Things I Hate About Third Year

[Kaustikos]

Misery loves company.

More like we enjoy making jokes about each specialist. Had a session in radiology with a few other classmates and it involved all the jokes you hear about our respective specialities.
Had an IM, rads, ortho and surgeon with radiologist.
The jokes were hilarious

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[BurghStudent]

Is there anything you can do to make your time more efficient? It seems like there's a lot of time wasting, like doctoring on speed, in 3rd year. It would suck to have to crack open a book for the first time after your shift is over at 7pm.

 

[grt398]

Is there anything you can do to make your time more efficient? It seems like there's a lot of time wasting, like doctoring on speed, in 3rd year. It would suck to have to crack open a book for the first time after your shift is over at 7pm.

Depends heavily on the residents, less so the rotation oddly enough. If you're lucky you can study in downtime while people write notes etc. If you're not lucky, you'll be told (or just have it show up in your evaluation) that studying during down time makes you seem like you're not interested in the rotation and you need to make an effort to get more involved. Doesn't matter if there's nothing going on...there are residents who just want you to sit there watching them type; I have no idea why but I've seen it multiple times now. I've definitely had both and the latter makes for an unpleasant rotation.

 

[Nasrudin]

I related a lot to atomi's post and wish that it were the case. I was the type of clerk who have been heavily rewarded on such an intern-->resident-->attending reporting system.

But that's just too far from normative to be realistic advice. Shelf exams are no joke and you can't work like an intern and do well on them. Also the random musings of my attendings were often what passed for evaluation. And contrary to attending mythology most of that was subjective nonsense that amounted to if the guy liked the way I dressed, had enough knowledge of his preferred musical genre, answered a few snappy questions on rounds, and whatever likeness I had to him or her. And that's your grade.

Well separated from all that. And earning a paycheck for actual designated responsibilities by my attending so that s/he doesn't have to do everything is another universe of evaluative process. We're hunting the same game. If I help us eat tonight then my worth is measurably felt. Very little of it is the song and dance nonsense of being a clerk.

The clerk's job isn't just to learn how to be an intern. It should be. But it isn't.

 

[tiedyeddog]

It would suck to have to crack open a book for the first time after your shift is over at 7pm.

There will be many days and entire rotations like that.

Take into consideration that as a resident you are also expected to learn once leaving work.

 

[PL198]

I related a lot to atomi's post and wish that it were the case. I was the type of clerk who have been heavily rewarded on such an intern-->resident-->attending reporting system.

But that's just too far from normative to be realistic advice. Shelf exams are no joke and you can't work like an intern and do well on them. Also the random musings of my attendings were often what passed for evaluation. And contrary to attending mythology most of that was subjective nonsense that amounted to if the guy liked the way I dressed, had enough knowledge of his preferred musical genre, answered a few snappy questions on rounds, and whatever likeness I had to him or her. And that's your grade.

Well separated from all that. And earning a paycheck for actual designated responsibilities by my attending so that s/he doesn't have to do everything is another universe of evaluative process. We're hunting the same game. If I help us eat tonight then my worth is measurably felt. Very little of it is the song and dance nonsense of being a clerk.

The clerk's job isn't just to learn how to be an intern. It should be. But it isn't.

this sounds way more like real world to me.

 

[alpinism]

I related a lot to atomi's post and wish that it were the case. I was the type of clerk who have been heavily rewarded on such an intern-->resident-->attending reporting system.

But that's just too far from normative to be realistic advice. Shelf exams are no joke and you can't work like an intern and do well on them. Also the random musings of my attendings were often what passed for evaluation. And contrary to attending mythology most of that was subjective nonsense that amounted to if the guy liked the way I dressed, had enough knowledge of his preferred musical genre, answered a few snappy questions on rounds, and whatever likeness I had to him or her. And that's your grade.

Well separated from all that. And earning a paycheck for actual designated responsibilities by my attending so that s/he doesn't have to do everything is another universe of evaluative process. We're hunting the same game. If I help us eat tonight then my worth is measurably felt. Very little of it is the song and dance nonsense of being a clerk.

The clerk's job isn't just to learn how to be an intern. It should be. But it isn't.

Agreed. I had a similar experience during M3.

