My confidence is shot and my self-worth is in question right now...

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Funny. Because my osce had a situation where I delivered bad news.

Which is a completely reasonable thing to practice in an OSCE

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Delivering terrible news is the part of being an attending I'm looking forward to the LEAST, and many of my mentors consider it one of the most emotionally draining and difficult parts of their job.

I can't imagine electing to do it right now as a student.

I think most places have policies about this sort of thing, but common sense goes a long way. I wouldn't want to hear about my own cancer diagnosis from a student or even a resident. I would want the news either from 1) the attending who would be directing my care or 2) my PCP who I've known for years now. I wouldn't mind others being in the room or even leading the conversation with the attending present, but conversations like those need to be had directly with the person ultimately responsible for the plan. Just my $0.02.

Definitely agree with mimelin about proactivity. I was the uber-proactive and insanely hard working student all last year and even this year. I've been told 'no' a number of times which I always accept graciously and professionally, but I've also been allowed to do a lot of stuff too. Not as much as mimelin did though, at least not yet! Evals were 100% glowing --even from attendings and residents who had a rep for being mean and/or never giving honors -- and had no difficulty honoring everything all year. It's amazing how far you can get with a modicum of self awareness, sensitivity to others, and basic human decency.
 
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That is the exact purpose of an OSCE. Not sure what you are trying to say.

I meant to say the one about the 7/16 nodes as the EXACT one I had. Like "wow...did you steal that from my OSCE"? thing.
 
You think that students are penalized for being proactive? For starters, it is illogical. Why would somewhere that doesn't teach or is an otherwise ****ty training location make a difference? It doesn't all of a sudden make sense that someone is being helpful and insightful, and people's thoughts are, "lets punish him!" I understand that every training site is going to be different. I don't think what people value when it comes to the basics changes. People aren't going to value not showing up, or yelling at patients just because it is a bad training spot. This is the exact same thing.

I don't know what to tell you. Yes, I think there are preceptors that I think would penalize students for being too proactive and have been reported to do so. You can reductio ad absurdum it if you want - you just made up a bunch of absurd situations there.
 
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You think that students are penalized for being proactive? For starters, it is illogical. Why would somewhere that doesn't teach or is an otherwise ****ty training location make a difference? It doesn't all of a sudden make sense that someone is being helpful and insightful, and people's thoughts are, "lets punish him!" I understand that every training site is going to be different. I don't think what people value when it comes to the basics changes. People aren't going to value not showing up, or yelling at patients just because it is a bad training spot. This is the exact same thing.

Mimelim, I think your opinion is slightly off-kilter, since it is clear that you have no issue with students being proactive, as they put in central lines and stuff at your institution.
 
Mimelim, I think your opinion is slightly off-kilter, since it is clear that you have no issue with students being proactive, as they put in central lines and stuff at your institution.

Couple of issues.

#1 You think that physicians out there agree with the statement, "Being proactive is a negative quality in a student"? Is that what you are saying?
#2 Putting central lines in has nothing to do with a student being proactive. Trying to connect the two is illogical.
 
Couple of issues.

#1 You think that physicians out there agree with the statement, "Being proactive is a negative quality in a student"? Is that what you are saying?
#2 Putting central lines in has nothing to do with a student being proactive. Trying to connect the two is illogical.

Possibly not 'proactive', but 'over-eager' (even if the student is performing well otherwise, as opposed to all your examples where he can't do basic MS3 tasks), for sure. What is the real difference between those two words besides the opinion of the person behind them? We're getting into semantics now, but that's what the differences are.

The fact that you are OK with students taking procedural steps on their rotation makes you, IMO, significantly less likely to consider a student 'over-eager', especially if that student is capable in his basic MS3 tasks.

Just my 2 cents, and obviously you are more than welcome to disagree.
 
Possibly not 'proactive', but 'over-eager' (even if the student is performing well otherwise, as opposed to all your examples where he can't do basic MS3 tasks), for sure. What is the real difference between those two words besides the opinion of the person behind them? We're getting into semantics now, but that's what the differences are.

The fact that you are OK with students taking procedural steps on their rotation makes you, IMO, significantly less likely to consider a student 'over-eager', especially if that student is capable in his basic MS3 tasks.

