Scutwork

[fuzzyerin]

So I'm giving a talk in March on Scutwork and I'm interested to hear some current medical student opinions. So my basic questions:

What tasks do you consider scutwork?

Who do you think should be responsible for doing the task? Who usually does it?

Can it ever be educational?

Thanks...I'm interested to see what the current opinions are!

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[OveractiveBrain]

So I'm giving a talk in March on Scutwork and I'm interested to hear some current medical student opinions. So my basic questions:

What tasks do you consider scutwork?

Who do you think should be responsible for doing the task? Who usually does it?

Can it ever be educational?

Thanks...I'm interested to see what the current opinions are!

"Scutwork" I personally define as the things a medical student CAN do so I can do the things i MUST do. Note dropping, Order Dropping, Scheduling Appointments, calling pharmacies, doing orthostatics (nursing always does them wrong).

Worse residents will give out what I call "slave work." Get me coffee, write my note, etc.

 

[justaregularmed]

Any task done without educational value or direct patient care(benefit?), scut.

 

[Substance]

Scut is degrading work normally done by a paid hospital employee instead thrust upon the medical student because the medical student has no grounds for appeal and can fail if he does not comply.

Examples: running blood to the lab, calling pharmacies and booking appointments, taking ward vitals, doing ward IVs, setting up ward ECGs, retraction in the OR, wheeling patients around.

Fetching coffee and personal affects etc. is not scut as much as it is a form of abuse.

 

[Guillemot]

Though I am familiar with this term "scut work", in my country we call this thing "handjob." For two reason we call this "handjob": it require the use of hand and not head, it is work that justly will be performed by the hired hand.

I have found the orthopedic surgeon in particular to give out many "handjob."

 

[Bacchus]

You should search for the "What Does Your School Do To Protect You from Scutwork" thread.

 

[DrDrToBe]

Scut is degrading work normally done by a paid hospital employee instead thrust upon the medical student because the medical student has no grounds for appeal and can fail if he does not comply.

Examples: running blood to the lab, calling pharmacies and booking appointments, taking ward vitals, doing ward IVs, setting up ward ECGs, retraction in the OR, wheeling patients around.

Fetching coffee and personal affects etc. is not scut as much as it is a form of abuse.

Your examples of scut work are interesting. Those are all things I did quite happily and didn't at all consider scut, because it meant I learned how to do them. Plus, I liked having even the tiny bit of responsibility to get in early, get the vitals on all my patients, call the labs if results weren't back etc. Retraction in the OR wasn't in itself a learning experience, but it made me feel like a part of the team; most of the times I could see what was going and ask questions at appropriate times. On my medicine rotation, I frequently saw my interns running blood to the lab to make things go faster; since this was something I could help with, I saw no problem in offering to do it.

Edit: Personal example of scut: one of my interns was constantly asking me to photocopy crap for her, even when I was in the middle of notes or other stuff for my patients. That was scut: zero learning value for me, not helping any of the patients on the team, and solely for the benefit of the intern.

 

[splik]

Though I am familiar with this term "scut work", in my country we call this thing "handjob." For two reason we call this "handjob": it require the use of hand and not head, it is work that justly will be performed by the hired hand.

I have found the orthopedic surgeon in particular to give out many "handjob."

 

[Dirt]

Anything that involves faxing.

 

[K31]

I have found the orthopedic surgeon in particular to give out many "handjob."

I know it's only January 2nd, but I'd like to nominate this for quote of the year.

 

[ZagDoc]

Scut is degrading work normally done by a paid hospital employee instead thrust upon the medical student because the medical student has no grounds for appeal and can fail if he does not comply.

Examples: running blood to the lab, calling pharmacies and booking appointments, taking ward vitals, doing ward IVs, setting up ward ECGs, retraction in the OR, wheeling patients around.

Funny, those are all things I've had to do as a resident.

 

[KeyzerSoze]

Funny, those are all things I've had to do as a resident.

Not really taking sides here, but did you miss the phrase "normally done by a paid hospital employee" in the post you quoted?

 

[ZagDoc]

Not really taking sides here, but did you miss the phrase "normally done by a paid hospital employee" in the post you quoted?

