Things I Hate About Third Year

[D elegans]

Yeah there's a lot of nonproductive time during 3rd year. One thing that took me a long time to get used to is studying during these downtimes. It's really hard to do when you're used to sitting in a library with hours for focus. If you take the scattered periods of time you get to flip through a review book or do some UWorld questions on your phone, it does add up.

Some people say they study so much less during third year. While I think that there is generally less to study, you have so much more time in the hospital/clinic that you still have to fit in some study time during the evenings if you want to do well on shelf exams. I found that I had to manage my time even more effectively during third year and definitely had much less free time than I did during the first two years. It's only going to be worse during residency so I think unfortunately it's just something you might as well get used to early.

---

Members don't see this ad.

 

[Psai]

Starting clinicals in July is the worst because you take a backseat to the new interns. The learning I've gotten is basically trickle-down from the learnings the interns get. Which I'm fine with because it's Ob/Gyn, but I can imagine the frustration if it's something you wanted to do.

So far, my experience has been that 3rd year is like 20% learning, 80% wasted time. I can write notes which no one really reads/uses. I get some decent feedback on them, but the interns need practice writing notes so seniors pay attention to them more (which is completely understandable). Most of the time, I'm just watching an intern or senior write a note and reading up on random **** that I come across. I don't really get to manage a patient, mostly because managing a patient in labor is the most boring thing ever. Is her Pitocin on? okay, wait 4 more hours and see if she's made any change. Anything complicated obviously gets bumped to the interns/residents.

I feel like I could have gotten the same education working 3-4 hours a day instead of 12-14 hours a day. Probably even better because then I would actually have had time to read.

So true my resident only looked at my note when I asked him to. He said "good note, you put this part of the physical in neuro when it should be msk though". My attending looked at my h&p only because my resident didn't write one up for my patient yet. All he said was "it was a good note". Not sure if it's actually a good note or not since they didn't say much else.
I always feel uncomfortable when I'm trying to read on my downtime because it seems like my classmates are doing stuff like calling people for records or writing super long notes while I'm just going through uworld.

 

[DermViser]

Starting clinicals in July is the worst because you take a backseat to the new interns. The learning I've gotten is basically trickle-down from the learnings the interns get. Which I'm fine with because it's Ob/Gyn, but I can imagine the frustration if it's something you wanted to do.

So far, my experience has been that 3rd year is like 20% learning, 80% wasted time. I can write notes which no one really reads/uses. I get some decent feedback on them, but the interns need practice writing notes so seniors pay attention to them more (which is completely understandable). Most of the time, I'm just watching an intern or senior write a note and reading up on random **** that I come across. I don't really get to manage a patient, mostly because managing a patient in labor is the most boring thing ever. Is her Pitocin on? okay, wait 4 more hours and see if she's made any change. Anything complicated obviously gets bumped to the interns/residents.

I feel like I could have gotten the same education working 3-4 hours a day instead of 12-14 hours a day. Probably even better because then I would actually have had time to read.

Welcome to third year (and depending on specialty - medicine in general)!!

 

[operaman]

Don't let your perception of third year be soiled by an early OB-GYN rotation. Your other rotations will likely be much better. Just keep writing your notes and manage your own patients and ask GOOD questions about the differences between your plan and the actual plan. Read like a fiend. Prepare well for the OR. Show interest and try to find things worth learning even if you don't plan to do OB (or whatever rotation it is). See as many patients as you can.

I feel like I was very fortunate because my first resident on my first rotation (surg) was amazing and really engaged with students, let us present and always asked questions about our plans and would teach about post-op management issues. I didn't realize just how good I had it until later on in the year; hopefully you'll have some experiences like that to balance out the others.

 

[DermViser]

Don't let your perception of third year be soiled by an early OB-GYN rotation. Your other rotations will likely be much better. Just keep writing your notes and manage your own patients and ask GOOD questions about the differences between your plan and the actual plan. Read like a fiend. Prepare well for the OR. Show interest and try to find things worth learning even if you don't plan to do OB (or whatever rotation it is). See as many patients as you can.

I feel like I was very fortunate because my first resident on my first rotation (surg) was amazing and really engaged with students, let us present and always asked questions about our plans and would teach about post-op management issues. I didn't realize just how good I had it until later on in the year; hopefully you'll have some experiences like that to balance out the others.

I think someone who only took 2 weeks to study for Step 1, will likely have different views much different than the rest of us on how MS-3 really is like.

 

[ExpatmeStat]

So true my resident only looked at my note when I asked him to. He said "good note, you put this part of the physical in neuro when it should be msk though". My attending looked at my h&p only because my resident didn't write one up for my patient yet. All he said was "it was a good note". Not sure if it's actually a good note or not since they didn't say much else.
I always feel uncomfortable when I'm trying to read on my downtime because it seems like my classmates are doing stuff like calling people for records or writing super long notes while I'm just going through uworld.[/QUOTE

I doubt the attending cared/was surprised.

