that might not be fulfilled.

I do not think it's a big stretch then to say a student could start intern year after MS3. But not all students' M3s are the same, especially if not self-motivated and if they have not worked at a sub-I level during their M3. My experience is that M4(outside of the sub-I) is applying and matching not really learning much more.

Your post is sort of contradictory....you say that you learned a lot during your 4 months as a sub-I, but then say this time isn't necessary. In addition, 4th year is not just Sub-Is, but also an opportunity to spend a month in the ER (which provides some much-needed perspective from the other side), in radiology (which serves most specialties), doing research electives, etc. Just because some people take advantage of its loose structure and screw-off for 6 months doesn't mean the entire thing should go away. If anything, we should be arguing that the year needs to be more strict and structured.

And when, during your proposed 3-year med school schedule, should people explore sub-specialties (derm/gas/rads/ENT/Ophtho/etc) they don't get exposure to during the core clerkships? When should they interview for residency?

At the end of the day, we can't simultaneously argue that med students don't get adequate training (compared to the yesteryears) while saying that we should shorten the training...

 

[illixir]

Your post is sort of contradictory....you say that you learned a lot during your 4 months as a sub-I, but then say this time isn't necessary. In addition, 4th year is not just Sub-Is, but also an opportunity to spend a month in the ER (which provides some much-needed perspective from the other side), in radiology (which serves most specialties), doing research electives, etc. Just because some people take advantage of its loose structure and screw-off for 6 months doesn't mean the entire thing should go away. If anything, we should be arguing that the year needs to be more strict and structured.

And when, during your proposed 3-year med school schedule, should people explore sub-specialties (derm/gas/rads/ENT/Ophtho/etc) they don't get exposure to during the core clerkships? When should they interview for residency?

At the end of the day, we can't simultaneously argue that med students don't get adequate training (compared to the yesteryears) while saying that we should shorten the training...

I did learn a lot, I don't think it made me terribly better off for intern year/residency though was my point and I was only required to do two months of sub-I.

I don't think M4 can be done away with. The application process is necessary during this time(could never be done in M3 due to time constraints/not having chosen specialty/etc). M4 is a good thing for the reasons you mentioned. A year is a long time and it allows students a great deal of flexibility in making sure their medical education is complete clinically to the extent they want it to be. To do without it is pretty ridiculous. (i.e. I was not actually trying to support shortening training for the tuition/well-roundedness like the original poster though I may have come off that way)

The point the original poster made that I supported was that a graduating fourth year is not that much better off than a finishing third year. This is mainly provided you had a good M3 where you were busy and active(I had thought this was the norm). Fourth year does provide electives and just overall more time in the hospital so your point is valid that you are somewhat better prepared, but I feel the difference may often be marginal.

I actually don't think fourth year should be more structured. If M3 has been done well, then the student should have adequate exposure to everything, fourth year is about further elective exposure(the very nature of which means that everyone's experience will be different). This is fine, but I guess the way I look at this is that these activities may make one a better doctor with more perspective rather than adding significant clinical experience that would make a student a better intern. I'm not saying that's not valuable. It is! The free time is also nice.

 

[MeRLin443]

I don't think M4 can be done away with. The application process is necessary during this time(could never be done in M3 due to time constraints/not having chosen specialty/etc).

Some Canadian schools eschew fourth year and the students are just fine.

 

[dpmd]

I did learn a lot, I don't think it made me terribly better off for intern year/residency though was my point and I was only required to do two months of sub-I.

Wait, are you a student or in residency. If not in residency yet, how can you say that nothing you did in 4th year helped you for residency. When I was in school I wanted to do ortho, so of course I did ortho sub-i's. But, I wanted to be better prepared for a variety of things so I did plastics (which helped me make better decisions for closure as an intern when I wasn't given instructions. I did infectious disease (which helped me understand antibiotic choice better so when the time came to start something I didn't just automatically pick the same thing), SICU (helped me feel more comfortable managing sick patients without having to ask my senior for every little thing), radiology (helped me know what I was looking at which was especially helpful with no radiologist at night-by second year I could comfortably read trauma films). Can't think of what other ones I did right now, but I'm sure they helped me as well. I ended up doing general surgery instead and even though I hadn't done any general surg sub-i's (so felt less comfortable about general surgery stuff), I still was able to function pretty comfortably during intern year, because I had a broader background than what I got in my core clerkships (and I wasn't trying to learn how to write an ICU note, orders, prescriptions, etc since I had already gotten comfortable with doing that).