No, but I took that as implying "some minimum wage hospital employee, not me, medical student/doctor"

I've wheeled many a patient I'm worried about down to radiology because it's the fastest way to get their STAT CT or down to the OR for an emergent case that no one else except us seems to act is all that emergent. When I had a patient in respiratory distress in the middle of the night and was deciding whether the wake the ICU fellow to transfer the patient, the only way I was getting a blood gas was if I drew it myself. Same goes for that IV that craps out in the middle of the night in a patient with MRSA bacteremia - you don't skip a dose of Vanc and wait for phlebotomy to come in, you either put the IV in or you track down someone you can. When a patient doesn't quite look right and you think they're septic, you don't trust the last blood pressure in the computer, you take your own blood pressure. Every patient I discharge or operate on, I'm the one who calls to arrange follow-up. Every outside call I take at night, I'm the one calling the pharmacy to get the patient the scrip.

Maybe I'm way disconnected from some people's view on medical education, but for me, those things are about patient care. The patient is getting better care because of your efforts.

 

[Skinceutical]

Maybe I'm way disconnected from some people's view on medical education, but for me, those things are about patient care. The patient is getting better care because of your efforts.

I completely agree. I've never asked a medical student to do a task that I wouldn't do myself (and often do end up doing myself).

I made a similar point in a different thread, pointing out that even these seemingly menial tasks are part of providing patient care. A number of med students told me that they didn't really see patient care as their responsibility, and that they were only there to "learn."

 

[McGillGrad]

No, but I took that as implying "some minimum wage hospital employee, not me, medical student/doctor"

I've wheeled many a patient I'm worried about down to radiology because it's the fastest way to get their STAT CT or down to the OR for an emergent case that no one else except us seems to act is all that emergent. When I had a patient in respiratory distress in the middle of the night and was deciding whether the wake the ICU fellow to transfer the patient, the only way I was getting a blood gas was if I drew it myself. Same goes for that IV that craps out in the middle of the night in a patient with MRSA bacteremia - you don't skip a dose of Vanc and wait for phlebotomy to come in, you either put the IV in or you track down someone you can. When a patient doesn't quite look right and you think they're septic, you don't trust the last blood pressure in the computer, you take your own blood pressure. Every patient I discharge or operate on, I'm the one who calls to arrange follow-up. Every outside call I take at night, I'm the one calling the pharmacy to get the patient the scrip.

Maybe I'm way disconnected from some people's view on medical education, but for me, those things are about patient care. The patient is getting better care because of your efforts.

 

[KnuxNole]

Not really taking sides here, but did you miss the phrase "normally done by a paid hospital employee" in the post you quoted?

this.

Med students are not workers, they have no job or real responsibility. Sure they interview patients and present and become involved in learning about what doctors do during the specialty, but the resident's JOB is to take care of patients while med students are here to just learn. That's why med students take hour lunch breaks and sit around and study. Cause like several attendings say "Med students pay us to be here, so you guys dont stress yourselfs out, leave by 5, take lunch at 12, etc." while for residents, they will get eaten alive if they leave early and such. It's not like med students work even close to 80 hrs >_>

 

[Skinceutical]

Med students are not workers, they have no job or real responsibility. Sure they interview patients and present and become involved in learning about what doctors do during the specialty, but the resident's JOB is to take care of patients while med students are here to just learn. That's why med students take hour lunch breaks and sit around and study. Cause like several attendings say "Med students pay us to be here, so you guys dont stress yourselfs out, leave by 5, take lunch at 12, etc." while for residents, they will get eaten alive if they leave early and such. It's not like med students work even close to 80 hrs >_>

The med student you're describing has done the bare minimum necessary to justify their presence on the team. If he/she did any less work, they'd be no different from a high school student or premed shadowing the team.

He or she deserves to pass the rotation with very average evaluations that reflect upon their mediocre and unremarkable performance.

 

[KnuxNole]

But plenty of med students I know have done this(and are considered to be good students) and gotten Honors. You don't have to be a gunner or suck up in 3rd year lol

Besides, not all rotations are like IM where you have a team you work with. Others, you observe the clinics, deliveries, surgeries, etc. It kinda reminds me of a momma duck and ducklings following along, taking notes as the momma goes around patients, etc. Then again, not all rotations have residents you have to follow with too..some sections you work 1on1 with an attending and observe or they let you interview/present and that determines your grade. I guess same goes with the wards, your grade mainly depends on if they like your presence, if you present well, etc. But different schools are different, I guess. It seems some really expect a student to be like one of the staff, like if there is danger they demand a 3rd year to save the day..

 

[Skinceutical]

Cause like several attendings say "Med students pay us to be here, so you guys dont stress yourselfs out, leave by 5, take lunch at 12, etc." while for residents, they will get eaten alive if they leave early and such. It's not like med students work even close to 80 hrs

When I was an MS3 on my general surgery rotation, our course director flat out told us that while interns and residents had ACGME mandated work hours, med students did not. That meant that we should expect to be in the hospital for more than 30 hrs when we were on call and that we would likely be working more than 80 hrs/week.