 

[KnuxNole]

Starting clinicals in July is the worst because you take a backseat to the new interns. The learning I've gotten is basically trickle-down from the learnings the interns get. Which I'm fine with because it's Ob/Gyn, but I can imagine the frustration if it's something you wanted to do.

So far, my experience has been that 3rd year is like 20% learning, 80% wasted time. I can write notes which no one really reads/uses. I get some decent feedback on them, but the interns need practice writing notes so seniors pay attention to them more (which is completely understandable). Most of the time, I'm just watching an intern or senior write a note and reading up on random **** that I come across. I don't really get to manage a patient, mostly because managing a patient in labor is the most boring thing ever. Is her Pitocin on? okay, wait 4 more hours and see if she's made any change. Anything complicated obviously gets bumped to the interns/residents.

I feel like I could have gotten the same education working 3-4 hours a day instead of 12-14 hours a day. Probably even better because then I would actually have had time to read.

True, which is why I feel rotations should be shorter for students. Especially cause as we know, students don't really manage patients, and honestly, there are lots of times where students stand around where they can easily go study and find better use of their time, which is small as it is. Hell, there are times where the residents would be pissed that students where there and questioned why we were still here at noon....one girl boasts how she always snuck out of her rotations. Yes, med students LEARN about management of disease, which is important. And practicing to present and write daily notes. It sucks that some notes don't get read. I read the student's notes, because I think it's important for someone to look at it. Sadly, that's not always the case....

 

[KnuxNole]

So true my resident only looked at my note when I asked him to. He said "good note, you put this part of the physical in neuro when it should be msk though". My attending looked at my h&p only because my resident didn't write one up for my patient yet. All he said was "it was a good note". Not sure if it's actually a good note or not since they didn't say much else.
I always feel uncomfortable when I'm trying to read on my downtime because it seems like my classmates are doing stuff like calling people for records or writing super long notes while I'm just going through uworld.

Those classmates aren't learning anything. You are.

Reading is important. I would fail every shelf if I didn't read or do questions. After all, when you see a small subset in your rotation, it doesn't do much. if it wasn't for an exam, I would never read, haha

 

[DermViser]

Those classmates aren't learning anything. You are.

Reading is important. I would fail every shelf if I didn't read or do questions. After all, when you see a small subset in your rotation, it doesn't do much. if it wasn't for an exam, I would never read, haha

Which can be gamed bc when a lot of your grade relies on the shelf, then you won't care as much to do well on the rotation.

 

[KnuxNole]

Which can be gamed bc when a lot of your grade relies on the shelf, then you won't care as much to do well on the rotation.

Exactly.

"No, OB-GYN/Surgery attending, I am not interested in doing a vaginal exam/rectal on the lady/man who has a BMI of 60. Or waking up during call night and snoozing in the call room. Oh, gonna get a pass? That's ok, I'll just ace the shelf ".

If everyone needed all honors to get into residency, we all would be PAs in Missouri....

 

[DermViser]

Exactly.

"No, OB-GYN/Surgery attending, I am not interested in doing a vaginal exam/rectal on the lady/man who has a BMI of 60. Or waking up during call night and snoozing in the call room. Oh, gonna get a pass? That's ok, I'll just ace the shelf ".

If everyone needed all honors to get into residency, we all would be PAs in Missouri....

Pretty much. There are many SDN posts of people who just got a High Pass bc of their shelf score on a rotation, but the moment on the next clerkship they released the pedal on how hard they tried on the wards and instead focused more on the shelf - they got Honors. High Pass is the new Pass.

 

[KnuxNole]

Pretty much. There are many SDN posts of people who just got a High Pass bc of their shelf score on a rotation, but the moment on the next clerkship they released the pedal on how hard they tried on the wards and instead focused more on the shelf - they got Honors. High Pass is the new Pass.

People who think like that need some shots of tequila. Chillax, it's med school, geeeeez. It's like the people who go ballistic over being better than the class mean but not in the "Top 10/20%".

 

[DermViser]

People who think like that need some shots of tequila. Chillax, it's med school, geeeeez. It's like the people who go ballistic over being better than the class mean but not in the "Top 10/20%".

I agree. Althought it's easier said once you're past it and you're a resident. The comparison game will drive you nuts. I guess some people thrive on it, though.

 

[D elegans]

At my place you have to be given honors by the clinical faculty AND get > 90th%tile on the shelf to get Honors. Eventually I just accepted that wasn't gonna happen

 

[ExpatmeStat]

At my place you have to be given honors by the clinical faculty AND get > 90th%tile on the shelf to get Honors. Eventually I just accepted that wasn't gonna happen

I'm all for pushing yourself, but I think your school will get diminishing returns with that policy. Medical school is tough!

