Incompetence

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Apoplexy__

Apoplexy__

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My attending today berated me, in front of my patients, for not knowing the vaccination schedule of HPV. It's a pretty fair thing to expect a medical student to know, except that this is my 3rd rotation and my first IM rotation. She's well aware of this. What's even sillier is that she was disappointed when I didn't know after asking me because she genuinely didn't know herself.

I later ask for feedback for how I'm doing, but I suppose I should have waited a little longer. She's still hung up on the vaccination thing, to which her criticism is that I "really need to work on my clinical skills". She tacks on the fact that my ICD codes are poorly chosen. A shame that's not in FA.

Of course, she's not really to blame for all this. I'm fortunate to have her donate her time to my education. But it's really annoying being annoying. And it sucks being incompetent in ways that I can't help. There are so many oceans of things I don't know, and no way in sight for me to start improving.

I'm worried that I'll get a negative eval, since my ultimate competitiveness in a residency is apparently so contingent upon ICD coding and vaccination schedules. What do you do about the grade implications when you're stuck with a harsh attending who isn't all flowers and happiness? How do you improve in an environment where there's no feedback and no time for teaching?
 
kirbymiester said:
My attending today berated me, in front of my patients, for not knowing the vaccination schedule of HPV. It's a pretty fair thing to expect a medical student to know, except that this is my 3rd rotation and my first IM rotation. She's well aware of this. What's even sillier is that she was disappointed when I didn't know after asking me because she genuinely didn't know herself.

I later ask for feedback for how I'm doing, but I suppose I should have waited a little longer. She's still hung up on the vaccination thing, to which her criticism is that I "really need to work on my clinical skills". She tacks on the fact that my ICD codes are poorly chosen. A shame that's not in FA.

Of course, she's not really to blame for all this. I'm fortunate to have her donate her time to my education. But it's really annoying being annoying. And it sucks being incompetent in ways that I can't help. There are so many oceans of things I don't know, and no way in sight for me to start improving.

I'm worried that I'll get a negative eval, since my ultimate competitiveness in a residency is apparently so contingent upon ICD coding and vaccination schedules. What do you do about the grade implications when you're stuck with a harsh attending who isn't all flowers and happiness? How do you improve in an environment where there's no feedback and no time for teaching?
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Did you have Peds before this? I guess that's where you'd technically learn about vaccination schedules. Also psst...MS-3 isn't going to pimp you on knowledge in First Aid.
 
DermViser said:
Did you have Peds before this? I guess that's where you'd technically learn about vaccination schedules. Also psst...MS-3 isn't going to pimp you on knowledge in First Aid.
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Nope, Psych and a Rad/Onc elective (lol). Yeah I'm not expecting to have my pre-clinical/boards knowledge carry over, more frustrated that it's not and worried about the grading consequences of it. Just looking for some "I know that feel bro" I guess.
 
southernIM said:
Icd codes?? Jeez I barely know any of those now!!
Click to expand...

CPT codes I started to get to know as a PGY1/2 because we had to use them for our ACGME case logs. ICD9 codes? Only when I started doing research and started needing them to datamine...

Prncssbuttercup said:
I know docs who don't know how to code...
Click to expand...

You mean you know some docs.
 
Yeah I don't think I can name any ICD9 codes off the top of my head. I can name a couple CPT codes but that's about it.

I'm trying to figure out why you would need to know the HPV vaccine schedule on IM since it's not really indicated for adults.
 
mimelim said:
CPT codes I started to get to know as a PGY1/2 because we had to use them for our ACGME case logs. ICD9 codes? Only when I started doing research and started needing them to datamine...



You mean you know some docs.
Click to expand...

Right. The only codes I know are ones I've used for research and even then they don't exactly stick in my brain.