But plenty of med students I know have done this(and are considered to be good students) and gotten Honors. You don't have to be a gunner or suck up in 3rd year lol

Plenty of med students also lie about their grades. Plenty of them also have a laid-back personality and aren't gunners, but are still team players who take some degree of responsibility for patient care and help out quite a bit (these tend to be the med students residents like the most).

 

[Substance]

No, but I took that as implying "some minimum wage hospital employee, not me, medical student/doctor"

I've wheeled many a patient I'm worried about down to radiology because it's the fastest way to get their STAT CT or down to the OR for an emergent case that no one else except us seems to act is all that emergent. When I had a patient in respiratory distress in the middle of the night and was deciding whether the wake the ICU fellow to transfer the patient, the only way I was getting a blood gas was if I drew it myself. Same goes for that IV that craps out in the middle of the night in a patient with MRSA bacteremia - you don't skip a dose of Vanc and wait for phlebotomy to come in, you either put the IV in or you track down someone you can. When a patient doesn't quite look right and you think they're septic, you don't trust the last blood pressure in the computer, you take your own blood pressure. Every patient I discharge or operate on, I'm the one who calls to arrange follow-up. Every outside call I take at night, I'm the one calling the pharmacy to get the patient the scrip.

Maybe I'm way disconnected from some people's view on medical education, but for me, those things are about patient care. The patient is getting better care because of your efforts.

Those things are wonderful examples of true patient care. Of course, those things are also individual examples. I have done all of those things too, and if a medical student wanted to take initiative and involve himself in those, then that's just wonderful!

What I was describing involves more regular duties that are often done by paid hospital employees. Early morning vitals that nurses are supposed to take, patients getting wheeled around for non STAT reasons because the porters are being lazy, fetching charts from archives because of a clerical error, calling the family doc to book an appointment for a patient because the ward clerk is being a bitch...those things are scut, plain and simple. The real lesson in these tasks is not learning how to do them but learning how to effectively delegate those responsibilities to the ancillary staff so they get done when you want them done. It's learning how to be a manager.

Another thing I hate about ward medicine is the whole concept of "team". The patient is the one with the disease. The "team" is there to serve the patient. The student is there, not to serve the team, but to learn medicine so that their future patients can be served. Wasting time running around doing scut takes up moments that could be better served reading or doing another admit.

 

[KnuxNole]

When I was an MS3 on my general surgery rotation, our course director flat out told us that while interns and residents had ACGME mandated work hours, med students did not. That meant that we should expect to be in the hospital for more than 30 hrs when we were on call and that we would likely be working more than 80 hrs/week.


Plenty of med students also lie about their grades. Plenty of them also have a laid-back personality and aren't gunners, but are still team players who take some degree of responsibility for patient care and help out quite a bit (these tend to be the med students residents like the most).

Damn that sucks though(referring to the first statement)! You would probably have to bring a book with you, cause being there for so long...there's only so much you can do after taking care of all the tasks. And small talk with classmates/residents might not last, especially on call days where people are too tired

 

[Skinceutical]

What I was describing involves more regular duties that are often done by paid hospital employees. Early morning vitals that nurses are supposed to take, patients getting wheeled around for non STAT reasons because the porters are being lazy, fetching charts from archives because of a clerical error, calling the family doc to book an appointment for a patient because the ward clerk is being a bitch...those things are scut, plain and simple. The real lesson in these tasks is not learning how to do them but learning how to effectively delegate those responsibilities to the ancillary staff so they get done when you want them done. It's learning how to be a manager.

Agreed. Those tasks (with the exception of calling for f/u appointments) are not the responsibility of residents at all but the crappiest hospitals, and should be delegated to the appropriate ancillary staff, not med students.

Damn that sucks though(referring to the first statement)! You would probably have to bring a book with you, cause being there for so long...there's only so much you can do after taking care of all the tasks. And small talk with classmates/residents might not last, especially on call days where people are too tired

What down time? That was general surgery - I remember entire days when I didn't even have time to eat anything more than a protein bar or two.

 

[KnuxNole]

Agreed. Those tasks (with the exception of calling for f/u appointments) are not the responsibility of residents at all but the crappiest hospitals, and should be delegated to the appropriate ancillary staff, not med students.


What down time? That was general surgery - I remember entire days when I didn't even have time to eat anything more than a protein bar or two.