 

[DermViser]

At my place you have to be given honors by the clinical faculty AND get > 90th%tile on the shelf to get Honors. Eventually I just accepted that wasn't gonna happen

That sucks. At my school, the shelf helped if the average of all your evaluations were HPs, which unless you're ridiculously unprofessional, didn't do your work, etc. you got at least an HP.

 

[Dave89]

Residents who seem to have forgotten what 3rd year is like. Just in case you've forgotten: we actually have shelf exams to study for.

 

[Psai]

Today an anesthesia attending gave me **** for politely asking to try to do an iv. Something about knowing my place as a student and that the patients are anxious before surgery so don't try to put the iv in until after they are asleep

Oh wait you need an iv to put them to sleep and the cases where you need a second iv are complicated so let's just have the resident or attending put the iv in.

Love the stories about people putting in epidurals and a lines as med students when I've had almost no opportunities to put in ivs or intubate

 

[courtnes]

Today an anesthesia attending gave me **** for politely asking to try to do an iv. Something about knowing my place as a student and that the patients are anxious before surgery so don't try to put the iv in until after they are asleep

Oh wait you need an iv to put them to sleep and the cases where you need a second iv are complicated so let's just have the resident or attending put the iv in.

Love the stories about people putting in epidurals and a lines as med students when I've had almost no opportunities to put in ivs or intubate

Sad, but true. This is one of the reasons it's hard to get to know anesthesia as a med student. Any attending should let you try to get an IV the first time, but honestly some of them are jumpier than others.

I was able to do tons of IVs and intubations as a student, but unfortunately no lines or blocks. One of my classmates lucked into a spinal, but that was it.

 

[DermViser]

Today an anesthesia attending gave me **** for politely asking to try to do an iv. Something about knowing my place as a student and that the patients are anxious before surgery so don't try to put the iv in until after they are asleep

Oh wait you need an iv to put them to sleep and the cases where you need a second iv are complicated so let's just have the resident or attending put the iv in.

Love the stories about people putting in epidurals and a lines as med students when I've had almost no opportunities to put in ivs or intubate

Highly depends on institution, the comfortableness of your resident/attending, the malpractice environment, etc. If you have this face:

they'll probably say no.

 

[boogaloo]

Today an anesthesia attending gave me **** for politely asking to try to do an iv. Something about knowing my place as a student and that the patients are anxious before surgery so don't try to put the iv in until after they are asleep

Oh wait you need an iv to put them to sleep and the cases where you need a second iv are complicated so let's just have the resident or attending put the iv in.

Love the stories about people putting in epidurals and a lines as med students when I've had almost no opportunities to put in ivs or intubate

I've run into attendings who were too scared to let me do anything, and it does suck. They suck. Eventually, I found someone who expected me to do everything from day one. Everything. Pre-op, induction, intubation, extubation, PACU, and everything in between except charting/orders. He just stood back and threw in suggestions if I was messing something up or forgetting to do something. Worked with him as much as possible, did a lot (probably more than what I should have been "allowed" to do), messed up a lot, and learned a lot. Even the O.R. staff and the PACU nurses came around and started being nice to me, probably because they all love him. I've had the ultimate experience as a fourth year, but I definitely ran into a few duds in the process.

Oh wait, this is a thread about third year. Carry on.

 

[SouthernSurgeon]

I've run into attendings who were too scared to let me do anything, and it does suck. They suck. Eventually, I found someone who expected me to do everything from day one. Everything. Pre-op, induction, intubation, extubation, PACU, and everything in between except charting/orders. He just stood back and threw in suggestions if I was messing something up or forgetting to do something. Worked with him as much as possible, did a lot (probably more than what I should have been "allowed" to do), messed up a lot, and learned a lot. Even the O.R. staff and the PACU nurses came around and started being nice to me, probably because they all love him. I've had the ultimate experience as a fourth year, but I definitely ran into a few duds in the process.

Oh wait, this is a thread about third year. Carry on.

So much of it depends on the people, and experiences are so varied.

I will always remember my trauma rotation as an M3. I had the most awesome team of residents. They let me do everything. I placed central lines, floated PA catheters, placed a-lines, sutured lacs, placed a chest tube, bronched, placed a PEG, reduced a shoulder dislocation, reduced and casted fractures with the ortho on call resident.

I also got to do the primary/secondary survey at the bedside in the ED on level 1 traumas a few times because we were sometimes so busy we'd have two traumas going at once.

But I will say, on the flip side, I also wrote more discharge summaries and progress notes than I could count. Part of the reason I got to do so much was that I did everything possible to offload work on the team and they appreciated that.

 

[DermViser]

I also got to do the primary/secondary survey at the bedside in the ED on level 1 traumas a few times because we were sometimes so busy we'd have two traumas going at once.