Not in the scope of an M3's education
 
kirbymiester said:
My attending today berated me, in front of my patients, for not knowing the vaccination schedule of HPV. It's a pretty fair thing to expect a medical student to know, except that this is my 3rd rotation and my first IM rotation. She's well aware of this. What's even sillier is that she was disappointed when I didn't know after asking me because she genuinely didn't know herself.

I later ask for feedback for how I'm doing, but I suppose I should have waited a little longer. She's still hung up on the vaccination thing, to which her criticism is that I "really need to work on my clinical skills". She tacks on the fact that my ICD codes are poorly chosen. A shame that's not in FA.

Of course, she's not really to blame for all this. I'm fortunate to have her donate her time to my education. But it's really annoying being annoying. And it sucks being incompetent in ways that I can't help. There are so many oceans of things I don't know, and no way in sight for me to start improving.

I'm worried that I'll get a negative eval, since my ultimate competitiveness in a residency is apparently so contingent upon ICD coding and vaccination schedules. What do you do about the grade implications when you're stuck with a harsh attending who isn't all flowers and happiness? How do you improve in an environment where there's no feedback and no time for teaching?
Click to expand...
it happens dude, the key is to find attendings/residence who actually enjoy teaching and stress understanding rather than memorizing. I am on surgery and 1 attending enjoys teaching me why certain procedures are done [he does ask some anatomy questions that are important] but another attending makes it his job to just ask obscure/ omg who cares anatomy questions like origin and insertion that I didnt even need to know while I was taking anatomy lol.
Best thing, go home and look up the stuff you got asked and didnt know, chances are you will be asked again and knowing it will show that you actually cared to look it up
 
ICD9 codes? LoL.
Someone go on their EMR and tell me if you use that or just click "cough"?
Also, brush it off, op. You did nothing wrong. And don't feel embarrassed about what happened with your patients. If you have spent as much time as I (or most medical students) have with their patients, then they probably thought no less of you. Make light of it.
As my attending told me: you're a student, you have every right to be wrong.
 
ICD9 codes, are you joking? That should be the LAST thing you have to worry about learning at this stage. Honestly I think the HPV schedule is also pretty unfair to expect, those schedules usually aren't tested on shelf exams because they're frequently changing anyways--but even if it WAS a fair pimp question, missing a single question should not trigger an avalanche of criticism, and it is NEVER ok to berate someone in front of patients.

You say that you're "fortunate that she donates her time," but in reality you got a raw deal here. Some people are not made to teach, and from the sounds of it they are not doing a great job at it.
 
kirbymiester said:
My attending today berated me, in front of my patients, for not knowing the vaccination schedule of HPV. It's a pretty fair thing to expect a medical student to know, except that this is my 3rd rotation and my first IM rotation. She's well aware of this. What's even sillier is that she was disappointed when I didn't know after asking me because she genuinely didn't know herself.

I later ask for feedback for how I'm doing, but I suppose I should have waited a little longer. She's still hung up on the vaccination thing, to which her criticism is that I "really need to work on my clinical skills". She tacks on the fact that my ICD codes are poorly chosen. A shame that's not in FA.

Of course, she's not really to blame for all this. I'm fortunate to have her donate her time to my education. But it's really annoying being annoying. And it sucks being incompetent in ways that I can't help. There are so many oceans of things I don't know, and no way in sight for me to start improving.

I'm worried that I'll get a negative eval, since my ultimate competitiveness in a residency is apparently so contingent upon ICD coding and vaccination schedules. What do you do about the grade implications when you're stuck with a harsh attending who isn't all flowers and happiness? How do you improve in an environment where there's no feedback and no time for teaching?
Click to expand...

I feel you.

Just take your licks and learn from it.

There is a special place on hell for this attending.

Sorry.
 
That's just insane.

Besides, ICD-10 is coming out "soon", so why do you need to learn ICD-9 now? 😉

Something tells me that this attending is either new to teaching (and doesn't know what's important) or got defensive and is picking on you because she forgot something important.
 
