What to do if residents in rotations do not want to teach/guide you and they are failing you?

[Racecar142019]

Hello,

I have a question. What do I do if the residents in my rotations are not helping me and/or guiding me? I failed a huge rotation because the residents did not want to tech me and/or guide me, and since it was my first rotation I was completely lost and did not learn anything. All I learned is that people in medicine are horrible, especially the residents, and this should not be happening to me or anyone else. How do I effectively report this? What can be done? Because I reported this on my faculty feedback and I noticed that no one did anything about it to address my concerns and I still failed the rotation with that failed letter on my transcripts all because of the residents lack of humanity.

I look forward to the responses from the internet.

Thank you for your time.

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[deleted697308]

Hello,

I have a question. What do I do if the residents in my rotations are not helping me and/or guiding me? I failed a huge rotation because the residents did not want to tech me and/or guide me, and since it was my first rotation I was completely lost and did not learn anything. All I learned is that people in medicine are horrible, especially the residents, and this should not be happening to me or anyone else. How do I effectively report this? What can be done? Because I reported this on my faculty feedback and I noticed that no one did anything about it to address my concerns and I still failed the rotation with that failed letter on my transcripts all because of the residents lack of humanity.

I look forward to the responses from the internet.

Thank you for your time.

Meet with your dean. I've had a couple tough rotations. Ask older students/friends what are easier rotations at your school. I always try to find rotations with easier attendings to get good grades. Honestly none of my residents ever taught. You're right, you shouldn't be failing. As a med student you have limitations so it all comes down to subjectiveness.

 

[cookiegrub]

Had one rotation where the residents tried to throw me under the bus after the attending kept saying to include me in doing the exams myself. One resident in particular kept rolling their eyes and muttering how they hated the attending. I asked the resident at the end of pt encounter how I could help (since they literally wouldn't let me do anything) and they said it would be great if I took initiative. This was absolutely ridiculous and it was clear to me they had their favorites picked out already so they intentially made the other students look bad in front of the attending since they had a lot of connections to help students who stood apart. FYI, I say this because another student shared the same perspective without having me say a word about these incidents.

 

[Keep2r]

Please do not generalize your experience of internal medicine residents to all of us. I take great pride in doing bedside teaching and afternoon interactive sessions with my medical students and have received great feedback from all of my students in providing them with knowledge useful for the shelf exam.

That being said, if you truly feel like the resident you have been assigned to has done a subpar job, bring it up to the course director and the program director for the internal medicine residency. At my institution, the course director is very protective of student learning and take all complaints seriously. Residents who consistently receive negative student feedback will have this brought to the attention of the program director and will be assigned to future floor rotations on teams where they do not interact with medical students.

 

[Racecar142019]

Please do not generalize your experience of internal medicine residents to all of us. I take great pride in doing bedside teaching and afternoon interactive sessions with my medical students and have received great feedback from all of my students in providing them with knowledge useful for the shelf exam.

That being said, if you truly feel like the resident you have been assigned to has done a subpar job, bring it up to the course director and the program director for the internal medicine residency. At my institution, the course director is very protective of student learning and take all complaints seriously. Residents who consistently receive negative student feedback will have this brought to the attention of the program director and will be assigned to future floor rotations on teams where they do not interact with medical students.

Hello,

First, I am not speaking about internal medicine. I am speaking about another rotation. Second, the clerkship director did nothing to address this issue and let it slide for those residents while I am stuck with the failing grade. Unless you have an answer to my original question and something I can effectively do aside from asking the director, this is not going to work. Not everyone is as good as you and not every school is as good as where you work.

 

[OrthoTraumaMD]

Based on these over the top responses like “all i learned is that people in medicine are horrible” (really?), the complete lack of ownership of the failed grade, and blaming the residents and using terms like “lack of humanity,” I suspect the problem is not the residents, but your expectations. Failing an entire rotation because the residents didn’t “guide” you is not the norm, unless the course does not provide any readings or study guides outside of “watch the residents.”

The residents are typically overworked and exhausted. Their primary responsibility is to learn their field first, take care of patients second, and teach third, and only if it doesn’t take away from the first two. Take responsibility for your own education if they dont have the time to teach you.