Your experience reminds me so much of this: http://www.kevinmd.com/blog/2013/10/good-medical-student-good-doctor.html

 

[TooMuchResearch]

Today an anesthesia attending gave me **** for politely asking to try to do an iv. Something about knowing my place as a student and that the patients are anxious before surgery so don't try to put the iv in until after they are asleep

Oh wait you need an iv to put them to sleep and the cases where you need a second iv are complicated so let's just have the resident or attending put the iv in.

Love the stories about people putting in epidurals and a lines as med students when I've had almost no opportunities to put in ivs or intubate

Was there anything about this patient where you would want to go out of your way to save them the discomfort of an extra attempt if you didn't get it right away?

Don't ask the anesthesiologist. Ask the CRNA or anesthesiology resident. And ask assertively.

 

[mimelim]

So much of it depends on the people, and experiences are so varied.

I will always remember my trauma rotation as an M3. I had the most awesome team of residents. They let me do everything. I placed central lines, floated PA catheters, placed a-lines, sutured lacs, placed a chest tube, bronched, placed a PEG, reduced a shoulder dislocation, reduced and casted fractures with the ortho on call resident.

I also got to do the primary/secondary survey at the bedside in the ED on level 1 traumas a few times because we were sometimes so busy we'd have two traumas going at once.

But I will say, on the flip side, I also wrote more discharge summaries and progress notes than I could count. Part of the reason I got to do so much was that I did everything possible to offload work on the team and they appreciated that.

+1, trauma is fantastic at a busy level 1 center for medical students.

 

[DermViser]

+1, trauma is fantastic at a busy level 1 center for medical students.

I have to give surgeons major props for resisting the urge to scream out loud or cry when 2 traumas are happening at the same time. The exhaustion afterwards and still having to function is immense.

 

[SouthernSurgeon]

I have to give surgeons major props for resisting the urge to scream out loud or cry when 2 traumas are happening at the same time. The exhaustion afterwards and still having to function is immense.

Nah, I love it.

 

[DermViser]

Nah, I love it.

Like I said, it truly takes a special type of person. Most people's nerves would be completely shot esp. w/2 traumas coming in at once. I still remember that experience and the surgery resident having to put in a chest tube and having to dig his finger deep between the guys ribs in order to accommodate putting in a chest tube.

 

[alpinism]

Today an anesthesia attending gave me **** for politely asking to try to do an iv. Something about knowing my place as a student and that the patients are anxious before surgery so don't try to put the iv in until after they are asleep

Oh wait you need an iv to put them to sleep and the cases where you need a second iv are complicated so let's just have the resident or attending put the iv in.

Love the stories about people putting in epidurals and a lines as med students when I've had almost no opportunities to put in ivs or intubate

Im sorry but this is absolute horse ****.

There's no reason why a 3rd year doctor of medicine student shouldn't be able to practice doing IVs during an anesthesia rotation. Now, I could understand if the patient was critical, had really crappy veins, or they were pressed for time. Fine. Let the resident or attending take care of it and wait for the next patient. But, if it was a routine surgical case that required a simple peripheral IV for medication access, then there's no excuse.

The whole malpractice argument is garbage. Im assuming you're at a teaching hospital. If thats the case, its their job to provide hands on training to med students and residents, not provide shadowing opportunities. Considering the fact that EMT and nursing students with a high school education can practice IVs on patients, your attending is FOS. If anything, he needs to learn his place and do his job which is teaching anesthesia. If he's too lazy or incompetent to do that then he shouldn't be in academic medicine.

If you're not getting at least a couple opportunities to do IVs/tubes every shift I'd seriously consider sending an email to the clerkship director or dean of students expressing your concerns.

/rant

 

[Kahreek]

that moment when the laparoscopic grasper tooth breaks off <3

 

[Psai]

Thanks guys. We're not allowed to do discharge summaries and our notes don't count. In fact, the interns have to write their own notes even if we write one because ours don't count for billing. So our notes go unread and unevaluated a majority of the time. In the meanwhile, the administration is patting themselves on the back for finally getting medical students access to the EMR. We even have these lovely separate templates that are dumbed down for us. So writing notes causes even more work for the residents, not less and it's a waste of time for the medical students.

Oh also the whole bull**** with marking down which patients and procedures we've done in e-value so that we can give the impression of having done stuff in clerkship even if we haven't just to satisfy LCME requirements. Instead of wasting our time with marking down what patients we saw, why not put some thought into providing educational rotations? Give actual opportunities to do things instead of shoving a list in our hands and saying "complete these" even if the residents and attendings don't give us a chance to do things.

 

[KnuxNole]

That's the case for most hospitals in terms of notes.

 

[Raryn]

Thanks guys. We're not allowed to do discharge summaries and our notes don't count. In fact, the interns have to write their own notes even if we write one because ours don't count for billing. So our notes go unread and unevaluated a majority of the time. In the meanwhile, the administration is patting themselves on the back for finally getting medical students access to the EMR. We even have these lovely separate templates that are dumbed down for us. So writing notes causes even more work for the residents, not less and it's a waste of time for the medical students.