If people think 3rd and 4th year are useless, perhaps something is wrong in how they are participating.

 

[illixir]

You're right. I can't say that. I can only say that I don't think it will have helped that much. I agree that there's a lot of elective exposure to be had and if one scheduled ICU rotations and the like, that would be useful actually. I think a required ICU rotation would be a great idea for fourth year even though I did get somewhat comfortable with ICU care during 3rd year. I guess I could call it the student's fault or my own fault then if they don't grow a lot clinically during fourth year itself since you determine your own rotations. I still don't think it would have helped a terrible amount though since you're doing the rotation as a med student. At least not like you would learn doing the ICU rotation as the intern. I could be wrong though, this is conjecture. I feel pretty comfortable about the idea of writing an ICU note and orders, I may not be in a few months, we'll see.

 

[Mr Cookie Pants]

As I dwindle out of medical school, my experience is that most of my classmates are lazy. Heck, even I probably would have been considered lazy in the past. The issue is it's hard to put the hours in when you can't do anything and have a shelf exam looming. By can't do anything, I don't mean technically, I mean that legally, we can't do anything. Medical education is being strangled.

With our EMR, med students can no longer write notes (or even skeletons!), put in orders. We can't be notified of lab results so you constantly have to check for new (which after the resident sees the flag, they clear). We're really out of the loop. Add in mandatory didactics, then you have to come fill in the gaps, which the resident doesn't feel like filling you in on. Surgery is nice because there are procedures galore, but with the shiftwork medicine services, the PGY2s are still clamoring for lines.

This is perpetuated by the overall quality of the medical student going down. The number of "I just wanna be a doctor" students are dwindling because of the "we need people with a story, not just normal people with good test scores" trend in medical applications. There's a lot of entitlement at our school and the concept of what medicine was actually like even just 10 years ago is foreign to everyone. The med students are about reading time, weekends and always getting A's. They might learn something along the way, but not intentionally.

For me, I can say that I always at bare minimum wanted to appear engaged. There's something to learn on every service, every day. It may not be the most interesting to you, but at least be respectful. So no, I don't think you've lost perspective. It's just a divergence of the surgery resident and the average medical student. I mean a 3rd year at my school wore SUNGLASSES to the OR.

 

[Butler]

It's just a divergence of the surgery resident and the average medical student. I mean a 3rd year at my school wore SUNGLASSES to the OR.

Well obviously because he was a boss and needed his haterblockers on. Not to mention, those surgical lights can be waaaaaaay too bright, especially when you have a hangover.

 

[SLUser11]

Well obviously because he was a boss and needed his haterblockers on. Not to mention, those surgical lights can be waaaaaaay too bright, especially when you have a hangover.

Nice.

I agree that this is a big problem. I think not even on a legal level, but an administrative level, med schools are putting more and more restrictions on students and changing the nature of their clerkships. When I have talked to students, they all say they want to do more, contribute, be a part of the team, etc. But the school says they aren't allowed to print the list, write notes, etc, etc. It's frustrating for everyone.

This is interesting because it's obvious from talking to students and reading SDN that the experience is greatly dependent on the school you attend. Some students are integral to the daily process at some county hospital with bullets whizzing by, while other schools mandate students become as useless as possible with as many non-clinical distractions as possible.

Should premeds be asking these types of questions when shopping around for schools? I'm very happy with my education at SLU, as we had a healthy number of bullets whizzing by, but I didn't think to ask those questions.


On a side note (which I'll probably elaborate on later), I've bumped the original "how will you grade your med students" thread in the clinical rotations forum, and students report that they get very little feedback from their residents, and it seems that surgery is one of the worst rotations in regards to feedback.

If we're so unhappy with how they are performing, as evidenced in this thread, don't you think we should let them know how we feel? In contrast, is it likely that they want feedback in theory, but really just want reinforcement/positive feedback, and will resent anything negative we have to say?

 

[Dissected]

If we're so unhappy with how they are performing, as evidenced in this thread, don't you think we should let them know how we feel? In contrast, is it likely that they want feedback in theory, but really just want reinforcement/positive feedback, and will resent anything negative we have to say?

Most of the time, I just want to hear how I am doing good or bad. I'd rather hear everything that I am doing wrong rather than nothing at all. It sucks not knowing what your perceived strengths and weaknesses are as a student until you read your final evaluation. I got good (as in frequent) feedback on my surgery rotation and it helped me develop my skills and communicate better. The rotations that were the most asinine and worthless for me this year were the ones where I was ignored or given only positive reinforcement. I'm a 3rd year, I'm not doing everything right so tell me so!