Some rotations I'd put in extra effort to help the interns get work done (H&Ps, DC summaries, making phone calls, answering pages, getting consent, etc..). Often times I'd even stay late or come back after afternoon lectures. The thing is, I'd end up with essentially the same clinical grade and evaluation comments as the students who spent their down time studying and left as early as possible. When it came to the final clerkship grade, the only thing that really mattered was the shelf exam. And, surprise, surprise, the people who studied instead of doing "intern level" work usually got higher scores. Many classmates had the same experience after taking to them and this was by far the most common complaint about 3rd year.

In a perfect world atomi would be right. However, many residents are just too overworked to notice or just don't care. Not to mention on many rotations I'd work with different residents every week. Its extremely hard if not impossible to evaluate someone in such a short time and even amongst residents there's a significant variety of expectations for med students. After going back and reading my M3 comments, its pretty clear that many attendings just wrote down random generic responses with minimal to no input from residents ("hard worker" "team player" "pleasure to work with").

In the end it basically came down to the senior resident's /attending's own personal philosophy towards grades
(almost never give honors vs. almost everyone gets honors) and how well the they personally liked you compared to everyone else.

 

[KnuxNole]

There will be many days and entire rotations like that.

Take into consideration that as a resident you are also expected to learn once leaving work.

This is truth. After the day is over, 1-2 hours of reading usually always happen. For call nights, if it starts out quiet, I might read, otherwise I say screw it and run around psychotically.

As a student though, for most rotations there should be some downtime. Having a smartphone/Ipad can be helpful to have virtual versions of review books handy. If you're on the wards and you're waiting for an admit, whip out some reading/questions for a little bit.

 

[tiedyeddog]

Agreed. I had a similar experience during M3.

Some rotations I'd put in extra effort to help the interns get work done (H&Ps, DC summaries, making phone calls, answering pages, getting consent, etc..). Often times I'd even stay late or come back after afternoon lectures. The thing is, I'd end up with essentially the same clinical grade and evaluation comments as the students who spent their down time studying and left as early as possible. When it came to the final clerkship grade, the only thing that really mattered was the shelf exam. And, surprise, surprise, the people who studied instead of doing "intern level" work usually got higher scores. Many classmates had the same experience after taking to them and this was by far the most common complaint about 3rd year.

In a perfect world atomi would be right. However, many residents are just too overworked to notice or just don't care. Not to mention on many rotations I'd work with different residents every week. Its extremely hard if not impossible to evaluate someone in such a short time and even amongst residents there's a significant variety of expectations for med students. After going back and reading my M3 comments, its pretty clear that many attendings just wrote down random generic responses with minimal to no input from residents ("hard worker" "team player" "pleasure to work with").

In the end it basically came down to the senior resident's /attending's own personal philosophy towards grades
(almost never give honors vs. almost everyone gets honors) and how well the they personally liked you compared to everyone else.

This was my experience as well.

 

[Morsetlis]

Learning how to be an intern should be done during the sub-internship, or, surprise, during intern year.

I was in charge of two 3rd year clerks during my medicine sub-I (hilarious, yes)... I taught a little bit after rounds, helped them w notes and plans, showed them how to do procedures, and sent them home by 2pm everyday :. One of them surprisingly actually stayed until 9pm once for the "my patient developed a PE now what do I do" experience. He probably learned a lot more from it than calling 100 nursing homes, faxing records, and doing transfer forms and discharge summaries until 6pm everyday.

 

[VisionaryTics]

Learning how to be an intern should be done during the sub-internship, or, surprise, during intern year.

I was in charge of two 3rd year clerks during my medicine sub-I (hilarious, yes)... I taught a little bit after rounds, helped them w notes and plans, showed them how to do procedures, and sent them home by 2pm everyday :. One of them surprisingly actually stayed until 9pm once for the "my patient developed a PE now what do I do" experience. He probably learned a lot more from it than calling 100 nursing homes, faxing records, and doing transfer forms and discharge summaries until 6pm everyday.

It took him 7 hours to order a heparin drip?

 

[Morsetlis]

Nah it was a short call night and the nurse paged us at 7pm. In case you're wondering, the guy had a 22g IV that infiltrated when we attempted CT angio for diagnosis (also a learning moment for both if us, never trust 22g IVs).