 

[FalconSlice]

Based on these over the top responses like “all i learned is that people in medicine are horrible” (really?), the complete lack of ownership of the failed grade, and blaming the residents and using terms like “lack of humanity,” I suspect the problem is not the residents, but your expectations. Failing an entire rotation because the residents didn’t “guide” you is not the norm, unless the course does not provide any readings or study guides outside of “watch the residents.”

The residents are typically overworked and exhausted. Their primary responsibility is to learn their field first, take care of patients second, and teach third, and only if it doesn’t take away from the first two. Take responsibility for your own education if they dont have the time to teach you.

Completely agree. Another thing I'll add is that something many third-years (usually the straight through from undergrad ones) do not realize (at least initially... some never do) is that third-year is not a passive thing. You cannot expect people to spoon-feed you information and hold your hand. You're an adult. Take initiative and engage patients, nurses, and physicians that are available. Actively read and critically think on your own. Try out what you think is right, whatever is deemed to be not correct should be changed, observe and prepare for the future by anticipating things--for example, you overhear that your service is going to be getting two new admits? Template a note for the resident, try to see the pt before them, present to your senior, amend your notes, get outside medical records, update the PCP, etc.

If you expect to show up and be taught, that is a spoiled-brat-way of thinking. You are not the priority, the patient is. If that's your attitude, you're basically indistinguishable from furniture---just sitting there in everyone's way.

Sorry to be harsh, but there it is.

Not saying OP is like the above... just my suspicion

 

[OrthoTraumaMD]

Completely agree. Another thing I'll add is that something many third-years (usually the straight through from undergrad ones) do not realize (at least initially... some never do) is that third-year is not a passive thing. You cannot expect people to spoon-feed you information and hold your hand. You're an adult. Take initiative and engage patients, nurses, and physicians that are available. Actively read and critically think on your own. Try out what you think is right, whatever is deemed to be not correct should be changed, observe and prepare for the future by anticipating things--for example, you overhear that your service is going to be getting two new admits? Template a note for the resident, try to see the pt before them, present to your senior, amend your notes, get outside medical records, update the PCP, etc.

If you expect to show up and be taught, that is a spoiled-brat-way of thinking. You are not the priority, the patient is. If that's your attitude, you're basically indistinguishable from furniture---just sitting there in everyone's way.

Sorry to be harsh, but there it is.

Not saying OP is like the above... just my suspicion

The internet is a wonderful place where unfiltered advice is freely dispensed. I always laugh when people post with warnings “i want only this kind of response” which tells me they don’t want advice at all, but confirmation of the echo chamber.

 

[Redpancreas]

Hello,

I have a question. What do I do if the residents in my rotations are not helping me and/or guiding me? I failed a huge rotation because the residents did not want to tech me and/or guide me, and since it was my first rotation I was completely lost and did not learn anything. All I learned is that people in medicine are horrible, especially the residents, and this should not be happening to me or anyone else. How do I effectively report this? What can be done? Because I reported this on my faculty feedback and I noticed that no one did anything about it to address my concerns and I still failed the rotation with that failed letter on my transcripts all because of the residents lack of humanity.

I look forward to the responses from the internet.

Thank you for your time.

I am sorry this was your perception, but I can't take this at face value. I'm sure residents love to teach. See above for what gets in their way. What could have happened was a lot of factors did not go your way combined with your reaction to that. Maybe it was your first rotation whereas everyone else had experience so residents perceived you as a lost cause and maybe something(s) you did confirmed that? I've been there.

You are free to go to meet with your Dean of Clerkships, Vice Chair of Edu or whoever people meet with at your school. Be warned that they will likely not get to the bottom of this. They will only gather more information and ruffle more feathers. The conventional wisdom of administration is if everyone acts a certain way besides you, the problem must be you.

Anyways, your post reads as a caricature with minimal detail. No one will be able to advise you with that. I know Racecar's post seems unrealistic but it's what's expected. In clinical medicine right now there's a huge disparity between what's expected of medical students on paper and what medical students actually do/know. At some schools that gap is wider than at others.

 

[Redpancreas]

Completely agree. Another thing I'll add is that something many third-years (usually the straight through from undergrad ones) do not realize (at least initially... some never do) is that third-year is not a passive thing. You cannot expect people to spoon-feed you information and hold your hand. You're an adult. Take initiative and engage patients, nurses, and physicians that are available. Actively read and critically think on your own. Try out what you think is right, whatever is deemed to be not correct should be changed, observe and prepare for the future by anticipating things--for example, you overhear that your service is going to be getting two new admits? Template a note for the resident, try to see the pt before them, present to your senior, amend your notes, get outside medical records, update the PCP, etc.