Thoughts from a 3rd year. Carry on.

 

[Dr.LeoSpaceman]

With regard to feedback, I never have a problem saying "you should read up on this more", "you should improve X-Y-Z about our presentations", "make sure you know the anatomy before the OR", etc. The thing I've had the most difficult time with are medical students who are, for lack of a better term, "annoying". Yes, I think we all recognize that grading students in a clerkship should be a strictly objective thing, but there is always that nebulous "professionalism" blank on the rubric. It's addressing that issue that I find most difficult/uncomfortable, simply because it's often something that's very difficult (if not impossible) for people to change.

 

[dienekes88]

This is all with the caveat that I am still a medical student.

Nice.



This is interesting because it's obvious from talking to students and reading SDN that the experience is greatly dependent on the school you attend. Some students are integral to the daily process at some county hospital with bullets whizzing by, while other schools mandate students become as useless as possible with as many non-clinical distractions as possible.

Should premeds be asking these types of questions when shopping around for schools? I'm very happy with my education at SLU, as we had a healthy number of bullets whizzing by, but I didn't think to ask those questions.


On a side note (which I'll probably elaborate on later), I've bumped the original "how will you grade your med students" thread in the clinical rotations forum, and students report that they get very little feedback from their residents, and it seems that surgery is one of the worst rotations in regards to feedback.

If we're so unhappy with how they are performing, as evidenced in this thread, don't you think we should let them know how we feel? In contrast, is it likely that they want feedback in theory, but really just want reinforcement/positive feedback, and will resent anything negative we have to say?

Agree that there may be a subpopulation that only wants positive feedback. However, the skeptical/cynical part of me thinks that the refrain "we don't get any feedback" is only meant to shift the blame for poor grades onto someone else: "obviously I did poorly, nobody told me what to do, so it has nothing to do with me." I think a lot of these people don't care for feedback, and I have seen it rebuked when it is given (except in the case of compliments).

An example of complaining that may/may not be real: some of the students I've worked with who complain that they don't learn anything will refuse to be taught by me. Maybe the 3rd years these days don't think they should be taught by a 4th year. I can almost see why a 3rd year might not want to be taught by another 3rd year, but to me it's still ridiculous. However, this all makes me think that people complaining about the low-educational yield of certain situations are just complaining about boredom in a way that is more socially acceptable.

Most of the time, I just want to hear how I am doing good or bad. I'd rather hear everything that I am doing wrong rather than nothing at all. It sucks not knowing what your perceived strengths and weaknesses are as a student until you read your final evaluation. I got good (as in frequent) feedback on my surgery rotation and it helped me develop my skills and communicate better. The rotations that were the most asinine and worthless for me this year were the ones where I was ignored or given only positive reinforcement. I'm a 3rd year, I'm not doing everything right so tell me so!

Thoughts from a 3rd year. Carry on.

Ok. Maybe you actually want feedback, but it's hard to tell who is who.

 

[SLUser11]

Most of the time, I just want to hear how I am doing good or bad. I'd rather hear everything that I am doing wrong rather than nothing at all. It sucks not knowing what your perceived strengths and weaknesses are as a student until you read your final evaluation. I got good (as in frequent) feedback on my surgery rotation and it helped me develop my skills and communicate better. The rotations that were the most asinine and worthless for me this year were the ones where I was ignored or given only positive reinforcement. I'm a 3rd year, I'm not doing everything right so tell me so!

Thoughts from a 3rd year. Carry on.

I'm having an awfully good time discussing this topic in the clinical forums, and getting the student perspective. It's obvious that no matter where the fault lies, residents and students just don't see eye to eye.

I think that residents are imperfect, and our mistakes/fallibility are more on our sleeves than doctors at the attending level. Students are smart enough to pick up on this, and since doctors are supposed to be perfect, they discredit the resident's opinion and abilities, and underestimate our value and experience.

I think that it's a natural progression of events, and as students become residents, then start to agree with our side of the argument. This is why I'm so interested in hearing what the PGY-1's and 2's think about this topic, because they're likely still in transition.

I don't think this process stops, either. As a senior resident, we are much more likely to discredit the opinions and abilities of some of our attendings. As junior attendings, we're more likely to do the same to the "old guard," and so on, and so on....