 

[Serous Demilune]

Nah it was a short call night and the nurse paged us at 7pm. In case you're wondering, the guy had a 22g IV that infiltrated when we attempted CT angio for diagnosis (also a learning moment for both if us, never trust 22g IVs).

Yikes, good to know. Shouldn't a radiologist be doing that?

 

[235009]

Yikes, good to know. Shouldn't a radiologist be doing that?

I'd be surprised if a radiologist knows what a 22g IV is....
(radiologists just protocol and read the studies.... the techs and primary team have to worry about all the details in between)

 

[22031 Alum]

Yikes, good to know. Shouldn't a radiologist be doing that?

Placing the IV for a CT??!!! Oh you sweet child. (No need for any interventionalists to comment; I know you guys can place lines.)

 

[22031 Alum]

On topic of the thread, I thought being an intern was a thousand times better than being an MS3. Once you're no longer a student, you can whine and complain freely about the more annoying aspects of the job. I still did them, but I didn't have to pretend to be thrilled about it for the sake of my grade. Just being able to say to my senior, "Ugh, this is dumb," made a huge difference in maintaining my sanity.


(Note: senior's reply was always, "Yeah it's dumb, but you're going to do it.")

 

[notbobtrustme]

On topic of the thread, I thought being an intern was a thousand times better than being an MS3. Once you're no longer a student, you can whine and complain freely about the more annoying aspects of the job. I still did them, but I didn't have to pretend to be thrilled about it for the sake of my grade. Just being able to say to my senior, "Ugh, this is dumb," made a huge difference in maintaining my sanity.


(Note: senior's reply was always, "Yeah it's dumb, but you're going to do it.")

not to mention you actually get paid to be there.

 

[gujuDoc]

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.

Personally I think as a student one of the high points was when your resident used elements of your note or your whole note with minor editions. You made their life easier and you felt good about yourself that you aren't a complete idiot and can be useful to the team even on a small level.

The stuff I hated was when I had to ask 5 times how to access an OR list bc neither the student or resident wanted to show me and mind you I'd been at a different hospital system for 2 months and out of that hospital system for 4 months at the time. Never been in an OR bc I had a leave of absence so didn't know how to get that information. How hard it is to give simple instructions how to get that info? Or when they didn't want to add us to the patient list. All of this stuff has since been less of an issue as I've gone to a different hospital system that is just easier to work within and allows students to do more be more involved and better educationally in teaching students. Kinda wish I had done my M3 rotations where I am now bc I would have been a lot happier in year 3 if I had and learned a lot more.

I would add my advice to students

Ways to be proactive 101
1. Agree to call that consult that needs to be called if one needs to be done
2. If there's patient tasks such as calling labs or rads about results do so. If it requires going to the rads reading room to get the read bc you need the results take that time to do so.
3. Notes do matter as stated above bc residents often use your note to do theirs if it is a great note or at least elements of it. You have more time to be more thorough then they do so they love med student notes that are well done bc they can reduce their workload. It makes you feel better too if you see they've copied your note bc you know its not done in vain and the only reason yours is not the primary note is bc it can't be legally used for billing.
4. Print your rounding list every morning and write the plan for the patient during rounds. It shows you are paying attn.
5. Understand the meaning of RIME
6. Try to read about landmark trials in that area or topics that are related to things your patient has and ask to present about it to the attending.
Failure

Reporter
Interpreter
Manager
Educator

This is the 5 point eval system
1 = failure
2 = Reporter (med student minimum to pass); able to report the facts on round
3 = interpreter (intern/med student level) able to interpret data
4 = manager (senior resident level but what med students and interns strive to achieve); able to have a working plan and know managmeent protocols
5 = educator (attending level) (can do all of the above and then some)

That 5 point eval system is how people are evaluated.

True scut to me is getting your resident coffee or something truly useless they can do by themselves. but if you can do all you can do within the level of your training to hlp the resident with their patient duties they will let you then do more exciting things if you show competency in doing the basics. So don't shun the basics.

 

[Ismet]

Personally I think as a student one of the high points was when your resident used elements of your note or your whole note with minor editions. You made their life easier and you felt good about yourself that you aren't a complete idiot and can be useful to the team even on a small level.