Just my 2 cents, and obviously you are more than welcome to disagree.

So if a student is already capable in basic MS3 tasks, you think he should turn down an opportunity to place a central line so that he doesn't come off as "overeager"? Yeah no. You can ask to perform or help with a procedure in a non-entitled way, completely understanding that the answer can be "no," and understanding and respecting your boundaries. It's an opportunity to learn, and you should take every opportunity offered to you, especially if your resident likes to teach.

Are you not permitted to perform procedures at your institution? It depends on the attending here, but procedures like line placement, catheterization, LPs, joint aspirations, etc are not unheard of on rotations (we were actually expected to log an LP on pediatrics but I never got the chance).
 
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Possibly not 'proactive', but 'over-eager' (even if the student is performing well otherwise, as opposed to all your examples where he can't do basic MS3 tasks), for sure. What is the real difference between those two words besides the opinion of the person behind them? We're getting into semantics now, but that's what the differences are.

The fact that you are OK with students taking procedural steps on their rotation makes you, IMO, significantly less likely to consider a student 'over-eager', especially if that student is capable in his basic MS3 tasks.

Just my 2 cents, and obviously you are more than welcome to disagree.

Interpretation of actions is subjective. I agree. However...

These issues that people are talking about are not even close to that line of confusion. As I stated previously and I think most residents/attendings in this thread would back me on... The people that say that they were punished for being 'proactive' were very VERY far from that line. I just haven't seen it. Maybe it takes several years of living in the hospital and being around medical students night and day to gain the perspective, but people's actions tend to be very transparent.
 
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It's funny how some people in this thread - as I have seen in many other threads - want to quibble with other people about ridiculous minutia when all they were trying to do was give very reasonable and level headed advice to the OP.
 
So if a student is already capable in basic MS3 tasks, you think he should turn down an opportunity to place a central line so that he doesn't come off as "overeager"? Yeah no. You can ask to perform or help with a procedure in a non-entitled way, completely understanding that the answer can be "no," and understanding and respecting your boundaries. It's an opportunity to learn, and you should take every opportunity offered to you, especially if your resident likes to teach.

Are you not permitted to perform procedures at your institution? It depends on the attending here, but procedures like line placement, catheterization, LPs, joint aspirations, etc are not unheard of on rotations (we were actually expected to log an LP on pediatrics but I never got the chance).

To the first bolded - Not at all. If I was offered ANY procedure, I would jump on the chance to do it.

To the second - Outside of a couple IVs and a couple intubations on my 3-week block of Anesthesia, I was not allowed to place any lines, and definitely not do any LPs. As a 4th year you have the possibility of doing central lines, but I won't have a significant number of ICU rotations to really get exposure to it.

I actually agree with you (Ismet and mimelim) that students are unlikely to be considered both competent and over-eager, but there is some percentage of students that are being classified as such.
 
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The fact that you are OK with students taking procedural steps on their rotation makes you, IMO, significantly less likely to consider a student 'over-eager', especially if that student is capable in his basic MS3 tasks.

I don't really see where the procedure thing fits into your argument. Letting a med student perform a procedure under supervision has nothing to do with whether or not students are being proactive.

If @mimelim was okay with students putting in central lines unsupervised and without being told to, that would maybe fall under the blanket of "overeager/proactive/whatever word we're using today"

I'd let a med student put in a central line under the right circumstances. Unfortunately usually I have an intern who still needs to learn how to do it, so their educational needs win. C'est la vie.
 
I don't really see where the procedure thing fits into your argument. Letting a med student perform a procedure under supervision has nothing to do with whether or not students are being proactive.

If @mimelim was okay with students putting in central lines unsupervised and without being told to, that would maybe fall under the blanket of "overeager/proactive/whatever word we're using today"

I'd let a med student put in a central line under the right circumstances. Unfortunately usually I have an intern who still needs to learn how to do it, so their educational needs win. C'est la vie.

How it fits is that someone like mimelim is not going to be one of the attendings we are talking about who wants med students to be more seen quietly in the background, not mucking up the team's flow, rather than up front, grabbing patients, forming and presenting plans, asking to do procedures, etc.
 
