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How can I protect myself third year from getting screwed?

Discussion in 'Allopathic' started by router1, 04.23.12.

  1. router1

    router1

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    I will be starting rotations in a couple of months and would like to know how to best protect myself 3rd year. I've heard way too many horror stories from people about how they they've gotten screwed.

    Aside from being on top of my game by reading every night after work and doing questions on Uworld CK and Kaplan, what else can I do? I'm looking for specific advice not general aphorisms such as "being nice, helpful, etc"

    I apologize in advance if this is a redundant thread. I'm sure this issue has been discussed numerous times in the past. If someone could point me to the thread where this has been discussed, I would appreciate that as well.

    Thank You!!
  2. drizzt3117

    drizzt3117 chick magnet

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    You can't. Attendings/residents are going to evaluate you how they see fit, regardless of how you perform. Just do well on the shelves and hope for the best.
  3. DrBowtie

    DrBowtie Responsible?!?! PGY3 Moderator Emeritus

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    I don't really think there is a good way.

    The only thing I can think of would be to always request a feedback session middle of the rotation. Most won't give you any real constructive criticism, but on the off chance they do, you can possibly correct your deficiencies. If anything it shows you care about how you are doing and looking for ways to improve.

    Other good ways: Always dress conservative and professional, always be on time. Be the one to carry and have "stuff" - Each rotation would be different ex. for surgery have wound care stuff, for neuro carry all though weird tuning fork etc. Always have an extra blank H&P/Order set/standard documents.

    Your medical school will hopefully have prepared you for the medicine aspect. The above is the social/team aspect that can often times carry more weight than the medical knowledge aspect.

    And above all, never ever ever complain. Keep those complaints for your pillow at night.
  4. Perrotfish

    Perrotfish Has an MD in Horribleness

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    I never figured it out and I'm not sure there's a good way to protect yourself. The issue is that 3rd year is basically like working a job, and the way to get good reviews in a job is to be whatever your boss wants you to be. If they're in a hurry to leave you need to make sure not to waste their time, if they like 'dedicated learners' you need to produce a steady stream of questions about their profession, and if they're relaxed you might need to give off a steady stream of jokes and small talk, both of which can get very crude.

    That's not that hard, right? And it isn't if you're in an office, where you have a real job and no more than a couple of superiors reviewing you an a given year. The problem with third year is that you don't have a real job, and at any given time you might have half a dozen different 'bosses' who get switched out for a new set of superiors every couple of weeks. Because you don't have a real job its easy for your superiors to ignore you entirely most of the time, and attempting to interject yourself when you're not needed can only result in annoying them, so you often make no impression at all. Since you have up to half a dozen people reviewing you, and you get a new set of bosses every month, you would need superhuman social skills to learn what they like and dislike before you get a brand new chain of comman the next week. Actually, since you report to half a dozen people, most of the time you CAN'T adapt to them, since you'll often have conflicting personalities on the same team. The steady stream of questions that makes you look like a go getter to your wonkish attending will make you look like a kiss ass to your chief resident. Laughing at your Interns crude joke will make you look a jackass to your feminist R2, but not laughing will make the Intern think you're a prude. You often can't win.

    So the advice is pretty generic. Avoid doing things that all bosses hate: never be late, never leave early, don't lie, don't complain, do your work well, dress professionally (iron your clothes), and have a positive attitude. Other than that focus on the shelf exam, since its the only part of your grade that's really under your control, don't allow someone to harass you for the sake of preserving you grade (since it normally won't help anyway), and when you get screwed don't let it get to you too much. Good luck.
    Last edited: 04.23.12
  5. router1

    router1

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    Thanks guys! Really appreciate the feedback...I guess work my ass off and hope for the best...Our school prepares us extremely well for the medicine part...Its just that I am kinda apprehensive about these "subjective" evals, particularly bc I really don't know how to small talk or for lack of a better word "brown nose" But if it comes down that maybe I can attend a weekend conference for socially awkward people...lol
  6. drizzt3117

    drizzt3117 chick magnet

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    http://www.amazon.com/How-Win-Friends-Influence-People/dp/0671723650
  7. operaman

    operaman

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    Dont forget that a lot of the horror stories on SDN often have another side since the poster fails to disclose some of the incredibly boneheaded things they said/did and tries to play the victim.