Definitely one of the best feelings as a 3rd year!!

 

[DrOwnage]

During my Ob/Gyn rotation the entire wing was closed and I was just sitting around and my attending was at a different hospital. I left for 3 hours to sign a car lease since my parents were cosigners and they had flown all the way from California. Got dinged by the attending because they found out. Clerkship director called me saying it was completely unprofessional, that I better study for the shelf (6 days before the shelf). Scored 90th percentile on the shelf, the clerkship director still put me all the way down to satisfactory for that once instance.

 

[PL198]

During my Ob/Gyn rotation the entire wing was closed and I was just sitting around and my attending was at a different hospital. I left for 3 hours to sign a car lease since my parents were cosigners and they had flown all the way from California. Got dinged by the attending because they found out. Clerkship director called me saying it was completely unprofessional, that I better study for the shelf (6 days before the shelf). Scored 90th percentile on the shelf, the clerkship director still put me all the way down to satisfactory for that once instance.

so you literally just sat around all day everyday

 

[Wordead]

During my Ob/Gyn rotation the entire wing was closed and I was just sitting around and my attending was at a different hospital. I left for 3 hours to sign a car lease since my parents were cosigners and they had flown all the way from California. Got dinged by the attending because they found out. Clerkship director called me saying it was completely unprofessional, that I better study for the shelf (6 days before the shelf). Scored 90th percentile on the shelf, the clerkship director still put me all the way down to satisfactory for that once instance.

Yeah, leaving the hospital for 3 hours without letting anyone know and then letting them find out? Id ding the **** out of you for that too. Come on dude

 

[22031 Alum]

During my Ob/Gyn rotation the entire wing was closed and I was just sitting around and my attending was at a different hospital. I left for 3 hours to sign a car lease since my parents were cosigners and they had flown all the way from California. Got dinged by the attending because they found out. Clerkship director called me saying it was completely unprofessional, that I better study for the shelf (6 days before the shelf). Scored 90th percentile on the shelf, the clerkship director still put me all the way down to satisfactory for that once instance.

I don't care if you got every question right. Not having the common sense to know that you can't just leave -even if you're just sitting around- is not a good look. I would've failed you.

 

[chipwhitley]

Yeah, leaving the hospital for 3 hours without letting anyone know and then letting them find out? Id ding the **** out of you for that too. Come on dude

I actually ditched on OB multiple times. They knew and didn't care, because they didn't even want us there. They didn't give a **** about med students other than to take out their frustrations on us.

 

[Wordead]

I actually ditched on OB multiple times. They knew and didn't care, because they didn't want me there. They didn't give a **** about med students other than to take out their frustrations on us.

Well then I stand corrected ditching without permission is totally okay

 

[chipwhitley]

Well then I stand corrected ditching without permission is totally okay

I wouldn't ding a med student for it if there was nothing going on and I wasn't even there...

 

[Wordead]

I wouldn't ding a med student for it if there was nothing going on and I wasn't even there...

Maybe you wouldnt, but surely you would agree that wouldnt be a universal view. And to complain about getting dinged, as though it's unjust, is cray.

 

[greatnt249]

I wouldn't ding a med student for it if there was nothing going on and I wasn't even there...

The point that everyone else is trying to make is that he/she should've given someone the heads up that they were going to be gone, even if in the end they wouldn't have cared. This falls under the category of professional integrity; without telling someone he/she was going to be gone, to find out afterward that he/she left makes it seem like they were "sneaking away from duties" for whatever reason and hoping not to get caught, regardless of whether this was actually the case.

 

[chipwhitley]

Maybe you wouldnt, but surely you would agree that wouldnt be a universal view. And to complain about getting dinged, as though it's unjust, is cray.

Yeah, you have to feel out the people first. Some people care and others don't. Doesn't make sense to complain though, you're right.

 

[chipwhitley]

The point that everyone else is trying to make is that he/she should've given someone the heads up that they were going to be gone, even if in the end they wouldn't have cared. This falls under the category of professional integrity; without telling someone he/she was going to be gone, to find out afterward that he/she left makes it seem like they were "sneaking away from duties" for whatever reason and hoping not to get caught, regardless of whether this was actually the case.