How it fits is that someone like mimelim is not going to be one of the attendings we are talking about who wants med students to be more seen quietly in the background, not mucking up the team's flow, rather than up front, grabbing patients, forming and presenting plans, asking to do procedures, etc.

I have never encountered an attending who considers "fly on the wall" the key to success as a medical student.

It's certainly not the advice I'd give to a medical student looking to succeed.

Like mimelim, I've worked with hundreds of medical students. I've written hundreds of clerkship evaluations. I've read hundreds of LORs. I cannot ever recall an instance where a student being engaged and proactive was brought up in a negative connotation. I can recall tons of times where it was highlighted as a positive trait.
 
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I have never encountered an attending who considers "fly on the wall" the key to success as a medical student.

It's certainly not the advice I'd give to a medical student looking to succeed.

Like mimelim, I've worked with hundreds of medical students. I've written hundreds of clerkship evaluations. I've read hundreds of LORs. I cannot ever recall an instance where a student being engaged and proactive was brought up in a negative connotation. I can recall tons of times where it was highlighted as a positive trait.

Honestly, I'm just confused that neither of you can even begin to believe that there are preceptors that run things differently. What about in residency? Did you never have an attending that did not teach, was an ass, and did the entire case instead of guiding you through a procedure? It's basically the same principle.
 
Did you never have an attending that did not teach, was an ass, and did the entire case instead of guiding you through a procedure? It's basically the same principle.

I think among the very basic qualities of medical students that residents and attendings value, being engaged and proactive is among, if not the, most common.

I will continue to give the advice to be proactive to every student I work with or mentor.

I would never give the advice to sit back and stay out of the way.

Do I accept that there are true dinguses out there who have no interest in teaching? Of course. But I also think, from my experience both as a student and a resident working with myriad faculty in different departments, that they are extremely rare. So giving students advice to cater to the whims of a capricious minority of dinguses is not going to be helpful to most students.
 
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I think among the very basic qualities of medical students that residents and attendings value, being engaged and proactive is among, if not the, most common.

I will continue to give the advice to be proactive to every student I work with or mentor.

I would never give the advice to sit back and stay out of the way.

Do I accept that there are true dinguses out there who have no interest in teaching? Of course. But I also think, from my experience both as a student and a resident working with myriad faculty in different departments, that they are extremely rare. So giving students advice to cater to the whims of a capricious minority of dinguses is not going to be helpful to most students.

I agree with everything you said. I think being an enthusiastic, proactive med student is a great quality and generally appreciated. The people on the other side of the argument have just probably experienced the rare poor teachers a little more often than you did/have and are cautious.
 
Honestly, I'm just confused that neither of you can even begin to believe that there are preceptors that run things differently. What about in residency? Did you never have an attending that did not teach, was an ass, and did the entire case instead of guiding you through a procedure? It's basically the same principle.

This has nothing to do with being proactive.

We all agree, there are surgeons who are asses. There are a lot of preceptors that don't teach.

Sorry, but proactive = positive. And that is universal. Logic on our side, overwhelming experience on our side. Game, Set, Match.
 
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I agree with everything you said. I think being an enthusiastic, proactive med student is a great quality and generally appreciated. The people on the other side of the argument have just probably experienced the rare poor teachers a little more often than you did/have and are cautious.

And I would argue that the people arguing that students being proactive is seen negatively don't know what they are talking about.

Poor teachers != "proactive is bad"

If a student claims, "They don't like me because I'm proactive" that student is full of it, whether they realize it or not. And, in my experience, they know it and are being defensive.
 
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And I would argue that the people arguing that students being proactive is seen negatively don't know what they are talking about.

Poor teachers != "proactive is bad"

If a student claims, "They don't like me because I'm proactive" that student is full of it, whether they realize it or not. And, in my experience, they know it and are being defensive.

I don't think there's anything further to argue. You guys see it one way as residents, and some of the med students see it another way.
 
I don't think there's anything further to argue. You guys see it one way as residents, and some of the med students see it another way.
And what you fail to see is from MS-3 onwards the way residents/attendings see it, matters. You will be evaluated here on out based on what someone thinks of you. The time for your performance to ONLY be evaluated by a multiple choice exam is over.
 