    No other sound advice to offer though as I haven't been there myself. If you know any 3rd/4th years at your school who are similar to you in intelligence, personality, work ethic, etc, you might be able to get a sense of what to watch out for. In any case, best of luck!
  8. Phyozo

    Phyozo

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    If the same advice comes up over and over again, take the advice and learn from it. Otherwise, learn not to take things personally and roll with the punches. You can't guarantee non-screw-age, just how you react to it.
  9. neusu

    neusu Chief Resident

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    I can relate, almost got burned by 3rd year. Try to learn to brown nose or feign interest. Most attendings are insecure and arrogant and get their feelings hurt if you don't fellate their ego. Just blow smoke up their ass as much as they need to think you're a swell guy, even if you hate yourself for it. In the long run compromising your short term personal integrity is better serving than being stubborn and failing a rotation.
  10. Mr RADical

    Mr RADical

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    I know students that have been ripped apart for doing this. Some attendings despise suck ups and make it their personal mission to make their lives miserable.
  11. Bartelby

    Bartelby

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    One thing I would mention is do not go into third year hyper vigilant and paranoid that your classmates, residents, and attendings will be out to get you. At least in my experience that kind of gunning or dumping the sh** downhill was pretty rare. Joking around with classmates and talking with/ learning from the residents was one of the best parts of third year. Basically until someone shows they are a gunner pretty unambiguously give them the benefit of the doubt and I bet you will have more fun.

    That said, do well on the shelf. I think this can end up being a tiebreaker between the "A" and the "B" on at least some important rotations, depending on how your school and department breaks the grading down. Practice questions will probably help with this, as do (apparently) carrying a larger patient load and reading thoroughly about their conditions on UpToDate and other reliable sources.
  12. router1

    router1

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    Thanks for the solid advice guys...I like the one about asking for feedback mid rotation. I'll try to do that. Grades are obviously important but whats more important to me is having a quality education to me. And, the thing that I have noticed mainly from working odd jobs in high school, college, etc is that people won't tell you that you are doing a ****ty job to your face and you don't know until you see your performance evaluation and with 3rd rotations, you don't see that until you complete your rotation so you don't get a chance to improve.

    But I am looking forward to busting ass at the hospital, i imagine its much better than staring at first aid all day...lol. As one of the surgeons that lectured us said, medicine is by far the greatest profession in the world, and I think I wholeheartedly agree with him. :)
  13. Guillemot

    Guillemot

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    :thumbup:
  14. mordounhas

    mordounhas

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    I agree with pretty much everything that's been said. Act interested, work hard and try to get along. Sometimes you won't get the grade you were hoping for, but that just might not be in the cards (maybe the resident or attending rarely gives out good grades or maybe you just weren't that good).

    If the shelf plays a role at all in your grade, study as much as possible and consider getting the year-long USMLEworld subscription. I got better grades on some rotations despite some mediocre evals because of this strategy (like Ob where everyone who rotated at the same hospital with me received 3.5/5 and we all received only one evaluation).

    At the end of the day, you may have rotations where people liked you but not enough to get honors. I should know as it happened to me repeatedly, including on Ortho Sub-Is as a 4th year. It's not necessarily the end of the world, though it might be something you should be prepared to address during interviews.
  15. CatFactorial

    CatFactorial

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    :rofl:
  16. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    I wouldn't say rare. I know very few people who didn't experience it at least once. But it wasn't a daily occurrence.
  17. Bartelby

    Bartelby

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    Yeah, I think we all will face some gunning at least once or twice in the year. For me it was only a couple of times, and it was relatively mild, although I'm sure it varies by school somewhat. All I am saying is that while an occasional person may be out to get you, in my experience the vast majority were not and approaching all of them with suspicion up front probably would have made my third year experience worse.
  18. exi

    exi EM, home of the cool kids

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    Far and away the best advice I was given when I started M3.