If you expect to show up and be taught, that is a spoiled-brat-way of thinking. You are not the priority, the patient is. If that's your attitude, you're basically indistinguishable from furniture---just sitting there in everyone's way.

Sorry to be harsh, but there it is.

Not saying OP is like the above... just my suspicion

This was the case with me when I was a trad in medical school, although you can't generalize all traditional students like that (which I know you didn't actually do). Many trads are second-gen medical students who know right away how the system works and what they need to do early on and others just had a better attitude or clinical perspective than I did I guess.

 

[Keep2r]

This was the case with me when I was a trad in medical school, although you can't generalize all traditional students like that (which I know you didn't actually do). Many trads are second-gen medical students who know right away how the system works and what they need to do early on and others just had a better attitude or clinical perspective than I did I guess.

I remember one resident telling me that being a stellar med student comes down to three basic characteristics: knowledge, likeability, and a hardworking attitude. If you have two out of the three and are not deficient in the third, you can get through third year without any issues. Sure the second gen med students have a leg up but that there are still plenty of ways to compete with them .

 

[Fatalis]

Based on these over the top responses like “all i learned is that people in medicine are horrible” (really?), the complete lack of ownership of the failed grade, and blaming the residents and using terms like “lack of humanity,” I suspect the problem is not the residents, but your expectations. Failing an entire rotation because the residents didn’t “guide” you is not the norm, unless the course does not provide any readings or study guides outside of “watch the residents.”

The residents are typically overworked and exhausted. Their primary responsibility is to learn their field first, take care of patients second, and teach third, and only if it doesn’t take away from the first two. Take responsibility for your own education if they dont have the time to teach you.

This 100%! Some med students I have encountered seem to think the hospital was built specifically for them and it all revolves around them. They didn't teach you? Ok well you know there are several textbooks, uptodate, uworld, etc that you can be reviewed to refine your knowledge on the pathologies you have/ have not seen.
As my dad says to new guys on his construction crew "You aren't even a number right now", I say the same to you.

 

[TwistedTea]

Lol we pretty much give everyone a good grade as long as you show up, try, and are normal. You musta been hella bad or something.

We do try to teach med students though at least some. We are busy but I feel like they are paying a lot and should get something out of being in the hospital.

 

[ohmanwaddup]

Completely agree. Another thing I'll add is that something many third-years (usually the straight through from undergrad ones) do not realize (at least initially... some never do) is that third-year is not a passive thing. You cannot expect people to spoon-feed you information and hold your hand. You're an adult. Take initiative and engage patients, nurses, and physicians that are available. Actively read and critically think on your own. Try out what you think is right, whatever is deemed to be not correct should be changed, observe and prepare for the future by anticipating things--for example, you overhear that your service is going to be getting two new admits? Template a note for the resident, try to see the pt before them, present to your senior, amend your notes, get outside medical records, update the PCP, etc.

If you expect to show up and be taught, that is a spoiled-brat-way of thinking. You are not the priority, the patient is. If that's your attitude, you're basically indistinguishable from furniture---just sitting there in everyone's way.

Sorry to be harsh, but there it is.

Not saying OP is like the above... just my suspicion

Sorry to reply a month later, but your comment really changed my perspective. I have definitely been too passive this year. I ask questions, try to look think up, but I’ve been way to scared I’ll mess up to fully take initiative.

ive gotten good grades and evals, but 100% this is the biggest area I need to work on

 

[FalconSlice]

Sorry to reply a month later, but your comment really changed my perspective. I have definitely been too passive this year. I ask questions, try to look think up, but I’ve been way to scared I’ll mess up to fully take initiative.

ive gotten good grades and evals, but 100% this is the biggest area I need to work on

Glad to have helped! This is what sdn is all about!

Don't be afraid of making mistakes as it's how all of us learn. (Obviously, don't take down dressings, pull drains, etc. without asking higher-ups if it's okay and only if you feel comfortable with it). Even having this attitude will put you above the vast majority of students!

Even realizing that this is something you need to work on is great. It shows great introspection.

Best of luck with your remaining third-year!