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This has nothing to do with being proactive.

We all agree, there are surgeons who are asses. There are a lot of preceptors that don't teach.

Sorry, but proactive = positive. And that is universal. Logic on our side, overwhelming experience on our side. Game, Set, Match.
Yeah, there is this thing called life-long learning. Medical students should know this by now. No one is going to spoon-feed you knowledge (not you).
 
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And what you fail to see is from MS-3 onwards the way residents/attendings see it, matters. You will be evaluated here on out based on what someone thinks of you. The time for your performance to ONLY be evaluated by a multiple choice exam is over.

I finished M3 with honors in everything except family med. I have a pretty good grasp of how the game is played. That doesn't mean I am unable to see that other students have been, in my mind, unfairly judged.
 
Yeah, there is this thing called life-long learning. Medical students should know this by now. No one is going to spoon-feed you knowledge (not you).

We aren't talking about being spoon fed. There is a marked difference between a preceptor pimping you and telling you this is important, go look it up later (which is teaching though not lecture-style spoonfeeding), and not even engaging the student - there were definitely preceptors I had that did not give three ****s what my name was, what I knew, or what I could do. Much less care about teaching.
 
We aren't talking about being spoon fed. There is a marked difference between a preceptor pimping you and telling you this is important, go look it up later (which is teaching though not lecture-style spoonfeeding), and not even engaging the student - there were definitely preceptors I had that did not give three ****s what my name was, what I knew, or what I could do. Much less care about teaching.
Your preceptor is not your bish. You're a rotator. It's not worth knowing your name bc you'll be gone next month.
 
I finished M3 with honors in everything except family med. I have a pretty good grasp of how the game is played. That doesn't mean I am unable to see that other students have been, in my mind, unfairly judged.
Yes, bc who better to evaluate your medical student friends fairly, than a fellow medical student classmate rather than the resident who sees them everyday on rotation.
 
Your preceptor is not your bish. You're a rotator. It's not worth knowing your name bc you'll be gone next month.

Therein lies the difference between us - what kind of a ****ty human being thinks like that?
 
Therein lies the difference between us - what kind of a ****ty human being thinks like that?
Mainly bc you're not dating your preceptor. his job is not to find out your life story and this isn't the classroom. Grow up.
 
Mainly bc you're not dating your preceptor. his job is not to find out your life story and this isn't the classroom. Grow up.

I pity you that you think that's normal. In the workplace you learn the names of people you work with for a couple days much less an entire month. Grow up? Be more of a condescending ass. Often wrong, never in doubt.
 
I pity you that you think that's normal. In the workplace you learn the names of people you work with for a couple days much less an entire month. Grow up? Be more of a condescending ass. Often wrong, never in doubt.
Didn't say it was "normal" whatever that is for each individual. What I am saying is you are ridiculously entitled for a medical student. In a normal workplace, you stay a lot longer than a month. In the MS-3 year, you are rotating amongst different clerkships: IM, Peds, Surgery, OB-Gyn, Neuro, Family Med, Psych. Don't expect an attending or an intern/resident, whom you are likely slowing them down, to drop everything to get to know and teach you like you're on the Love Connection.

The expression, often wrong, never in doubt, ironically enough applies to you here.
 
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Therein lies the difference between us - what kind of a ****ty human being thinks like that?

I pity you that you think that's normal. In the workplace you learn the names of people you work with for a couple days much less an entire month. Grow up? Be more of a condescending ass. Often wrong, never in doubt.

It makes you a ****ty human being for not knowing someone's name? Sorry, but most preceptors are working, hard. Most medical students (in my opinion, wrongfully) are expecting to be spoon fed and don't take an active role in their education. If you are going to function as a shadow, people aren't going to remember your name. If you think that proactivity is bad (lol) and interact with people accordingly, nobody is going to bother learning your name. What is the point? This is no different in any other profession that moves as fast pace as we do. It is NOT unique to medicine. It is purely a function of what people value and I'm sorry, but some entitled kid following you around is very low on most people's lists.
 