    Focus on what you can control. Do what you can for everything else. Don't be an idiot or a douche.
  19. auburnO5

    auburnO5

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    So do people use UW to study for shelf exams? What qbank? Are we talking about the same on for Step 1 or a different one?
  20. CatFactorial

    CatFactorial

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    I think they mean the step 2 q bank.
  21. Valadi

    Valadi

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    Never talk back to attendings, never correct people (unless patient care is in jeapordy), don't go there to try and make friends, don't just start reading if there's nothing to do - there's always something to do, always let them know where you are, smile, never condemn, criticize, or complain, make residents life easier by checking up on labs, screening for depression, whatever, know everything about your patients (if you don't know their pmh and how they presented, you don't know them. period.), better if you can do progress notes from memory, make patients love you because they will advocate for you.

    and, allow yourself to be human. it's ok if you don't know the answer to every question or feel like you just don't want to come in. recharge, reboot, and get back in it
    Last edited: 06.02.12
  22. Valadi

    Valadi

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    yup
  23. Roguelyn

    Roguelyn

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    It's tough, but you'll be doing it all through residency, too. Every month is another game of guessing what is expected and what sort of worker your colleagues want. All the stuff that's been said here is true. Sometimes you need to be chatty and crude, other times you need to know the best golf course in Atlanta, other times you need to have lots of medical knowledge....the list goes on and on. Good luck.
  24. auburnO5

    auburnO5

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    Ok so Step 2 q bank for shelf exams during third year. Is this pretty common? Can anyone here talk about that?
  25. Perrotfish

    Perrotfish Has an MD in Horribleness

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    Its very common. It's mostly medicine questions, so for all other subjects its just a couple of hundred supplemental questions to add to whatever other question books you're using. For your medicine rotation you can use Uworld exlusively, or you can use the MKSAP, or if you're really gunning for honors you can try and finish all of those thousands of questions in a single rotation.
  26. auburnO5

    auburnO5

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    What are the other supplemental questions for other rotations? Books, online, etc?
  27. ArcGurren

    ArcGurren only one will survive

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    I think the definition of "gunning" is somewhat different as well. It's funny when first/second years talk about the "gunners" in their class, because you don't reaaaally know who they are until third year. I haven't encountered much of it at all, but the few times I did was once when a student would stay extra late on non-call days because he was "interested in watching a surgery" (total lie) while the other students had left, and once when another student was running 10 minutes late the other person on his team went out of his way to let the resident know that he "didn't know where the other guy was" - as if it was any of his business.

    Either way the vast majority of the time, the gunner's efforts usually don't net him/her a higher grade than the other students on his/her team. And trying to hide it usually backfires since badmouthing spreads like wildfire amongst students and residents.
  28. KnuxNole

    KnuxNole Sweets Addict

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    Thankfully, I've only met ONE girl who was a semi-gunner, but she ended up getting a Pass in the rotation and cried to the attendings about it :laugh:

    It's good to be a normal student, who tries to realize that it's better to be nice and have fun with your classmates in this learning process instead of lame gunning. There's no justification that can ever be said for out-competing a classmate on a "third year rotation" haha. And trust me, you don't wanna be pinned as an uggo gunner :D
  29. hrandani

    hrandani

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    The above is all good advice but there's nothing you can do to make yourself immune. You just do the best you can and recognize it's going to be a long, nonsensical year.

    My biggest struggle was probably maintaining the appearance of giving a **** after a 12 hour day when the attending decided to drop in at 6PM.

    I am worried about my abuse of caffeine and my long term health, but what can you do. I have had to drastically change my diet only a few weeks into third year because apparently I'm a stress eater.

    Don't think about complaining, but treat yourself for signs of burnout early and aggressively. Also, buy some really comfortable shoes and consider real inserts, not the gel stuff. They're hard to find and/or expensive but they're so worth it.
  30. seelee

    seelee

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    Most of it has been covered but I want to emphasize that despite your best efforts you will still get ****ed over on at least one rotation (if not more).

    Remember this one truth, it isn't how good of a medical student you are, it is how good of a medical student your resident THINKS you are.

    Unfortunately, so often their opinion is based on their own half-crazed, caffeine addled imagination than reality.

    I am burning off some steam here because I just got raked over the coals by a particularly ass-hattish group of residents.

    My absolute favorite was the morning I came in early to take on an extra patient, and found a previously undiagnosed 3/6 systolic murmur in a post-op patient. When I went to present to the resident I got reamed out because I "shouldn't have said anything to her. This isn't cardiology and now we might actually have to do something about it.

    That resident proceded to gripe to everyone else that I was "counseling patients" and "overstepping" my bounds. You can guess what my evals said.

    Compare this to a guy who sits in the OR reading Case Files while a case is going on, argues with staff, and skips every single morning report, and gets an A in the rotation.
  31. cowme

    cowme ACFAS Member

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    1) Always look busy, even if you have absolutely nothing to do. Show up 30 minutes early, leave 30 minutes late. All it takes is not being on time once or for the attending to see you surfing the internet for them to consider you lazy.