 

[mwsurg]

I'm having an awfully good time discussing this topic in the clinical forums, and getting the student perspective. It's obvious that no matter where the fault lies, residents and students just don't see eye to eye.

I think that residents are imperfect, and our mistakes/fallibility are more on our sleeves than doctors at the attending level. Students are smart enough to pick up on this, and since doctors are supposed to be perfect, they discredit the resident's opinion and abilities, and underestimate our value and experience.

I think that it's a natural progression of events, and as students become residents, then start to agree with our side of the argument. This is why I'm so interested in hearing what the PGY-1's and 2's think about this topic, because they're likely still in transition.

I don't think this process stops, either. As a senior resident, we are much more likely to discredit the opinions and abilities of some of our attendings. As junior attendings, we're more likely to do the same to the "old guard," and so on, and so on....

So what are your expectations that you lay out to your students at the beginning of their rotation? You mentioned how important it is several times, but I don't think you mentioned what they exactly are. Some of my residents did this (that is, after I asked) but most of them were quite vague like "work hard," "be interested," or "read a lot." I don't think these comments really helped.

 

[anonperson]

So what are your expectations that you lay out to your students at the beginning of their rotation? You mentioned how important it is several times, but I don't think you mentioned what they exactly are. Some of my residents did this (that is, after I asked) but most of them were quite vague like "work hard," "be interested," or "read a lot." I don't think these comments really helped.

I know this wasn't directed at me, but I feel that I should add to the conversation.

I try to spell out exactly what I want them to do when on Labor and Delivery or OR time.

I tell my med students who to round on (patients they helped delivery, cases they were involved with), how their note should be structured and what is considered pertinent, how to efficiently present during team rounds, doing post op checks and general expectations. I can knock this out on their first day in a short time.

Same thing in the clinic. When they start out, I tell them what I want them to ask with a patient and give them a finite period of time (i.e 5 minutes for a HPI and PMHx) etc. I feel they have a better grasp on what to do and they work efficiently instead of BSing on non pertinent info.

I try to be as specific as possible and consider all med students in general to be a litte clueless, which is completely acceptable. I'm only a PGY2 and I was a fairly ******ed medical student so I can sympathize with them if they feel lost or don't know their role.

I do agree that vague things like 'work hard' and 'read a lot' is worthless. I want medical students to know what their function is on the team.

 

[cpants]

So what are your expectations that you lay out to your students at the beginning of their rotation? You mentioned how important it is several times, but I don't think you mentioned what they exactly are. Some of my residents did this (that is, after I asked) but most of them were quite vague like "work hard," "be interested," or "read a lot." I don't think these comments really helped.

Be interested and work hard go without saying.

My expectations are:
-Show up on time
-Get your notes done on time
-Read about your patients and/or cases to a level appropriate to your knowledge
-Try to come up with a plan for every patient encounter(doesn't have to be right)
-Don't disappear
-Never lie
-Communicate with me and other team members
-Show respect to everyone: patients, residents/midlevels, nursing, etc.
-Along those lines: never make anyone on the team look bad, including other students
-Ask decent questions, ie. not stuff you should have looked up on your own

These are applicable for every rotation, not just surgery. If you are doing these things, you will get decent clinical grades. The residents will be glad to have you and happy to teach you. I speak not just as a resident but as someone who lived by these rules in medical school with some relatively good success.

 

[SLUser11]

So what are your expectations that you lay out to your students at the beginning of their rotation? You mentioned how important it is several times, but I don't think you mentioned what they exactly are. Some of my residents did this (that is, after I asked) but most of them were quite vague like "work hard," "be interested," or "read a lot." I don't think these comments really helped.

I give them a layout of their daily routine, where they'll be, what curveballs occur, what to do/who to talk to when there's free time, what time they can expect to be done.

I tell them how many patients I want them to follow, and some tips on writing notes ("here's how I like to do it...") I tell them what time they should have their notes completed. I tell them "on time" really means 15+ minutes early, and tardiness is not acceptable. Of course, they all usually oversleep once during the rotation, and I allow that because I think it just happens....I just don't tell them it will be okay until it actually happens...

I tell them what resources to study when preparing for the OR, and what material they'll be responsible for. I tell them to practice suturing, and practice writing orders, because they need to be ready when called upon. I tell them to know ADC VAN DIML/DISMAL/Whatever.

I tell them how I expect them to progress and improve during the rotation.