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Didn't say it was "normal" whatever that is for each individual. What I am saying is you are ridiculously entitled for a medical student. In a normal workplace, you stay a lot longer than a month. In the MS-3 year, you are rotating amongst different clerkships: IM, Peds, Surgery, OB-Gyn, Neuro, Family Med, Psych. Don't expect an attending or an intern/resident, whom you are likely slowing them down, to drop everything to get to know and teach you like you're on the Love Connection.

The expression, often wrong, never in doubt, ironically enough applies to you here.

Entitled for expecting a teacher to know my name. Just listen to yourself. Now it's just a generic term you throw around. I learn the names of people I meet for one night at a party. It takes active disinterest to ignore someone you work with for 12 hours a day for a month. Your attitude is disgusting.

I was a consultant for 3 years before medical school. I worked with people for 1-2 months all the time before rotating teams. I'm still in contact with most of the people I worked with. What jobs have you worked? You clearly have no idea what an actual job entails.

It makes you a ****ty human being for not knowing someone's name? Sorry, but most preceptors are working, hard. Most medical students (in my opinion, wrongfully) are expecting to be spoon fed and don't take an active role in their education. If you are going to function as a shadow, people aren't going to remember your name. If you think that proactivity is bad (lol) and interact with people accordingly, nobody is going to bother learning your name. What is the point? This is no different in any other profession that moves as fast pace as we do. It is NOT unique to medicine. It is purely a function of what people value and I'm sorry, but some entitled kid following you around is very low on most people's lists.

I never said proactivity is bad, I said it had potential to be interpreted in a negative light. Too busy to teach is a funny explanation. Frankly, if you're not capable of teaching while taking care of clinical duties, maybe you should leave academia.

I agree that people should not be spoon fed, but not learning a ****ing name is ridiculous.
 
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Being proactive is different from demonstrating poor judgment and doing/saying things you shouldn't be doing. Students who think they are being proactive by taking on tasks they are unprepared for or are inappropriate are actually demonstrating poor judgment and insight. I have several times seen students being a little too eager during rounds (thinking they are being 'proactive') but not reading the preceptors face (I once even saw the preceptor subtly roll his eyes when the med student started).

Generally, students who complain that they were being docked for being proactive are actually signalling to me that they have poor insight and instead pissing a preceptor off. These students are the same ones who troll these threads with hyperbolic statements and accusing others outright of being "****ty" human beings. hahaha. This thread is rich guys. Just rich.
 
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Entitled for expecting a teacher to know my name. Just listen to yourself. Now it's just a generic term you throw around. I learn the names of people I meet for one night at a party. It takes active disinterest to ignore someone you work with for 12 hours a day for a month. Your attitude is disgusting.

I was a consultant for 3 years before medical school. I worked with people for 1-2 months all the time before rotating teams. I'm still in contact with most of the people I worked with. What jobs have you worked? You clearly have no idea what an actual job entails.



I never said proactivity is bad, I said it had potential to be interpreted in a negative light. Too busy to teach is a funny explanation. Frankly, if you're not capable of teaching while taking care of clinical duties, maybe you should leave academia.

I agree that people should not be spoon fed, but not learning a ******* name is ridiculous.

My problem with this conversation is that I don't get a sense that you know much about clinical medicine or the wards.

#1 Virtually no attending works that closely with medical students. When they do work with people closely, they learn names, universally. Even if they are terrible human beings, if they are spending time with someone or working with them, they learn names because that is how you effectively communicate with people.

#2 Your attending is not your teacher. They may teach, but they are an attending. They are NOT a 'teacher'. They are a hybrid of boss, professor, teacher, etc. To expect every person that teaches to know your name is just silly. There are many professors in undergrad who don't know all their student's names because of class size or other reason. Attendings are no different. If you are of some sort of consequence on the rotation, good or bad, your name gets learned.

#3 Like many medical students are under the impression that academia means teaching. I'm sorry, but if you spent any time in a university, you would know that this is simply not true. Saying, "Frankly, if you're not capable of teaching while taking care of clinical duties, maybe you should leave academia." shows a fundamental lack of understanding of how academics work. We see this quite a bit when we ask at interviews, "what are you interested in?" and someone says, "academic medicine because I want to teach".
 