Oh also the whole bull**** with marking down which patients and procedures we've done in e-value so that we can give the impression of having done stuff in clerkship even if we haven't just to satisfy LCME requirements. Instead of wasting our time with marking down what patients we saw, why not put some thought into providing educational rotations? Give actual opportunities to do things instead of shoving a list in our hands and saying "complete these" even if the residents and attendings don't give us a chance to do things.

The notes thing is a legal requirement for billing. The only thing that a resident/attending can legally use from a medical student note is the past medical hx, family hx, social hx, ROS. Everything else must be documented separately by an actual physician. Are there some residents that straight out copy/paste the med students notes? Yes. But it really isn't kosher.

 

[DermViser]

The notes thing is a legal requirement for billing. The only thing that a resident/attending can legally use from a medical student note is the past medical hx, family hx, social hx, ROS. Everything else must be documented separately by an actual physician. Are there some residents that straight out copy/paste the med students notes? Yes. But it really isn't kosher.

So then no one should be surprised if the intern/resident doesn't care about the med student note, bc doing so slows them down.

 

[Psai]

I'm not surprised or saying I don't understand. Just listing the things I hate about third year

 

[SouthernSurgeon]

The way my med schools' EMR worked was really nice because you could work on a draft note and then forward the draft to the resident and they could finish it and submit it. And by "finish" it I mean hit submit.

And for discharge summaries, the narrative portion of the clinical course was always something that could be edited and saved by any member of the team (since you never knew exactly when someone would get discharged and don't want to save that whole thing for day of discharge for complex patients) - so the students could always work on that.

 

[DermViser]

I'm not surprised or saying I don't understand. Just listing the things I hate about third year

That was more directed at Raryn. Not you specifically.

 

[cloudysh]

Attendings making fun of my chosen specialty

If you don't want students to diplomatically lie about their future career of choice, don't **** all over the specialty that I just told you I wanted to dedicate my life to.

Shouldn't you be glad there's someone else willing/eager to do something that you hate so much?

This experience makes me very sad.

 

[Fatalis]

Starting clinicals in July is the worst because you take a backseat to the new interns. The learning I've gotten is basically trickle-down from the learnings the interns get. Which I'm fine with because it's Ob/Gyn, but I can imagine the frustration if it's something you wanted to do.

So far, my experience has been that 3rd year is like 20% learning, 80% wasted time. I can write notes which no one really reads/uses. I get some decent feedback on them, but the interns need practice writing notes so seniors pay attention to them more (which is completely understandable). Most of the time, I'm just watching an intern or senior write a note and reading up on random **** that I come across. I don't really get to manage a patient, mostly because managing a patient in labor is the most boring thing ever. Is her Pitocin on? okay, wait 4 more hours and see if she's made any change. Anything complicated obviously gets bumped to the interns/residents.

I feel like I could have gotten the same education working 3-4 hours a day instead of 12-14 hours a day. Probably even better because then I would actually have had time to read.

Doing OB/GYN now and ya this is pretty much it! Then again this is my last core rotation, I honestly tried to care during this rotation but the residents are so nasty to each other and to us, sometimes it is really unbearable!

 

[atomi]

Guys, let me give you some advice for your third year. First, do not disrespect the interns. We see this all the time, the interns ask the med students to help them with something and they either question the order with the upper level or flat out ignore it. Your job as a med student is to learn how to function as an intern. Unfortunately med students have this arrogant tendency to regard most of what interns do as scut. Interns are the workhorses of the team. Yes, the higher level decisions occur at the attending and resident level, but the interns make everything happen. It's irritating when med students want to participate in the discussion with the attending, but don't want to lift a finger to make things happen. This is not scut, this is patient care. This is learning how to function on a medical team and communicate with other providers. We had a group of med students recently whose apparent only interest was trying to impress the attending on rounds. Any mistakes that happened were blamed on the intern during the med students' presentation "I don't have any labs to report because somebody didn't order them." Here's a free piece of advice, NEVER call out a resident or intern in front of the attending to try and make yourself look better. We all cringe when this happens. After rounds, their goal was to get out of the hospital asap. At first they would say something along the lines of "is there anything else I can help you with" around 2 pm after helping the team with nothing. When we asked them to do something, they would either sigh and do a half assed job at what we asked or just not do it. eventually they started saying "I finished my work, I'll see you tomorrow" OK, we notice this.