 

[ohmanwaddup]

Glad to have helped! This is what sdn is all about!

Don't be afraid of making mistakes as it's how all of us learn. (Obviously, don't take down dressings, pull drains, etc. without asking higher-ups if it's okay and only if you feel comfortable with it). Even having this attitude will put you above the vast majority of students!

Even realizing that this is something you need to work on is great. It shows great introspection.

Best of luck with your remaining third-year!

Thanks friend

 

[deleted954943]

The residents I've worked with haven't been malignant or mean per se. They sort of just treat us with a cold indifference and there's a lot of awkward standing around. It's easy to say "take initiative" but when you're a 3rd year, you have absolutely no idea how the hospital system works. I was tripping over my own two feet constantly at the start of 3rd year and it's only slightly better as a new 4th year. I agree the blame shouldn't be placed on the residents for failing a rotation but many of them take no interest in students and act as if we're nothing more than a nuisance to them.

 

[Lem0nz]

The residents I've worked with haven't been malignant or mean per se. They sort of just treat us with a cold indifference and there's a lot of awkward standing around. It's easy to say "take initiative" but when you're a 3rd year, you have absolutely no idea how the hospital system works. I was tripping over my own two feet constantly at the start of 3rd year and it's only slightly better as a new 4th year. I agree the blame shouldn't be placed on the residents for failing a rotation but many of them take no interest in students and act as if we're nothing more than a nuisance to them.

The reality is that you are. It doesn’t mean they don’t want you around but they’re overworked and struggling (and soon, you will be too). Their own evaluations and metrics that will get them to fellowship or their next job has absolutely nothing to do with teaching medical students. You *only* create more work in 97/100 cases.

Again, that doesn’t mean they don’t want to teach you and wouldn’t like to contribute. You just have to couch your expectations in the context of what a resident’s job is. Teaching medical students is the last thing in an extremely long list of other things and one that does not have tangible value to a resident, just intangible benefits of feeling good they did it and were able to help a student. That is worth more to some than others. You will be a resident soon and you’ll be on that spectrum as well.

 

[deleted954943]

The reality is that you are. It doesn’t mean they don’t want you around but they’re overworked and struggling (and soon, you will be too). Their own evaluations and metrics that will get them to fellowship or their next job has absolutely nothing to do with teaching medical students. You *only* create more work in 97/100 cases.

Again, that doesn’t mean they don’t want to teach you and wouldn’t like to contribute. You just have to couch your expectations in the context of what a resident’s job is. Teaching medical students is the last thing in an extremely long list of other things and one that does not have tangible value to a resident, just intangible benefits of feeling good they did it and were able to help a student. That is worth more to some than others. You will be a resident soon and you’ll be on that spectrum as well.

Fine then as long as we have that understanding don’t act all pissy whenever we don’t fulfill some vague, undefined expectations as “members of the team”. I never once expected a resident to drop what he is doing to teach me. Their most glaring defect is in basic communication skills and human decency. I guess that’s not as important as chasing a career though

 

[Lem0nz]

Fine then as long as we have that understanding don’t act all pissy whenever we don’t fulfill some vague, undefined expectations as “members of the team”. I never once expected a resident to drop what he is doing to teach me. Their most glaring defect is in basic communication skills and human decency. I guess that’s not as important as chasing a career though

This level of maturity is indicative of why you're struggling. Carry on.

 

[deleted954943]

This level of maturity is indicative of why you're struggling. Carry on.

And your smug, dismissive attitude is the reason why people think “everyone is horrible” in medicine.

 

[Lem0nz]

And your smug, dismissive attitude is the reason why people think “everyone is horrible” in medicine.

I didn't dismiss you at all. I actually validated you, then explained why it occurred and that you and any other students encountering the problem should adjust expectations accordingly because that is reality. You responded with passive aggressive rage and are in fact 'acting all pissy' just like you described.

So... yea. I will dismiss your incredibly whiny rebuttals as childish and will continue to do so as long as you keep posting them since you didn't care for a measured response and just want to cry at the mean doctors.

 

[deleted954943]

I didn't dismiss you at all. I actually validated you, then explained why it occurred and that you and any other students encountering the problem should adjust expectations accordingly because that is reality. You responded with passive aggressive rage and are in fact 'acting all pissy' just like you described.