A teacher/educator (or a decent person) never berates a learner in front of the patients. It is just not appropriate and lacks professionalism (on the part of the educator). The only time an educator should immediately jump in and intervene (or berate) is if there is an immediate life/limb/organ situation (eg don't cut the sutures keeping the IABP in place, etc)

We are all life-long learners. There is no way to learn and memorize everything. I don't know the HPV vaccination schedule off the top of my head (I did at one point). If you ask me for the catch-up schedule for someone who missed several doses of DTaP, I wouldn't know it off the top of my head (again, I did at one point). But I know where to go to look up that information (and no, it's not UpToDate). Knowing where to look up reliable information is an important skills, and a missed opportunity for your attending to teach you the resources that clinicians used in actual practice.

You are there to learn outpatient medicine, to put into practice what you have read in books and studied for exams. But in addition, you should be exposed to "real" medicine - the ugly side that medical students seldom see (and academic faculty seldom talk about). The paperworks, phone calls, etc. Part of your education should also be learning the business side of medicine - being exposed to concepts such as billing, documentation requirements, ICD9 (and soon ICD10), modifiers, etc. But that's the physician's job to "open" your eyes to this hidden side of medicine. In reality, students (and even residents) shouldn't even have to know or memorized ICD9s/ICD10s - just the concepts of what they are, and why they are so important (for both outpatient and inpatient side). Expecting you to know (and properly) pick the correct ICD9s is like expecting a college freshman to know how to obtain R01 NIH grants -expectations are completely inappropriate and above the level expected. Besides, ICD9s aren't that important for billing as an outpatient - it's the appropriate billing codes (ie 99204, 99203, etc) that's important as well as having the right documentation to support that level of billing (so you won't be accused of upcoding or overbilling)

While your attending may be volunteering her time, the fact that she said yes to having a student meant that she made a commitment to your education, and she has to take that seriously. Looks like she has a lot to learn on how to be an effective educator. Looks like she has a lot to learn on how to be an effective communicator. Teaching the next generation of physicians is its own rewards but if she has no desire or interest in teaching, then either she should have refused the assignment, or find an appropriate mentor to take her place. If she's in an academic environment, then it's part of the job description that she signed up (can't have the title without the responsibility)

I would let your clerkship director know the issues you are facing (and use examples, avoid injecting emotions or personal commentaries) and that you have tried to ask for feedback on multiple occasions. If enough students (and residents) complain, then either she will stop having students assign to her, or her mentor/advisor (if she's a junior faculty attending in academic medicine) will have a chat with her.

But 3rd year clerkships grading is very subjective. Best you can do is to control what you can control (your behavior, your own learning, and the shelf). Keep your head low, survive this clerkship, write honest feedback at the end-of-rotation evaluation, and move on. Part of clinical rotations is learning the right way to do stuff. Part of clinical rotation is learning the wrong way to do stuff. Unfortunately you are getting a "balanced" education in this.
 
Winged Scapula said:
That's just insane.

Besides, ICD-10 is coming out "soon", so why do you need to learn ICD-9 now? 😉

Something tells me that this attending is either new to teaching (and doesn't know what's important) or got defensive and is picking on you because she forgot something important.
Click to expand...

I agree. While many cases on SDN are constructive criticism taken wrongly, this is not. OP DEFINITELY do not beat yourself on yourself not knowing ICD-9 codes (Good lord).
 
This actually reminds me of an embarrassing story during peds surgery...
We went into this patients room and I didn't really know much about the patient. We walk in and the parents are there... attending makes a comment about how well the procedure went, mom talks about how much of a fighter the kid is. I remark "He's a tough kid". Attending looks at me weird. Fellow glares. I'm wondering why the rude looks.
5
4
3
2
1
OH MY GOD THIS KID IS A GIRL! In my defense - the kid had a mullet and was wearing a boys tshirt. But damn... That moment; I did NOT want to leave the room because of what was going to happen outside. We're done. I step outside and I have deer in headlights as they all walk out. I start my apology but my attending immediately bursts into laughter and stops me. He remarks about how he almost made the same mistake when he first saw the kid and that he was thinking the same thing when he saw her this morning.
Sigh of relief... Now I always make sure to check "Male or Female" for every patient....
 