You can complain all you want about your notes "not mattering," but they do. This is not "work." Work is what the interns and residents do. You are here to LEARN. To learn how to write notes, to learn how to run the list and take care of daily tasks. You are learning to be an intern. When we provide you with feedback on your notes,do not make excuses. We notice when you don't write notes, we notice when you do a crappy job on them because you think they don't matter, we notice when you copy and paste portions or even all of our notes (yes I had a med student that just copied and pasted my entire note). We notice when you avoid picking up new patients, we notice when you only want to to carry the patients who are dispso issues without active medical problems, we notice when you try to leave early. We notice when you dont do a single H&P the entire block. How can you learn to be an intern if you actively avoid everything they do? You even avoid enrichment activites we try to provide for you. If you are asked if you want to see an operation on one of your patients who is going to the OR today, don't say "maybe, if I can finish my notes beforehand" then try to leave early before it even starts.

Guys, it is really so easy to get a good evaluation from your residents and interns. All you have to do is show up, have a good attitude, be enthusiatic, act like you care about you patients, and always be ready and willing to do anything that's asked. THAT'S IT! I don't give two $$×&#$ whether or not you can get the attending's pimp questions right on rounds. You can answer virtually everything wrong, but if you actually try hard, you will get a good evaluation. Remember, the interns and residents write your evaluations too, and their comments can be used verbatim in your dean's letter.

 

[Uafl112]

Time for a little vent thread, for my sanity. Feel free to add your own....

1) Putting 4 hours of work into a 12 hour day. No, I don't want to watch you write notes. No, I don't want to listen to you talk on the phone to your girlfriend. No, I don't want to type you a 349th practice H&P that doesn't count. If we're done here, let me go home. If this were the corporate world, this stuff would never be acceptable.

2) Classmates who would sell their mother to make themselves look good/ make you look bad. Dude, that's my patient. The attending asked for a procedure to be done and you saw me leave the room to get my supplies. Running out of the room after me, past me, and grabbing the supplies before I can get there and doing the procedure on my patient isn't cool. This isn't a contest. Well, it may be the biggest d-bag contest.... Congrats, you won.

3) Residents or Attendings who have me pick up a patient.... after they have already seen them, examined them, and ordered everything. Nothing says "I'm a little poser" like walking into a room and saying to that patient, "Hi ma'am, I'm the medical student working with Dr. X. Tell me about what's going on today". Patient: "Uh, I already saw the doctor". Me: "Yeah.... he wants me to play doctor with you, see my cool short white coat!!"

4) Attendings with rules designed to put you in your place. Example: I am not allowed to sit down when they are sitting talking to the patient. 30 minute office visit, three stools in the room. But when they are in there, I am to stand - no sitting, no leaning on the counter. Stand at attention.

Some days I feel like third year is going to suck the life out of me. Sometimes I miss corporate America. Wow, never thought I'd say that.

Feel free to add your own.... a good vent feels good!

#3 sounds so strange to me. When shadowing a Neurologist, he told me to sit down every single chance I got. Thats how he lived his life and he recommended I do the same.

 

[calvnandhobbs68]

Guys, let me give you some advice for your third year. First, do not disrespect the interns. We see this all the time, the interns ask the med students to help them with something and they either question the order with the upper level or flat out ignore it. Your job as a med student is to learn how to function as an intern. Unfortunately med students have this arrogant tendency to regard most of what interns do as scut. Interns are the workhorses of the team. Yes, the higher level decisions occur at the attending and resident level, but the interns make everything happen. It's irritating when med students want to participate in the discussion with the attending, but don't want to lift a finger to make things happen. This is not scut, this is patient care. This is learning how to function on a medical team and communicate with other providers. We had a group of med students recently whose apparent only interest was trying to impress the attending on rounds. Any mistakes that happened were blamed on the intern during the med students' presentation "I don't have any labs to report because somebody didn't order them." Here's a free piece of advice, NEVER call out a resident or intern in front of the attending to try and make yourself look better. We all cringe when this happens. After rounds, their goal was to get out of the hospital asap. At first they would say something along the lines of "is there anything else I can help you with" around 2 pm after helping the team with nothing. When we asked them to do something, they would either sigh and do a half assed job at what we asked or just not do it. eventually they started saying "I finished my work, I'll see you tomorrow" OK, we notice this.

You can complain all you want about your notes "not mattering," but they do. This is not "work." Work is what the interns and residents do. You are here to LEARN. To learn how to write notes, to learn how to run the list and take care of daily tasks. You are learning to be an intern. When we provide you with feedback on your notes,do not make excuses. We notice when you don't write notes, we notice when you do a crappy job on them because you think they don't matter, we notice when you copy and paste portions or even all of our notes (yes I had a med student that just copied and pasted my entire note). We notice when you avoid picking up new patients, we notice when you only want to to carry the patients who are dispso issues without active medical problems, we notice when you try to leave early. We notice when you dont do a single H&P the entire block. How can you learn to be an intern if you actively avoid everything they do? You even avoid enrichment activites we try to provide for you. If you are asked if you want to see an operation on one of your patients who is going to the OR today, don't say "maybe, if I can finish my notes beforehand" then try to leave early before it even starts.