There was down time on my surgery rotation, where I ended up reading in the student's library when everything was done or waiting for a surgery case to start. And had lunches for around 30 mins(the general rule for all my rotations was 30 mins unless someone says an hour for lunch, cause then I feel bad staying. Unless I'm with other students, then I follow what they do)

I guess that sucks though about that experience, only having a protein bar to eat...that sounds like what the residents have to go through, not the students, who go away for lunch break every day

 

[SouthernSurgeon]

this.

Med students are not workers, they have no job or real responsibility. Sure they interview patients and present and become involved in learning about what doctors do during the specialty, but the resident's JOB is to take care of patients while med students are here to just learn. That's why med students take hour lunch breaks and sit around and study. Cause like several attendings say "Med students pay us to be here, so you guys dont stress yourselfs out, leave by 5, take lunch at 12, etc." while for residents, they will get eaten alive if they leave early and such. It's not like med students work even close to 80 hrs >_>

Right...except somehow you have to LEARN how to do that job. If someone needs a stat IV in the middle of the night and you've never put one in before, you're certainly not going to get it on the first try.

And if you haven't figured out how to effectively handle the "paperwork" side of medicine as a student, you're going to struggle as an intern.

It's all a balance. Certainly there are extremes in which a student is truly being abused and asked to do true "scut" - but I've found that too often students balk at anything which requires effort...even if it would (a) benefit the patient and (b) help them be a better intern in the future.

Another thing I hate about ward medicine is the whole concept of "team". The patient is the one with the disease. The "team" is there to serve the patient. The student is there, not to serve the team, but to learn medicine so that their future patients can be served. Wasting time running around doing scut takes up moments that could be better served reading or doing another admit.

The student is a part of the team. Learning how to function efficiently within the team dynamic is just as important as your reading.

 

[RySerr21]

this.

Med students are not workers, they have no job or real responsibility. Sure they interview patients and present and become involved in learning about what doctors do during the specialty, but the resident's JOB is to take care of patients while med students are here to just learn. That's why med students take hour lunch breaks and sit around and study. Cause like several attendings say "Med students pay us to be here, so you guys dont stress yourselfs out, leave by 5, take lunch at 12, etc." while for residents, they will get eaten alive if they leave early and such. It's not like med students work even close to 80 hrs >_>

edit: is that smiley thing at the end supposed to mean the previous comment was sarcastic?

 

[KnuxNole]

edit: is that smiley thing at the end supposed to mean the previous comment was sarcastic?

no it was kinda like "It would be silly for that to happen"

But it seems it does happen in some schools which must suck

 

[Skinceutical]

no it was kinda like "It would be silly for that to happen"

But it seems it does happen in some schools which must suck

I don't think it sucked. I actually think it was good preparation for intern year, when those tasks unequivocally become your responsibility.

Starting residency is a huge adjustment for everyone, but personally I think it must really suck for people who had such fluffy clinical exposure during med school.

 

[DrDrToBe]

For my gen surg rotation, I am pretty sure I was at the hospital close to 80 hrs, and no it didn't suck. Brutally tiring yes, but I got some of the greatest teaching after that 6 pm sign out. Of course, if nothing was going on I went home, but when that acute appy comes in at 6, and the day intern signs out, that's when I got to first assist. When the day intern is gone, the R2 let's you help with that central line. If you help out with those ABG's, your intern has some time to sit with you and explain the pathophys of sepsis or something else going on with your pt. furthermore, I think it would suck to finish med school and never get to do these things, and have to do it for the first time as an intern.

 

[RySerr21]

no it was kinda like "It would be silly for that to happen"

But it seems it does happen in some schools which must suck

dude i was consistently in the 90s for OB and medicine. I wouldnt be surprised if i had broken 100 at some point. Im sure it will be similar for surgery too.

 

[KnuxNole]

seriously? even for medicine...? what were your hours that it added up in the 90s?

At first, when I read your post, I thought it meant your shelf scores were consistently in the 90s. Why? I dunno

 

[RySerr21]

seriously? even for medicine...? what were your hours that it added up in the 90s?

At first, when I read your post, I thought it meant your shelf scores were consistently in the 90s. Why? I dunno

haha, i wish.

The week was broken in to no call day, early day, long call, super long call.

you get there at 630am regardless of the day cuz thats when sign out is. If its an early day, you admit til 2pm . If it was a long day you admit til 8pm. If its a super long day you admit til 9pm. So on a super long call day your minimum shift was 14 and a half hours.