We see this quite a bit when we ask at interviews, "what are you interested in?" and someone says, "academic medicine because I want to teach".

Ugh this so much. Every year there are a few applicants who are really interested in "surgical education" - and I'm like ok, well what areas are you interested in? Have you done any research in it? Where do you see that fitting into your career?
...
"ummm...I want to teach?"
 
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My problem with this conversation is that I don't get a sense that you know much about clinical medicine or the wards.

#1 Virtually no attending works that closely with medical students. When they do work with people closely, they learn names, universally. Even if they are terrible human beings, if they are spending time with someone or working with them, they learn names because that is how you effectively communicate with people.

#2 Your attending is not your teacher. They may teach, but they are an attending. They are NOT a 'teacher'. They are a hybrid of boss, professor, teacher, etc. To expect every person that teaches to know your name is just silly. There are many professors in undergrad who don't know all their student's names because of class size or other reason. Attendings are no different. If you are of some sort of consequence on the rotation, good or bad, your name gets learned.

#3 Like many medical students are under the impression that academia means teaching. I'm sorry, but if you spent any time in a university, you would know that this is simply not true. Saying, "Frankly, if you're not capable of teaching while taking care of clinical duties, maybe you should leave academia." shows a fundamental lack of understanding of how academics work. We see this quite a bit when we ask at interviews, "what are you interested in?" and someone says, "academic medicine because I want to teach".

Maybe at your institution. I got to know all my attendings, even non-surgical ones that knew I had no interest in their field. And that's all I was saying. Obviously, if you never work with a student you can't be expected to remember them. Which is a different situation than DV had brought up, in my opinion.

And sure, maybe I dont know what clinical medicine or the wards are. I'm just a M4 done with subIs. Maybe I'll learn what it is at some point during residency. But I didnt have attendings that ignored me, and they all learned my name, and for the most part they all tried to teach somehow. It's always been a good culture that I've been in and what you and DV describe sounds like an incredibly ****ty environment to learn in.
 
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Maybe at your institution. I got to know all my attendings, even non-surgical ones that knew I had no interest in their field. And that's all I was saying. Obviously, if you never work with a student you can't be expected to remember them. Which is a different situation than DV had brought up, in my opinion.

And sure, maybe I dont know what clinical medicine or the wards are. I'm just a M4 done with subIs. Maybe I'll learn what it is at some point during residency. But I didnt have attendings that ignored me, and they all learned my name, and for the most part they all tried to teach somehow. It's always been a good culture that I've been in and what you and DV describe sounds like an incredibly ****ty environment to learn in.

I'm saying that those ****ty attendings, if they exists, are such a minuscule fraction of the preceptor population, it is a far better guess that the issue is with the student, not the attending if they complain about being penalized for being proactive. My faculty were fantastic. They sure as **** knew my name if it mattered. When it didn't, they didn't.
 
I'm saying that those ****ty attendings, if they exists, are such a minuscule fraction of the preceptor population, it is a far better guess that the issue is with the student, not the attending if they complain about being penalized for being proactive. My faculty were fantastic. They sure as **** knew my name if it mattered. When it didn't, they didn't.

*shrug* I agree with all that.
 
I'm saying that those ****ty attendings, if they exists, are such a minuscule fraction of the preceptor population, it is a far better guess that the issue is with the student, not the attending if they complain about being penalized for being proactive. My faculty were fantastic. They sure as **** knew my name if it mattered. When it didn't, they didn't.
It never hurt me if they didn't remember my name. I don't even know how you can when you have so many students rotating multiple times. But when they remember me and talk to me, it's nice.
I was surprised when the neurosurgeon remembered me and bringing up the joke about "vessel of kaustikos". Or, anytime they hit a vein that bled.
In the end: I've had few attendings that didn't involve students in one way or another. You just need to show some interest so they feel ok letting you do things/educating you. Yes, you might not get to do as much as you want, but get over it.
I've had times where residents apologized when they didn't let me close but I always respond "please... You do this way faster and better. I don't need to do something all the time."
 
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