Yeah I get that what the OP did was wrong, but if I was the clerkship director I would just talk to him about it and not ding his grade for it. He didn't "sneak away from duties" because the ward was closed and the attending wasn't even at the hospital. He had no duties. If he actually was told to do something and then left without doing it, that's a different story. The punishment should be adjusted to the severity of the crime.

 

[greatnt249]

Yeah I get that what the OP did was wrong, but if I was the clerkship director I would just talk to him about it and not ding his grade for it. He didn't "sneak away from duties" because the ward was closed and the attending wasn't even at the hospital. He had no duties. If he actually was told to do something and then left without doing it, that's a different story. The punishment should be adjusted to the severity of the crime.

He had no duties that he chose to make us aware of. I didn't say he snuck away from his duties; I said that's the impression it gives when you don't tell someone you're leaving from work and then someone discovers you're gone without prior notice. What's ridiculous about the scenario is that this really wouldn't have been a big deal if he had just told someone about it before leaving. It doesn't matter if the ward was closed or the attending was off-site; was it really that hard to ask?

 

[Janitor In Training]

Weirdly enough, this thread is making me more than excited to experience all of these things and I haven't even started med school yet. Does it ever help if you have a more charismatic personality when dealing with the subjective evaluations of residents/attendings?

 

[chipwhitley]

Weirdly enough, this thread is making me more than excited to experience all of these things and I haven't even started med school yet. Does it ever help if you have a more charismatic personality when dealing with the subjective evaluations of residents/attendings?

Sometimes it does, but sometimes it backfires. It depends on what the attending or resident's personality is like.

 

[22031 Alum]

Weirdly enough, this thread is making me more than excited to experience all of these things and I haven't even started med school yet. Does it ever help if you have a more charismatic personality when dealing with the subjective evaluations of residents/attendings?

I think of "charisma" as going a bit beyond just being normal and personable, and that can help or hurt. I've seen students get dinged for being overly chummy/familiar with either patients, or staff- it is still a professional workplace after all. True life example- do not affectionately clap a patient or charge nurse on the back and call her "old gal." You have to be able to read the room, to decide whether you're going to turn that used-car salesman charm up to 11, when to keep it at a 4-5, and when to turn it off.

 

[tiedyeddog]

Weirdly enough, this thread is making me more than excited to experience all of these things and I haven't even started med school yet. Does it ever help if you have a more charismatic personality when dealing with the subjective evaluations of residents/attendings?

IMO yes, it helps.

 

[tiedyeddog]

During my Ob/Gyn rotation the entire wing was closed and I was just sitting around and my attending was at a different hospital. I left for 3 hours to sign a car lease since my parents were cosigners and they had flown all the way from California. Got dinged by the attending because they found out. Clerkship director called me saying it was completely unprofessional, that I better study for the shelf (6 days before the shelf). Scored 90th percentile on the shelf, the clerkship director still put me all the way down to satisfactory for that once instance.

Wow that sucks.

 

[JimmyB123]

It took him 7 hours to order a heparin drip?

Ever hear or see a heparin infusion cause segmental PEs? Curious to know

And on unrelated note, why cant you just tPA that bad boy

Sorry if this sounds stupid but I'm a lowly pre med

 

[JimmyB123]

I'd be surprised if a radiologist knows what a 22g IV is....
(radiologists just protocol and read the studies.... the techs and primary team have to worry about all the details in between)

.

 

[Frazier]

And on unrelated note, why cant you just tPA that bad boy

Sorry if this sounds stupid but I'm a lowly pre med

Maybe pt had some contraindications.

 

[da8s0859q]

Weirdly enough, this thread is making me more than excited to experience all of these things and I haven't even started med school yet. Does it ever help if you have a more charismatic personality when dealing with the subjective evaluations of residents/attendings?

Yes. As above -- know your audience. Some nurses and attendings, I don't **** around with. Others I can talk to as if I'm getting a beer with them later. Some of them, I do. Did similar as a med student. Just know that the earlier you are at any point -- a brand-new M3 versus a graduating M4, a brand-new intern versus a senior resident -- the more touchy this can be.