Guys, it is really so easy to get a good evaluation from your residents and interns. All you have to do is show up, have a good attitude, be enthusiatic, act like you care about you patients, and always be ready and willing to do anything that's asked. THAT'S IT! I don't give two $$×&#$ whether or not you can get the attending's pimp questions right on rounds. You can answer virtually everything wrong, but if you actually try hard, you will get a good evaluation. Remember, the interns and residents write your evaluations too, and their comments can be used verbatim in your dean's letter.

As for the last paragraph...meh this is institution and even rotation dependent. There are some places where only the attending evals count towards your actual final grade. I've known plenty of attendings who obviously never ask the residents how you've been doing either and just give you the old straight high pass across the board.

Now the students you're talking about do sound terrible, but it is pretty stressful for the average student trying to figure out what you're going to get pimped on next so you can get a "honors" eval from the attending while doing everything else you're talking about. Should third years ideally be trying to learn how to act as an intern? Definitely. However, learning how to act as an intern and actually getting honors in the d*mn rotation don't always line up neatly.

 

[atomi]

As for the last paragraph...meh this is institution and even rotation dependent. There are some places where only the attending evals count towards your actual final grade. I've known plenty of attendings who obviously never ask the residents how you've been doing either and just give you the old straight high pass across the board.

Now the students you're talking about do sound terrible, but it is pretty stressful for the average student trying to figure out what you're going to get pimped on next so you can get a "honors" eval from the attending while doing everything else you're talking about. Should third years ideally be trying to learn how to act as an intern? Definitely. However, learning how to act as an intern and actually getting honors in the d*mn rotation don't always line up neatly.

At my med school and residency program, the intern and resident comments are used verbatim in your dean's letter.
Also, most attendings won't ding you for missing pimp questions. They do this to help you learn, not test you. They WILL ding you if they watch you throw the intern under the bus on rounds, see that you are not picking up new patients, or learn that you are skipping out on patient care duties the team has asked you to help with. You get your honors by acing the shelf. You get your good dean's letter comments by not acting like an ass to your team. Getting pimp questions right will not get you honors. But acting like you are above the "scut" work we do and generally being an arrogant know it all will get you some pretty damning remarks that you might have to explain on residency interviews. Like I said, it's so easy to get strong evaluations.

 

[calvnandhobbs68]

At my med school and residency program, the intern and resident comments are used verbatim in your dean's letter.
Also, most attendings won't ding you for missing pimp questions. They do this to help you learn, not test you. They WILL ding you if they watch you throw the intern under the bus on rounds, see that you are not picking up new patients, or learn that you are skipping out on patient care duties the team has asked you to help with. You get your honors by acing the shelf. You get your good dean's letter comments by not acting like an ass to your team. Getting pimp questions right will not get you honors. But acting like you are above the "scut" work we do and generally being an arrogant know it all will get you some pretty damning remarks that you might have to explain on residency interviews. Like I said, it's so easy to get strong evaluations.

Sure, like I said those students you're talking about sound pretty terrible. You can't make overarching statements like "most attendings won't ding you for missing pimp questions though". Surgery, pretty much the only interaction you get with attendings is in the OR answering pimp questions and retracting all day. Plentyyy of "needs to improve fund of knowledge" with straight pass/high passes have been caused by missing pimp questions in the OR. You also can't just say "it's so easy to get strong evaluations" when plenty of people on here would beg to differ. Sure, maybe with you on your team and that's great and thanks for being a resident who actually cares about what your med students do, but that's not necessarily true for plenty of other third years across the country.

 

[TooMuchResearch]

Sure, like I said those students you're talking about sound pretty terrible. You can't make overarching statements like "most attendings won't ding you for missing pimp questions though". Surgery, pretty much the only interaction you get with attendings is in the OR answering pimp questions and retracting all day. Plentyyy of "needs to improve fund of knowledge" with straight pass/high passes have been caused by missing pimp questions in the OR. You also can't just say "it's so easy to get strong evaluations" when plenty of people on here would beg to differ. Sure, maybe with you on your team and that's great and thanks for being a resident who actually cares about what your med students do, but that's not necessarily true for plenty of other third years across the country.

I am once again reminded how lucky I was that most of my OR pimping was on classic rock and 80s music.

 

[JimmyB123]

I am once again reminded how lucky I was that most of my OR pimping was on classic rock and 80s music.