I do lots of things similar to that....so it goes beyond generic advice on how to succeed (e.g. read a lot, be on time, don't lie). I also make sure they know that I'm keeping track, and they're accountable. I tell them to ask questions when necessary. I tell them that I'm detailed oriented, in part, to eliminate the "I didn't know excuse." I tell them ignorance is no excuse (e.g. nobody told us we had to do X, or we were supposed to be at Y....because I did tell you).

 

[45408]

I tell them how many patients I want them to follow, and some tips on writing notes ("here's how I like to do it...") I tell them what time they should have their notes completed. I tell them "on time" really means 15+ minutes early, and tardiness is not acceptable. Of course, they all usually oversleep once during the rotation, and I allow that because I think it just happens....I just don't tell them it will be okay until it actually happens...

I really only overslept on my family med rotation, and I don't even know how that happened, because the usual start time was 9am.

We've had a few students and even a few residents oversleep, but I haven't done it yet (knock on wood). I've slept through my pager going off at 3am though...

 

[SLUser11]

I really only overslept on my family med rotation, and I don't even know how that happened, because the usual start time was 9am.

We've had a few students and even a few residents oversleep, but I haven't done it yet (knock on wood). I've slept through my pager going off at 3am though...

In my experience, most students (and junior residents for that matter) oversleep once per difficult rotation, and it's usually the result of fatigue, altered routine, and/or alarm clock accidents (meant to hit snooze, but actually turned it off, etc) rather than laziness.

Once they wake up, they are often overcome with panic since they all think surgery residents are unforgiving @-holes. I usually tell them it's normal and try to alleviate their stress so they can actually learn something with the remainder of the day.

Other students are chronically late, and they tend to have the more elaborate excuses. Once or twice a year, I get a student who cites an unspecified medical condition as the culprit....it's usually bull$#@t.

 

[filter07]

In my experience, most students (and junior residents for that matter) oversleep once per difficult rotation, and it's usually the result of fatigue, altered routine, and/or alarm clock accidents (meant to hit snooze, but actually turned it off, etc) rather than laziness.

Once they wake up, they are often overcome with panic since they all think surgery residents are unforgiving @-holes. I usually tell them it's normal and try to alleviate their stress so they can actually learn something with the remainder of the day.

Other students are chronically late, and they tend to have the more elaborate excuses. Once or twice a year, I get a student who cites an unspecified medical condition as the culprit....it's usually bull$#@t.

 

[Leforte]

...The response I got (and I'm not kidding) was something along the lines of "the dean says we can't miss conference for any reason and you can't make us go to this case, so no we're not going, and we'll tell on you if you try to make us."

If I were to hear that statement, I would have immediately called the hospital switch and paged the Dean. I would have then explained to the Dean that the students, who I would have named, have indicated that it is their belief that the Dean does not want them participating in this surgical learning experience, and that I wanted to confirm the information. If confirmed, I would send them to the Dean's office until their conference. If the Dean disagreed - they would scrub. Seriously. I think that if a Dean feels that this is how medical education should go - they should take responsibility. Honestly, I think the backlash would be minimal and there would actually be a decent amount of support from your attendings - if not, then they have no leg to stand on complaining about current students attitudes.

 

[ThePursuit]

Incoming resident this summer here. In regards to the original question of whether or not residents are getting better or meaner:

I've seen students and residents both do some pretty dumb things. I really think a lot of it has to do with the growing pains some people have of learning how to function properly in a professional work environment. As a person who worked his way through most summers, paid his way through undergrad and currently owns a business, I think I have a somewhat novel perspective compared to most of my fellow students. I think a lot of my colleagues have really pretty minimal work experience in the real world (especially considering their age).

For the students, this means they look at med school as an extension of undergrad (which = try not to be too hungover for test days). They fail to fully see that they are training to become a professional and leader who's job is to care for others and enhance/save lives. This mindset of immaturity is supported because you still get student loans, don't really have a job and are occasionally made to feel useless/unimportant etc. in the hospital ("your notes don't matter" etc.).

For the residents, I would expect that these same students are suddenly given a hearty helping of grow-the-F@#$ up. All of a sudden their notes do matter, and they are suddenly held accountable for what they do. All of a sudden, it's not SCUT work, it's their job and they are getting paid to do it. All of a sudden "car problems" isn't an excuse to not show up for a day with little to no explanation. End of rotation evals are suddenly replaced with morbidity and mortality conferences.