You guys are great. That's all the empathy I needed, hah. Some really articulate and insightful feedback here.

By the way, to clarify, she only has been on me for choosing poor ICD codes for my patients, not expecting me to memorize what the codes are for diagnoses.

To those of you who mentioned that this doctor sounds like a poor/inexperienced educator, I really think that's the heart of the situation. As malicious as everything I said sounds, I think she just doesn't realize what she's doing. I get the feeling she liked the idea of teaching students, but then mentally hopped off the train when the time came to actually deal with us.
 
I don't think a lot of these attendings are "donating" their time. To be faculty you have to do some sort of academic scholarship whether research or education. She may have chosen teaching med students as the filler. Although some faculty may go above and beyond and teach extra med students and get involved in all sorts of things, it doesn't sound like your attending is doing this because she loves teaching med students and she doesn't sound very good at it. Therefore, wouldn't say she is donating time. On the flip side, some people try to be good teachers but make mistakes like berating the learner. Others just aren't good at teaching. Hopefully you learn something and get a good grade.
 
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The spacecraft Discovery lost power and the crew members in space when aliens took over their computer systems.

NASA DENIES THIS EVIDENCE OF UFOs.

Maybe your attending is the one who believes this.
 
One pearl I have learned in dealing with this type of personality is that it's useless to try to please them by trying to learn all these random things. It's easier to just work on making them like you. Talk about non medical stuff. Ask about kids, hobbies, local restaurants, etc etc. Just like patients don't like to sue doctors they like whether they are at fault or not; attendings don't like to give bad grades to students they like. Just be personable and friendly and you'll probably be alright.
 
joeDO2 said:
One pearl I have learned in dealing with this type of personality is that it's useless to try to please them by trying to learn all these random things. It's easier to just work on making them like you. Talk about non medical stuff. Ask about kids, hobbies, local restaurants, etc etc. Just like patients don't like to sue doctors they like whether they are at fault or not; attendings don't like to give bad grades to students they like. Just be personable and friendly and you'll probably be alright.
Click to expand...

If I applied that amount of energy and effort towards making everyone I was with like me, I'd have burned out the middle of third year. People in med school are just not comfortable with failure and try to make every effort to rectify it. It's unfortunate... but the truth. The OP was probably torn not just by being burned by their attending, but the humiliation and feeling of failure. The sooner that you realize that not every bad mark/missed question/failure is because you suck but because other people do, the better you'll be able to survive. There are some people who just don't deserve the effort you recommend... Some, on the other hand, definitely do. If I took your approach, I'd of asked that OB/GYN resident what she does on the weekends and sucked her metaphorical cock so she wouldn't write a negative review because of my shoes. But I'll take the failed review over my gf murdering me for banging a dog. I say dog because she's an OB/GYN bitch. :banana::corny:🤣
 
kirbymiester said:
Of course, she's not really to blame for all this. I'm fortunate to have her donate her time to my education. But it's really annoying being annoying. And it sucks being incompetent in ways that I can't help.
Click to expand...

Stockholm syndrome

You "deeply regret the role you played the night of the incident"
 
GuyWhoDoesStuff said:
Yes it is.
Click to expand...

Right. I routinely asked peeps on IM about that. OB/GYN I can believe. But if someone tried berating me on IM about that as a third year... I'd put it under "I don't give a ****" category. Or being asked if a patient met the criteria for psychoaffective disorder on any rotation outside of psych...
 
Kaustikos said:
Right. I routinely asked peeps on IM about that. OB/GYN I can believe. But if someone tried berating me on IM about that as a third year... I'd put it under "I don't give a ****" category. Or being asked if a patient met the criteria for psychoaffective disorder on any rotation outside of psych...
Click to expand...