The problem was that the system was terrible, they are transitioning to EMR and it doesnt help that the EMR is also terrible. So those times didn't actually mean anything. On early days we would get out at around 8pm (even tho you stop admitting at 2pm, you dont actually get to see any of the admits before then because you are rounding, at morning report, lunch report, etc so you dont even start to see your admits til after 2pm). On long and super long days we would get out at 10 pm, 11pm, 12am at the latest depending on when your last admit was. The no call days I always had off (my one day a week) because that was the day our senior had off, so I admitted every day i was at the hospital. Needless to say, it was a miserable time. They have sense changed the system b/c there were so many complaints from the residents and studenty. apparently it has improved altho i doubt its within the 80 hour restrictions.

 

[Depakote]

PGY-1 here... read as 6 months into residency, but only 6 months removed from having been in the student's shoes.

Honestly, most patient related tasks don't qualify as scut in my book... I see it as my job to prepare you for residency, that means if it's part of my job, it's fair game for a student. Will I make a student fill out every discharge form and hand write the d/c prescriptions? No, but they should know how to do it. IV starts? That's good practice. I wish I did more as a student and actually had some proficiency coming into residency. Running stat labs/ABGs to the lab. Again, patient care... and I'll be happy to discuss the reasoning for the tests and the results of those tests with you. If I'm having you scribe orders on rounds, it's not b/c I cant do it myself, I want you to learn how to write orders so when you have to write that first dose of tylenol all by yourself on July 1st, you know what you're doing.

As mentioned above, there's more to being a resident than just knowing the pathophys of xyz and passing your shelf.

 

[ZagDoc]

this.

Med students are not workers, they have no job or real responsibility. Sure they interview patients and present and become involved in learning about what doctors do during the specialty, but the resident's JOB is to take care of patients while med students are here to just learn. That's why med students take hour lunch breaks and sit around and study. Cause like several attendings say "Med students pay us to be here, so you guys dont stress yourselfs out, leave by 5, take lunch at 12, etc." while for residents, they will get eaten alive if they leave early and such. It's not like med students work even close to 80 hrs >_>

See, I think this is the disconnect I'm talking about. That is certainly one way to look at the clinical years - that you are there to learn "medicine", nothing more, nothing less. But I also see the clinical years as learning how to be a resident. And you learn that by doing the things residents do, which involved taking ownership of your patients and participating in patient care. That was the expectation at my med school, it may be different at others. It certainly seems to be different where I'm at for residency. Med students are no longer allowed to help with the list in the AM, do dressing changes, pull drains, etc because students complained these things were "scut" and not "educational". My comeback would be: well, if you aren't doing to changes dressings on surgical wounds, don't expect to sew in the OR. And it doesn't just have to be from your specialty of choice. I've drawn on my experiences from all my rotations, from medicine to peds to anesthesia to ICU to FM, as a surgical resident.

Those things are wonderful examples of true patient care. Of course, those things are also individual examples. I have done all of those things too, and if a medical student wanted to take initiative and involve himself in those, then that's just wonderful!

What I was describing involves more regular duties that are often done by paid hospital employees. Early morning vitals that nurses are supposed to take, patients getting wheeled around for non STAT reasons because the porters are being lazy, fetching charts from archives because of a clerical error, calling the family doc to book an appointment for a patient because the ward clerk is being a bitch...those things are scut, plain and simple. The real lesson in these tasks is not learning how to do them but learning how to effectively delegate those responsibilities to the ancillary staff so they get done when you want them done. It's learning how to be a manager.

Another thing I hate about ward medicine is the whole concept of "team". The patient is the one with the disease. The "team" is there to serve the patient. The student is there, not to serve the team, but to learn medicine so that their future patients can be served. Wasting time running around doing scut takes up moments that could be better served reading or doing another admit.

Agreed. There is a line between "menial" and "helpful" tasks. Where to draw that line? I don't know. But like I said above, I see an MS3/MS4 as much more than someone who "shadows" what I do, who stands around and thinks all day, but rather someone who is supposed to be learning what I do. Medicine is more than just a cognitive exercise, there are skills that have to be learned and developed, and completely removing the student from those patient care things to give them more time to "think" and "study" seems to be a disservice to students all around.

 

[justaregularmed]

PGY-1 here... read as 6 months into residency, but only 6 months removed from having been in the student's shoes.