    2) Know your patients

    3) NEVER complain about anything

    4) Ask questions, but not to the point of being annoying

    5) Ask for feedback from your residents and attendings at least once per week. Nobody expects you to be good. They expect you to care and try to improve.
  32. KnuxNole

    KnuxNole Sweets Addict

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    Smart guy, you learn much more from Case Files than in the OR :p
  33. eli20

    eli20

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    Good. A few attendings on the side of justice is never a bad thing.
  34. seelee

    seelee

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    Absolutely, but how many surgery attendings would give a good eval to someone who just read in the OR instead of scrubbing in?
  35. KnuxNole

    KnuxNole Sweets Addict

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    Not very many(which is sad, cause surgery residents/attendings have this STRANGE belief that knowing those tiny anatomic details is the primare/main thing we care about)...

    but, that's why you read in between cases, particularly NOT in the OR, and go to the OR when the case is set and hopefully good things will suffice :)
  36. seelee

    seelee

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    That's my point. I was there for every case. Got my own gloves and gown, helped prep the patient, scrubbed, retracted, asked questions, helped wherever I could, and at the end of the rotation my comments were "too comfortable with the attending, overstepped his bounds".

    My friend sat on a stool and read. "Best medical student I have ever seen".

    The point is that you can do everything right still get a bad eval for no particular reason
  37. jcu

    jcu should have been dr. who

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    Out of curiosity, did you actually counsel that post-op patient about having an undiagnosed murmur without first checking with your resident? Or was your resident crazy and actually wanted you to omit that finding in your presentation? If I was the resident I might have also had a problem with the former. But the latter's just nuts.
  38. Gut Shot

    Gut Shot

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    While many students do get "screwed" inside the subjective and piecemeal third year system, remember that there are two sides to every story. When I was a rising M3, a student one year ahead of me made a big production about how he got screwed at a particular rotation site, to the point that he had to remediate some or all of the clerkship as an M4.

    Lo and behold, I got assigned to that site as an M3, and saw the entire staff roll their eyes in unison at mention of that student's name. According to them, said student was chronically late, perpetually ill-prepared, vocally disinterested, and had been busted napping in empty patient rooms on more than one occasion.

    If you really want to "protect yourself" during M3, it's fairly simple:

    - Show up early
    - Try and engage with the specialty and actually learn something
    - Don't be a douche to your fellow students
    - Stay late
  39. Gut Shot

    Gut Shot

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    qft. :thumbup:
  40. seelee

    seelee

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    I noticed a murmer on physical exam. I asked the patient if she was aware that she had one. She said no and asked a few questions about what a murmur was, what it meant, etc.

    I explained what a murmur was and that they were very common and usually benign. I asked her if she was having any cardiac or respiratory sx. I advised her to not worry about it, that I would speak with my resident and see if he thought we should do anything. I assured her we would be back to let her know what we planned to do, if anything.

    When I found my resident, before I could say anything he abruptly asked me why I told the patient about the murmur. I explained my reasoning, to determine whether it was a new onset murmur or not.

    He then began to rant about how this wasn't cardiology, and now we may have to do something about it. And how I shouldn't counsel patients.

    It bears pointing out that 1) this was a surgical patient and 2) our grading criteria is such that students who want an A in the clerkship are expected to be experts at communicating with patients, family members, consultants, and ancillary staff to the effect that they the medical student is perceived as the primary provider.
  41. jcu

    jcu should have been dr. who

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    Ah, that's unfortunate. Clearly there's some miscommunication between your school's expectations and the resident's. Still you'd think he'd at least be appreciative of your observations. Personally, I'm of the opinion that med students SHOULD counsel patients (especially regarding established diagnoses), but first check with their residents before revealing any new info to patients (even if you can hear the murmur from the door). I'm sure you were just trying to elicit a better history so I don't think you're at fault here. But yea ... surgeons.
  42. router1

    router1

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    Thats kinda scary dude. A resident brushing off a new findings and bitching about having to do something about it? While I haven't done any rotations, I have done a few preceptorships, and our preceptors expected us to counsel patients under their supervision ofcourse...How else do you learn? In fact, we've also done labs where they brought in standardized patients and taught us to counsel patients albeit on benign issues like weight management, diabetes, etc.

    On a separate note:
    Great advice from a lot of people on this thread! Thank you all every much!

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