So... yea. I will dismiss your incredibly whiny rebuttals as childish and will continue to do so as long as you keep posting them since you didn't care for a measured response and just want to cry at the mean doctors.

My expectations of resident conduct are nothing outside of what a normal, decent human being is capable of (regardless of their workload). Some of them are quite pleasant and interact with students well. It mostly comes down to personality traits. A lot of them have massive egos which makes them very unlikable. It has nothing to do with their long list of responsibilities. Everyone in the hospital is overworked. By the way, how exactly do you know what my expectation are? I've never stated them but I can assure they are firmly grounded in reality. I merely commented on how they normally behave toward us which is distinct from the way I expect them to behave. Your response is based on what you think my expectations are.

I simply ask for mutual human respect while on rotations. I sincerely doubt this would get in the way of attaining any "tangible benefit" or interfere with any career goals the resident may have.

You probably think I'm "incredibly whiny" and "childish" in proportion as I think you are smug and tone-deaf. Good day to you doctor.

 

[Matthew9Thirtyfive]

My expectations of resident conduct are nothing outside of what a normal, decent human being is capable of (regardless of their workload). Some of them are quite pleasant and interact with students well. It mostly comes down to personality traits. A lot of them have massive egos which makes them very unlikable. It has nothing to do with their long list of responsibilities. Everyone in the hospital is overworked. By the way, how exactly do you know what my expectation are? I've never stated them but I can assure they are firmly grounded in reality. I merely commented on how they normally behave toward us which is distinct from the way I expect them to behave. Your response is based on what you think my expectations are.

I simply ask for mutual human respect while on rotations. I sincerely doubt this would get in the way of attaining any "tangible benefit" or interfere with any career goals the resident may have.

You probably think I'm "incredibly whiny" and "childish" in proportion as I think you are smug and tone-deaf. Good day to you doctor.

You start out by saying they haven’t been malignant or mean, and then when your perception is challenged, that changes to them lacking basic human decency. Your response to a measured post was very over the top, passive aggressive, and reactionary. That demonstrates a lack of maturity. Since they went from not mean or malignant to lacking human decency, maybe you can give actual examples to show that it’s their behavior and not your expectations.

 

[deleted954943]

It is possible to lack basic human decency without being mean or malignant. As an example of malignant behavior, a resident has never cursed me out or intentionally tried to humiliate me. But they have completely ignored the fact that I am even on the rotation at all with entire days going by with no contact whatsoever. That is unprofessional, rude, and yes indecent. It takes 5 seconds to send a text message saying "hey sorry really busy but you can go study". Then I would understand. So my position has been consistent the whole while.

The kind doctor in his "measured post" affirmed that I am in fact a nuisance whose presence brings no tangible benefit to the team whatsoever. How can he say that that is true in all cases and how am I supposed to respond to such a snide, condescending remark?

 

[Lawpy]

The reality is that you are. It doesn’t mean they don’t want you around but they’re overworked and struggling (and soon, you will be too). Their own evaluations and metrics that will get them to fellowship or their next job has absolutely nothing to do with teaching medical students. You *only* create more work in 97/100 cases.

Again, that doesn’t mean they don’t want to teach you and wouldn’t like to contribute. You just have to couch your expectations in the context of what a resident’s job is. Teaching medical students is the last thing in an extremely long list of other things and one that does not have tangible value to a resident, just intangible benefits of feeling good they did it and were able to help a student. That is worth more to some than others. You will be a resident soon and you’ll be on that spectrum as well.

I think residents should not have the grading power to sink MS3s when they're overwhelmed and don't care

 

[Matthew9Thirtyfive]

It is possible to lack basic human decency without being mean or malignant. As an example of malignant behavior, a resident has never cursed me out or intentionally tried to humiliate me. But they have completely ignored the fact that I am even on the rotation at all with entire days going by with no contact whatsoever. That is unprofessional, rude, and yes indecent. It takes 5 seconds to send a text message saying "hey sorry really busy but you can go study". Then I would understand. So my position has been consistent the whole while.

You think ignoring you for multiple days is rude but not mean? You’re splitting hairs here man. That is rude, and if they are actually just straight up ignoring you, I agree that’s ****ty and isn’t a matter of expectations.