I'm wagering that in many cases these newly minted professionals now in their late 20's/early 30's still have very limited work experience. It's even less likely that they have ever worked in a position of significant authority where they must act as a leader and learn to develop/nurture those they are leading. All these factors seem to commonly result in residents fumbling around with said newfound authority. Sometimes it gets abused, sometimes it gets ignored, sometimes it works out great.

Meaner? Maybe yes, but just because they are often holding medical students up to a higher standard than the students want to be held to.

Better? I sure hope so

My 2 cents.

 

[neusu]

Currently the med students where I'm at have successfully protested that because the interns are no longer allowed to take overnight call that they should not be forced to either. All services have caved except surgery.....the only service students actually take call on is surgery, and its q7. Knowing that our clerkship director won't give in, they went to the dean of the medical school and complained that when they are post call they miss out on cases and should not have to take call during the week because they miss out on learning stuff, so we are changing up all the call schedules again. Basically students will take call like twice during their 8 week rotation.

We also can't make them come in before the interns....so no pre-rounding and no list. They kind of just follow me around on rounds, scrub one case, then hide from the interns in the library all day. Its kind of sad really....

A similar rebellion occurred recently where I went to medical school. My friends in residency there took it rather poorly and said, essentially, that if the students don't want to be there and learn they're not going to teach.

As far as the work-hours rules affecting surgical culture, I absolutely agree that students and residents alike will work as little as possible to meet expectations. ... If I was an intern today, and was told that I could not take overnight call, or that as a resident I had to leave after 24 hours, I probably would have quickly adapted to that, and expected that level of work.

Shifting the goal line has a fair amount to do with it, but also selecting residents who make it clear that taking one for the team is not in their interest also hurts. When I started no one asked about duty hour compliance or "lifestyle." Now, it is one of the first things out of applicants mouths.

For the residents, I would expect that these same students are suddenly given a hearty helping of grow-the-F@#$ up. All of a sudden their notes do matter, and they are suddenly held accountable for what they do. All of a sudden, it's not SCUT work, it's their job and they are getting paid to do it. All of a sudden "car problems" isn't an excuse to not show up for a day with little to no explanation. End of rotation evals are suddenly replaced with morbidity and mortality conferences.

This is true. Although, as a student I figured I wouldn't know what was scut and what wasn't until I was a resident. Maybe it is working in different systems, but it is sad seeing some residents absolutely lose it when the EMR or tube system goes down and they have no concept that orders had to be hand written or labs delivered in person.



For what its worth, and it has already been said, clearly laying out expectations at the beginning of a rotation (or student preceptoring period) including daily workflow, task assignment, hours, call schedule and sticking to it is important. An attitudinal correction, one on one, early on can help students adjust to the expectations. If the student continues to ignore/flaunt the expectations, raise the concern early with administration that they will likely receive a poor mark, these corrective measures have been taken, there is ample time for the situation to change. Likewise, following through and administering a poor evaluation, when necessary, is justified.

 

[DoctwoB]

+1 to defining expectations off the bat and providing honest, constructive feedback early in the rotation. Makes life easier for everyone.

 

[deleted103644]

This probably varies from school to school, but for us, resident evaluations meant almost nothing, so I wouldn't worry too much.

I think occasionally someone left a really bad impression that affected his/her grade, but usually it was all preceptors, papers, and shelves.

For surgery, even attendance didn't really matter - knew quite a few students who simply disappeared, and some of them received better grades than others who showed up every day on time.

 

[SLUser11]

This probably varies from school to school, but for us, resident evaluations meant almost nothing, so I wouldn't worry too much.

I think occasionally someone left a really bad impression that affected his/her grade, but usually it was all preceptors, papers, and shelves.

For surgery, even attendance didn't really matter - knew quite a few students who simply disappeared, and some of them received better grades than others who showed up every day on time.

Thankfully, your experience is quite different from the norm. I can't imagine trying to train students in an environment where performance doesn't matter and attendance is optional.

Of course, there's a large cohort of students in the "clinical rotations" forum who would kill for your situation.

 

[deleted103644]

Thankfully, your experience is quite different from the norm. I can't imagine trying to train students in an environment where performance doesn't matter and attendance is optional.

Of course, there's a large cohort of students in the "clinical rotations" forum who would kill for your situation.

Meh, I showed up every day - in all honesty it ticked me off a bit. I think it varied a lot team by team, and since no one really kept tabs on who observed which surgery, I guess people just assumed those students were in the OR (they were not).