Honestly, most patient related tasks don't qualify as scut in my book... I see it as my job to prepare you for residency, that means if it's part of my job, it's fair game for a student. Will I make a student fill out every discharge form and hand write the d/c prescriptions? No, but they should know how to do it. IV starts? That's good practice. I wish I did more as a student and actually had some proficiency coming into residency. Running stat labs/ABGs to the lab. Again, patient care... and I'll be happy to discuss the reasoning for the tests and the results of those tests with you. If I'm having you scribe orders on rounds, it's not b/c I cant do it myself, I want you to learn how to write orders so when you have to write that first dose of tylenol all by yourself on July 1st, you know what you're doing.

As mentioned above, there's more to being a resident than just knowing the pathophys of xyz and passing your shelf.

Would be happy to work with you, someone who gets it.

 

[da8s0859q]

Would be happy to work with you, someone who gets it.

My thoughts exactly. Beats the hell out of this "you better do it or else" bull**** from people who forgot they were medical students too.

Depakote, how was your adjustment to residency as a CA-0? I remember seeing the current interns come in last July and wondering what it was like in their shoes.

 

[SLUser11]

Though I am familiar with this term "scut work", in my country we call this thing "handjob." For two reason we call this "handjob": it require the use of hand and not head, it is work that justly will be performed by the hired hand.

I have found the orthopedic surgeon in particular to give out many "handjob."

Where we are from, residents respect students who volunteer for extra work, and this often leads to better evaluations.....so you need to be asking your residents for extra handjobs. Some of the male residents will be resistant, but this is usually because they don't want to create extra work for you, so you'll have to ask them repeatedly before they will comply.

Right...except somehow you have to LEARN how to do that job. If someone needs a stat IV in the middle of the night and you've never put one in before, you're certainly not going to get it on the first try.

And if you haven't figured out how to effectively handle the "paperwork" side of medicine as a student, you're going to struggle as an intern.

It's all a balance. Certainly there are extremes in which a student is truly being abused and asked to do true "scut" - but I've found that too often students balk at anything which requires effort...even if it would (a) benefit the patient and (b) help them be a better intern in the future.



The student is a part of the team. Learning how to function efficiently within the team dynamic is just as important as your reading.

Nice post from SouthernIM. To the students: having played on SDN for many years, I promise that your concept of scutwork will change as you mature in your training. Also, at this point, you're not really in a position to know which activities are truly menial, and which ones contain educational value.

The only thing I'll say, which I've said before and is a quote from a SLU Neurologist, is that It's not scutwork until it's old hat. If you've never done something (e.g. Foley placement, IVs, patient transport, paperwork), then you're not above it. Overly-entitled med students become crappy residents.

 

[Substance]

The only thing I'll say, which I've said before and is a quote from a SLU Neurologist, is that It's not scutwork until it's old hat. If you've never done something (e.g. Foley placement, IVs, patient transport, paperwork), then you're not above it. Overly-entitled med students become crappy residents.

You're only part right. Just as "scut" can't be generalized, "not-scut" can't be generalized.


Foleys and IVs are not scut unless the ancillary staff responsible for them want the med student to do it so they don't have to work. Then it is scut.

Patient transport, unless STAT, is scut.

Paperwork that requires a physician's signature is not scut. Charting is not scut. Orders are not scut. Discharge meds are not scut. Dictations are not scut.

Talking to patients or their families is certainly never scut.

Calling pharmacies for med lists and physicians for appointment booking is scut. Get the ward clerk to book the appointments and have the med lists faxed over.

Running blood to the lab and forms to radiology, unless STAT, is scut.

Taking routine ward vitals is scut. That's nursing work. STAT vitals where the responsible ancillary staff is unavailable is not scut. Taking vitals because you don't trust the nurse's vitals is not scut.

Placing the leads during a routine ECG is scut. In a STAT situation where the ancillary staff responsible is unavailable, then it is not scut.

Bed placement issues is scut. If a patient needs to be moved to a ward and there are space issues, then those issues can be worked out by the nurses and bed managers of those units. The physician should have no part in those negotiations aside from their order that patient x needs to go to floor y.



A rule that I tend to follow is: "If I refuse to do it, a med student shouldn't have to do it either."


I think it is important to teach med students that some duties are for the ancillary staff, and to give them the confidence to delegate those duties to such staff. It's a lot better than just having them bend over and take it in the anus. Last I checked, physicians don't have that bright a future ahead of them, and I think our castration-style training is partly responsible.

 

[Substance]

dbl post. delete pls kthx

 

[Skinceutical]

My thoughts exactly. Beats the hell out of this "you better do it or else" bull**** from people who forgot they were medical students too.