I'm not saying I expect that you run into it a whole lot on IM. Maybe some people do, maybe some people don't.

But it is indicated for females ages 9-26 (and has since gained indications in some males since I was in medical school).

Most of the stuff the OP mentions seems to indicate that this preceptor is new to teaching. There should really be no expectation that a medical student would know any ICD-9 codes. You can hash out diagnoses and perhaps the attending was actually trying to get him to focus his assessment into a more specific diagnosis. But no one was impressed that I could rattle off a bunch of primary care ICD-9 codes when I was rotating, nor should they have been. I have a bunch of them still engraved in my mind from my medical assistant days ~10 years ago.

And you know what that skill helped me with?

I could quickly abbreviate hypothyroidism as "244.9" in my notes in the preclinical years of medical school. Saved me about a dozen letters. Whoopdeedoo.

With EMR, most of the codes are afterthoughts. You type in the diagnosis and it comes up, with the code attached. Memorizing them might help the nurse who fills out your lab sheets when you order routine labs for the patient. It's not gonna do a ton for you as a medical student or young physician, at least not anytime soon.
 
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GuyWhoDoesStuff said:
I'm not saying I expect that you run into it a whole lot on IM. Maybe some people do, maybe some people don't.

But it is indicated for females ages 9-26 (and has since gained indications in some males since I was in medical school).

Most of the stuff the OP mentions seems to indicate that this preceptor is new to teaching. There should really be no expectation that a medical student would know any ICD-9 codes. You can hash out diagnoses and perhaps the attending was actually trying to get him to focus his assessment into a more specific diagnosis. But no one was impressed that I could rattle off a bunch of primary care ICD-9 codes when I was rotating, nor should they have been. I have a bunch of them still engraved in my mind from my medical assistant days ~10 years ago.

And you know what that skill helped me with?

I could quickly abbreviate hypothyroidism as "244.9" in my notes in the preclinical years of medical school. Saved me about a dozen letters. Whoopdeedoo.

With EMR, most of the codes are afterthoughts. You type in the diagnosis and it comes up, with the code attached. Memorizing them might help the nurse who fills out your lab sheets when you order routine labs for the patient. It's not gonna do a ton for you as a medical student or young physician, at least not anytime soon.
Click to expand...

I... Think we are in agreement. I didn't mean to say it's not indicated in young adults. Just that it's no reason to berate. Pimping can be fun and informative.
The best pimping I got was during the VA where my attending made sure I had guidelines down cold. I'd give my A&P and he'd always ask what the guidelines were. It was nice because I was using what I was learning.
Then you have pimping on movies and music... Which I love. Nothing makes morning rounds more tolerable than that
 
Yeah dude, try not to take it to heart. I mean from reading the tone of your OP it sounds like you are aware this lady is being unreasonable but you don't want to outright say it because you have this ingrained idea that attending are to be respected and etc. But doctors are humans, and they are under a lot of stress, and some people don't take that stress well. I'd maybe wait a week or so before you ask for feedback again, but you aren't doing anything wrong if you are working hard and trying to get better.

EDIT: and definitely talk to your course director or administration if she gives you bad feedback/ a bad eval based on these things. You might not be able to get rid of a bad grade but you will help out future med students.
 
As far as difficulty choosing the right diagnosis in the ICD coding, even that is not something you won't necessarily get right the first time you di it, and the person teaching you is supposed to give you feedback at the time you choose the diagnosis, like "I would put ___ because it is more descriptive, etc"
 
Winged Scapula said:
That's just insane.

Besides, ICD-10 is coming out "soon", so why do you need to learn ICD-9 now? 😉

Something tells me that this attending is either new to teaching (and doesn't know what's important) or got defensive and is picking on you because she forgot something important.
Click to expand...

Probably something super important like the HPV vaccination schedule.
 
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