The kind doctor in his "measured post" affirmed that I am in fact a nuisance whose presence brings no tangible benefit to the team whatsoever. How can he say that that is true in all cases and how am I supposed to respond to such a snide, condescending remark?

It’s not snide and condescending. It’s also not personal. In many situations, med students are a nuisance. We create more work, not less. Now on my surgery rotation in clinic, we saw our own patients and staffed directly with the attending. Our notes went right to the attending, so we took some of the work away from the residents, which they were happy about. On some of my other rotations, the residents had to check my notes and **** before the attending saw them. That just adds to their workload and is a hassle.

 

[Drrrrrr. Celty]

What I've learned is that miserable people make miserable residents and they will often go out of their way to make you miserable too. Likewise nothing is worse than a med student who whines or doesn't do their due diligence to listen, learn, or practice good social graces.

 

[Lawpy]

What I've learned is that miserable people make miserable residents and they will often go out of their way to make you miserable too. Likewise nothing is worse than a med student who whines or doesn't do their due diligence to listen, learn, or practice good social graces.

Miserable people should not be the ones grading people and should be removed from teaching services

 

[Drrrrrr. Celty]

Miserable people should not be the ones grading people and should be removed from teaching services

Should is a beautiful word.

 

[Lawpy]

Should is a beautiful word.

That's why i'm pushing for huge salary increases and fast tenure tracks to incentivize good attendings to join med education

 

[Matthew9Thirtyfive]

That's why i'm pushing for huge salary increases and fast tenure tracks to incentivize good attendings to join med education

How are you pushing for this?

 

[Drrrrrr. Celty]

That's why i'm pushing for huge salary increases and fast tenure tracks to incentivize good attendings to join med education

There's more to it than money can solve unfortunately.

I hate to say it but a lot of physicians just aren't good educators. Further a lot of physicians who are good educators have too much going on in their lives. This isn't like a PhD environment where you can write on a board and call it teaching. In medical education there is ego, team work, money, and patient's lives.

 

[Chads2]

Help me out here...who is Racecar142019 and who is Actually MadeIt? Are you two different people? Looking back over this thread has me confused.

But never mind that. Let me speak in more general terms. I pride myself on being a good teaching attending because of the complete lack of instruction at some of my 3rd year random DO clinical sites. I am consistently rated 9+/10 on my cumulative student evaluations. Yet, I still have the random eval where I was given a 1/10 and received the comment that I had no interest in teaching. Blew my mind!

What I mean from that tale, however, is that unfortunately everyone’s idea of “instruction” is different and it sounds like the OP (?) wanted more guidance... a lot more. I’m just not sure how realistic that expectation is. And the preponderance of the responses in this thread are in agreement that residents have a long long priority list, which includes keeping people alive and that teaching Med students is pretty low on that list. Yes, forwarding their careers is more important to them than teaching medical students and that really shouldn’t come as a surprise.

And for those of us of an older generation, we remember when Med students were able to do more and actually “manage” some patients. CMS has handcuffed medical students to the point where a lot of what they do is extraneous and is of no actual help to a resident’s workload. So your perceived value is less. Still, sounds like Racecar and/or ActuallyMadeIt needed to be more assertive.

 

[Dave1980]

Hello,

I have a question. What do I do if the residents in my rotations are not helping me and/or guiding me? I failed a huge rotation because the residents did not want to tech me and/or guide me, and since it was my first rotation I was completely lost and did not learn anything. All I learned is that people in medicine are horrible, especially the residents, and this should not be happening to me or anyone else. How do I effectively report this? What can be done? Because I reported this on my faculty feedback and I noticed that no one did anything about it to address my concerns and I still failed the rotation with that failed letter on my transcripts all because of the residents lack of humanity.

I look forward to the responses from the internet.

Thank you for your time.

You really shouldn't need that much guidance. Are you an IMG? This doesn't sound like a typical American med student post.

 

[Dave1980]

How are you pushing for this?

By wishing upon a star

 

[Maximus2020]

The problem is admin talks the talk but does not walk the walk. Despite reporting conduct of bad residents or attendings, not much is done unless it is something major. I think finding aid in a fellow med student or 4th year would prove useful. Interns are overworked so they will not be the go-to. Senior residents should be the go-to but the variability in kindness/helpfulness is astounding. Attendings do not have the time either. Hopefully talking to other med students on the same rotation or on your upcoming rotation will be able to provide the best insight.