I think most residents are more than happy to explain why we do things a certain way, and teach medical students who demonstrate some enthusiasm for learning. My issue is with students who come in with a lackadaisical attitude, assuming that they have no responsibilities for actual patient care because there's also a intern/resident following all of their patients. If it's a patient care task that I have to do every day, then you need to learn how to do it too, and you shouldn't feel like you're above it.

In any case, I'm just glad I'm not a medicine intern anymore. At least the med students we get in derm are enthusiastic about the field, to the point where I've actually had to stop some of them from legitimately scutting themselves out.

 

[turkeyjerky]

you're only part right. Just as "scut" can't be generalized, "not-scut" can't be generalized.


Foleys and ivs are not scut unless the ancillary staff responsible for them want the med student to do it so they don't have to work. Then it is scut.

Patient transport, unless stat, is scut.

Paperwork that requires a physician's signature is not scut. Charting is not scut. Orders are not scut. Discharge meds are not scut. Dictations are not scut.

Talking to patients or their families is certainly never scut.

Calling pharmacies for med lists and physicians for appointment booking is scut. Get the ward clerk to book the appointments and have the med lists faxed over.

Running blood to the lab and forms to radiology, unless stat, is scut.

Taking routine ward vitals is scut. That's nursing work. Stat vitals where the responsible ancillary staff is unavailable is not scut. Taking vitals because you don't trust the nurse's vitals is not scut.

Placing the leads during a routine ecg is scut. In a stat situation where the ancillary staff responsible is unavailable, then it is not scut.

Bed placement issues is scut. If a patient needs to be moved to a ward and there are space issues, then those issues can be worked out by the nurses and bed managers of those units. The physician should have no part in those negotiations aside from their order that patient x needs to go to floor y.



A rule that i tend to follow is: "if i refuse to do it, a med student shouldn't have to do it either."


i think it is important to teach med students that some duties are for the ancillary staff, and to give them the confidence to delegate those duties to such staff. It's a lot better than just having them bend over and take it in the anus. Last i checked, physicians don't have that bright a future ahead of them, and i think our castration-style training is partly responsible.

qft

 

[fuzzyerin]

Thanks everyone for the candid replies so far!

I was wondering if you think it makes a difference based on the type / location of the hospital. For example, academic university hospital versus community hospital, city hospital versus suburban hospital, public versus private.

I know I personally trained in NYC as a med student and felt the nurses most frequent response to doing tasks (that I considered nursing tasks) was "that's not my job." I was never very clear on what exactly their job was...because of this, we did everything. We drew blood, got vitals, transported patients, and I even remember having to go down to the cafeteria to get my patient a lunch tray. But I did my residency in a suburban university hospital where nurses did pretty much all of that - you just put orders in for those things. But you still had to write prescriptions, do discharge summaries, dictate...

I'll tell you, one of the biggest "scut" of attending life is dealing with insurance companies preauthorization, denial of claims on top of all of the disability and other type forms that patients come in with regularly and don't understand why you can't do it THIS*VERY*SECOND.

 

[unicornssong]

Thanks everyone for the candid replies so far!

I was wondering if you think it makes a difference based on the type / location of the hospital. For example, academic university hospital versus community hospital, city hospital versus suburban hospital, public versus private.

In my limited opinion, yes. I finished a rotation with a cardiac surgeon and i'm rotating in a mandatory inpatient family practice department. The difference is astounding. The staff there was top notch - pleasant, polite, professional - never heard "not my job". I learned an incredible amount there. I think in my 4 weeks at cardiothoraic, I can count the amount of scutwork I did on my left hand.

Contrast that to this state run family practice department - let's see. I have yet to see a patient. I've done nothing but what I consider scut - photocopying, appointment bookings, fetching lab results and echos. My resident outright told another resident while i was standing next to her "If you have anything annoying to do, just give it to the medical student". The outpatient clinicals all over the hospital know me by name and voice because I call so often. When I ask questions during rounds or try to report on patients, I'm brushed off. Oh and last time I showed up at the "mandatory lectures" for medical students, the residents told me to get out because there weren't enough spots for us. hmmmmmmm.

But I think I speak for most students when I say most of us don't mind scutwork - down to fetching your lunch - as long as it's balanced out by an equal amount of teaching and learning.

 

[SLUser11]

Contrast that to this state run family practice department - let's see. I have yet to see a patient. I've done nothing but what I consider scut - photocopying, appointment bookings, fetching lab results and echos. My resident outright told another resident while i was standing next to her "If you have anything annoying to do, just give it to the medical student". The outpatient clinicals all over the hospital know me by name and voice because I call so often. When I ask questions during rounds or try to report on patients, I'm brushed off. Oh and last time I showed up at the "mandatory lectures" for medical students, the residents told me to get out because there weren't enough spots for us. hmmmmmmm.