That would be as hard for me

 

[Ismet]

Guys, let me give you some advice for your third year. First, do not disrespect the interns. We see this all the time, the interns ask the med students to help them with something and they either question the order with the upper level or flat out ignore it. Your job as a med student is to learn how to function as an intern. Unfortunately med students have this arrogant tendency to regard most of what interns do as scut. Interns are the workhorses of the team. Yes, the higher level decisions occur at the attending and resident level, but the interns make everything happen. It's irritating when med students want to participate in the discussion with the attending, but don't want to lift a finger to make things happen. This is not scut, this is patient care. This is learning how to function on a medical team and communicate with other providers. We had a group of med students recently whose apparent only interest was trying to impress the attending on rounds. Any mistakes that happened were blamed on the intern during the med students' presentation "I don't have any labs to report because somebody didn't order them." Here's a free piece of advice, NEVER call out a resident or intern in front of the attending to try and make yourself look better. We all cringe when this happens. After rounds, their goal was to get out of the hospital asap. At first they would say something along the lines of "is there anything else I can help you with" around 2 pm after helping the team with nothing. When we asked them to do something, they would either sigh and do a half assed job at what we asked or just not do it. eventually they started saying "I finished my work, I'll see you tomorrow" OK, we notice this.

You can complain all you want about your notes "not mattering," but they do. This is not "work." Work is what the interns and residents do. You are here to LEARN. To learn how to write notes, to learn how to run the list and take care of daily tasks. You are learning to be an intern. When we provide you with feedback on your notes,do not make excuses. We notice when you don't write notes, we notice when you do a crappy job on them because you think they don't matter, we notice when you copy and paste portions or even all of our notes (yes I had a med student that just copied and pasted my entire note). We notice when you avoid picking up new patients, we notice when you only want to to carry the patients who are dispso issues without active medical problems, we notice when you try to leave early. We notice when you dont do a single H&P the entire block. How can you learn to be an intern if you actively avoid everything they do? You even avoid enrichment activites we try to provide for you. If you are asked if you want to see an operation on one of your patients who is going to the OR today, don't say "maybe, if I can finish my notes beforehand" then try to leave early before it even starts.

Guys, it is really so easy to get a good evaluation from your residents and interns. All you have to do is show up, have a good attitude, be enthusiatic, act like you care about you patients, and always be ready and willing to do anything that's asked. THAT'S IT! I don't give two $$×&#$ whether or not you can get the attending's pimp questions right on rounds. You can answer virtually everything wrong, but if you actually try hard, you will get a good evaluation. Remember, the interns and residents write your evaluations too, and their comments can be used verbatim in your dean's letter.

One of the best pieces of advice I got for succeeding on 3rd year rotations is to make the interns' and residents' lives easier. Don't be a slug and don't make life harder for them. Especially on inpatient rotations, if you truly take ownership of your patients (daily notes, putting in orders, following up on labs/imaging, calling consults, writing a discharge summary, working on med rec and discharge papers), that's 2-3 fewer patients that they have to be closely following. They of course still follow the patient and have to put in their own notes, co-sign your orders, etc but their workload for those patients is greatly reduced. You're learning a ton and helping out at the same time. Happiness is an intern who gets to leave on time because you already wrote the discharge summary of a patient who was admitted for 3 months.

Of course the attending also evaluates you, but I've found that by doing the above (as well as reading up on stuff and presenting on rounds), the attending evaluations were always similar to the resident evaluations. Attendings see your notes and you bet that the team talks about you and how you're doing. A lot of the attending eval comes from resident/intern input and how you work with the team.

 

[Ismet]

Attendings making fun of my chosen specialty

If you don't want students to diplomatically lie about their future career of choice, don't **** all over the specialty that I just told you I wanted to dedicate my life to.

Shouldn't you be glad there's someone else willing/eager to do something that you hate so much?

This experience makes me very sad.

Maybe I have a thick skin but this wouldn't bother me a bit.

I've had multiple people tell me I should go into surgery over the last 3 weeks and try to talk me out of my chosen specialty. Honestly I love working with my hands and the technical aspect of surgery, but that's the extent of my desire to do surgery. If you're confident in your choice, you shouldn't let whatever they say about it phase you.

 

[username456789]

Maybe I have a thick skin but this wouldn't bother me a bit.

I've had multiple people tell me I should go into surgery over the last 3 weeks and try to talk me out of my chosen specialty. Honestly I love working with my hands and the technical aspect of surgery, but that's the extent of my desire to do surgery. If you're confident in your choice, you shouldn't let whatever they say about it phase you.

Misery loves company.

 

[235009]

Of course the attending also evaluates you, but I've found that by doing the above (as well as reading up on stuff and presenting on rounds), the attending evaluations were always similar to the resident evaluations. Attendings see your notes and you bet that the team talks about you and how you're doing. A lot of the attending eval comes from resident/intern input and how you work with the team.

Every attending I've had as a resident has asked me for my opinion of the med students and you bet my opinions affected his/hers and vice versa. As an intern I would complain to my resident if a med student wasn't pulling their weight, being disrespectful or just sucked and as a resident I take those kind of comments from my interns very seriously. I would also make it a point to tell the attending when I was an intern to give honors to med students who were particularly fantastic.