Ever hear or see a heparin infusion cause segmental PEs? Curious to know

And on unrelated note, why cant you just tPA that bad boy

Sorry if this sounds stupid but I'm a lowly pre med

Because tPA and/or embolectomy is generally reserved for hemodynamically unstable patients who are trying to die, and/or those with significant cardiac strain as a result of clot burden or with severe respiratory compromise, and even then in select situations. Respect tPA and any other thrombolytic or anticoagulant agent of any kind. Don't even use the phrase "just tPA."

Someone with a PE, even bilateral PEs, can be -- and often is -- completely stable and not worth running at risk with systemic thrombolytics. I quite literally have caught several people with bilateral emboli with major clot burdens that I would never dream of pushing tPA on if I were out in some smaller ED moonlighting.

 

[TooMuchResearch]

Ever hear or see a heparin infusion cause segmental PEs? Curious to know

And on unrelated note, why cant you just tPA that bad boy

Sorry if this sounds stupid but I'm a lowly pre med

High risk PE and no contraindications? tPA.

Intermediate risk PE? Depends on your definition of intermediate risk, the pool of data you believe, and if any other options (i.e. catheter directed intrarterial tPA, clot retrieval, etc.) are available.

Low risk? (I.e. subsegmental without any signs of hemodynamic compromise, RV strain, etc.). No tPA.

 

[VisionaryTics]

Yes. As above -- know your audience. Some nurses and attendings, I don't **** around with. Others I can talk to as if I'm getting a beer with them later. Some of them, I do. Did similar as a med student. Just know that the earlier you are at any point -- a brand-new M3 versus a graduating M4, a brand-new intern versus a senior resident -- the more touchy this can be.



Because tPA and/or embolectomy is generally reserved for hemodynamically unstable patients who are trying to die, and/or those with significant cardiac strain as a result of clot burden or with severe respiratory compromise, and even then in select situations. Respect tPA and any other thrombolytic or anticoagulant agent of any kind. Don't even use the phrase "just tPA."

Someone with a PE, even bilateral PEs, can be -- and often is -- completely stable and not worth running at risk with systemic thrombolytics. I quite literally have caught several people with bilateral emboli with major clot burdens that I would never dream of pushing tPA on if I were out in some smaller ED moonlighting.

I think you were getting towards it with "significant cardiac strain", but the indications for tPA are growing a little bit for PE. The 2011 AHA guidelines are against tPA for submassive PE, but a few recent trials (MOPETT probably the best) have shown reduced rates of pulmonary hypertension and recurrent PE when low-dose tPA is given.

 

[PL198]

I think of "charisma" as going a bit beyond just being normal and personable, and that can help or hurt. I've seen students get dinged for being overly chummy/familiar with either patients, or staff- it is still a professional workplace after all. True life example- do not affectionately clap a patient or charge nurse on the back and call her "old gal." You have to be able to read the room, to decide whether you're going to turn that used-car salesman charm up to 11, when to keep it at a 4-5, and when to turn it off.

sounds like a complete idiot

 

[22031 Alum]

sounds like a complete idiot

Changed things around after some... constructive... feedback. Ended up doing great on Sub-I's and interviews. Learning how to "read" a situation is definitely a skill.

 

[atomi]

In a perfect world atomi would be right. However, many residents are just too overworked to notice or just don't care. Not to mention on many rotations I'd work with different residents every week. Its extremely hard if not impossible to evaluate someone in such a short time and even amongst residents there's a significant variety of expectations for med students. After going back and reading my M3 comments, its pretty clear that many attendings just wrote down random generic responses with minimal to no input from residents ("hard worker" "team player" "pleasure to work with").

In the end it basically came down to the senior resident's /attending's own personal philosophy towards grades
(almost never give honors vs. almost everyone gets honors) and how well the they personally liked you compared to everyone else.

Keep telling yourself this, but I'm telling you how it looks behind the curtain. typically the clerkship director compiles the evaluations by the attending, resident, and interns and uses these to create a summary statement, usually including verbatim comments from the evaluators, that will go into your dean's letter. FYI anything other than a positive comment in your dean's letter is a glaring red flag, so this extends beyond simply getting a grade for the clerkship. If a student has two starkly negative, paragraph long evaluations from both interns citing specific examples of unprofessional behavior and attitude problems, a generic one liner From the resident "keep up the good work billy" type of eval, and a short eval from the attending that appears positive "billy was always prepared. I was impressed when he answered my question on rounds about about the function of 24 methylwhogivesa****alayse in the south Georgian dodo bird" I can promise you you are not going to get a strong clinical grade, and even if you ace the shelf probably won't honor the rotation, and some amount of negativity is going to find its way into your dean's letter.