That sounds like an absolutely horrible rotation. That is a situation where reporting your experiences to the clerkship director might actually be a good idea. If you can't get what you need from a place, then something has to change.

 

[dozitgetchahi]

PGY-1 here... read as 6 months into residency, but only 6 months removed from having been in the student's shoes.

Honestly, most patient related tasks don't qualify as scut in my book... I see it as my job to prepare you for residency, that means if it's part of my job, it's fair game for a student. Will I make a student fill out every discharge form and hand write the d/c prescriptions? No, but they should know how to do it. IV starts? That's good practice. I wish I did more as a student and actually had some proficiency coming into residency. Running stat labs/ABGs to the lab. Again, patient care... and I'll be happy to discuss the reasoning for the tests and the results of those tests with you. If I'm having you scribe orders on rounds, it's not b/c I cant do it myself, I want you to learn how to write orders so when you have to write that first dose of tylenol all by yourself on July 1st, you know what you're doing.

As mentioned above, there's more to being a resident than just knowing the pathophys of xyz and passing your shelf.

God, I wish I had you as a resident/intern.

My 3rd year IM rotation is over and I've never done discharge paperwork/prescriptions, started an IV less than a handful of times, scribed orders perhaps three times, and maybe done a single admit. Aside from the above, I've written a bunch of notes and pulled a few EJs/midlines/PICC lines.

Why? Well, the interns are extremely reluctant to let students do most of this stuff because "they're signing the paperwork and it's their ass on the line". If I manage to get with certain residents, then I get to do stuff...but it doesn't happen often enough IMHO.

And this was just the 2nd half of the IM rotation - the first half I was at a hospital where the attending wouldn't let students touch pts or do anything whatsoever - no H&Ps, no notes, no nothing. Why? "Liability". The douche basically did the same to the resident we had, and thus the rotation was completely and totally useless for everyone involved.

I'd love to be doing almost any of the "scutwork" discussed in this thread because then I'd feel like I was contributing rather than just reading and/or being bored out of my mind most of the time.

 

[Dirt]

Why? Well, the interns are extremely reluctant to let students do most of this stuff because "they're signing the paperwork and it's their ass on the line".

Maybe they should just read the damn notes?

I was actually at a place like that as a fourth year.

The M3s were not having a good educational experience at all. I suggested that they pick a patient and write notes every day even if they didn't go into the chart. I even offered to read them and let them know what I thought. Two of them thanked me, one of them told me he was glad he didn't have to do anything cause he could sleep later and focus on acing the shelf. Needless to say he was an idiot.

 

[turkeyjerky]

Maybe they should just read the damn notes?

I was actually at a place like that as a fourth year.

The M3s were not having a good educational experience at all. I suggested that they pick a patient and write notes every day even if they didn't go into the chart. I even offered to read them and let them know what I thought. Two of them thanked me, one of them told me he was glad he didn't have to do anything cause he could sleep later and focus on acing the shelf. Needless to say he was an idiot.

Wait, he was an idiot cause he didn't want to do pointless busywork and have someone six months ahead of him in training (w/ no power over him whatsoever) give him feedback on it? Not sure if serious...


The educational value of writing notes is vastly overrated, imho.

 

[Dirt]

Wait, he was an idiot cause he didn't want to do pointless busywork and have someone six months ahead of him in training (w/ no power over him whatsoever) give him feedback on it? Not sure if serious...


The educational value of writing notes is vastly overrated, imho.

Dead serious.

He was an idiot because like you apparently he thought of seeing patients and writing progress notes as pointless busywork.

 

[turkeyjerky]

Dead serious.

He was an idiot because like you apparently he thought of seeing patients and writing progress notes as pointless busywork.

Interesting theory. I especially like the thoughtless extrapolation. I have a high suspicion that you're gonna be one of those malignant basterd residents who make people hate third year.

 

[Dirt]

Interesting theory. I especially like the thoughtless extrapolation. I have a high suspicion that you're gonna be one of those malignant basterd residents who make people hate third year.

Because I overheard M3s on their first rotation ever complaining that they aren't even getting to write progress notes, suggested they just write them on their own, and even offered to read them?

You may be right though if making M3s write progress notes and see patients makes them hate third year...

 

[turkeyjerky]

No, because you are calling someone an idiot because he wasn't grateful to you for suggesting he do meaningless busywork.