What you need to understand is that it's RARE for someone to write either a detailed evaluation or a negative evaluation (given the ramifications of these, we try to avoid negativity at all costs). But when somebody writes both, it tends to raise eyebrows. Especially when somebody has no history of writing negative evals in the past. If one intern has a problem with you, believe me that the other intern will hear about it and will begin to notice your deficiency as well. This happened to me before. Day 1 I noticed that one of the ms3 students had a major attitude problem. I asked my co intern if she noticed the same thing and she said no. Three days later she is ranting to me about how he is the biggest dingus she ever has worked with.

My advice is really simple. Be present, work hard, say yes to everything, act enthusiatic, care about your patients, and don't dress like a clown. We don't expect you to function like an intern, just LEARN how to. We do not expect you to stay with us until 10pm. We know you need to study on your own. But if you are the good kind of med student like I described above, I am going to be much more inclined to tell you to leave early at 2pm every chance I get. But if you an dingus who doesn't care about his patients, scoffs at everything the interns ask him to do, does half assed work, tries to leave early constantly, smugly presents patients on rounds, etc, I am NEVER going to tell you to go home early and am going to ignore your not so subtle pleas to leave which tend to start right after lunch. Instead you get to leave at the godforsaken hour of 5pm. What a rough life.

On some rotations the doucheiest slackers might get honors, but this is the exception and not the rule, so why risk it? Having a positive attitude is always the best policy.

 

[charmiedermie]

Agreed. I had a similar experience during M3.

Some rotations I'd put in extra effort to help the interns get work done (H&Ps, DC summaries, making phone calls, answering pages, getting consent, etc..). Often times I'd even stay late or come back after afternoon lectures. The thing is, I'd end up with essentially the same clinical grade and evaluation comments as the students who spent their down time studying and left as early as possible. When it came to the final clerkship grade, the only thing that really mattered was the shelf exam. And, surprise, surprise, the people who studied instead of doing "intern level" work usually got higher scores. Many classmates had the same experience after taking to them and this was by far the most common complaint about 3rd year.

In a perfect world atomi would be right. However, many residents are just too overworked to notice or just don't care. Not to mention on many rotations I'd work with different residents every week. Its extremely hard if not impossible to evaluate someone in such a short time and even amongst residents there's a significant variety of expectations for med students. After going back and reading my M3 comments, its pretty clear that many attendings just wrote down random generic responses with minimal to no input from residents ("hard worker" "team player" "pleasure to work with").

In the end it basically came down to the senior resident's /attending's own personal philosophy towards grades
(almost never give honors vs. almost everyone gets honors) and how well the they personally liked you compared to everyone else.

Waiting for the SDN avalanche from the usual suspects who will say that you didn't work hard enough to earn Honors and their experiences were the complete opposite of yours and were wonderful.

 

[charmiedermie]

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.

Honestly asking, how do you know it may not have been based on personality?

 

[Ismet]

Honestly asking, how do you know it may not have been based on personality?

Whose personality? Mine or the person doing the ridiculing?

 

[charmiedermie]

Whose personality? Mine or the person doing the ridiculing?

Sorry, I meant your personality. I'm assuming these were surgery residents trying to recruit you into their field. Were they really ridiculing you because you chose something else?

 

[Ismet]

Sorry, I meant your personality. I'm assuming these were surgery residents trying to recruit you into their field. Were they really ridiculing you because you chose something else?

I wouldn't call it "ridiculing" because usually these things are in jest and I just take it in stride and go along with it. The typical arguments against peds, like who wants to deal with crazy parents, no one likes well child checks, screaming/crying kids etc. Stuff I've heard before and doesn't phase me (I actually really like well child checks....). I'm good with my hands and I apparently learn very quickly when it comes to procedural stuff so that's why they kept trying to talk me into surgery. Although I will say that if I did surgery, I'd probably want to do plastics. Those reconstruction surgeries after removing half of a person's face are works of art. If only they didn't take 12+ hours.