Meal breaks while on call

vir0n said:

I am curious if others have run into a similar situation. You are on call and hungry. There is some down time so you ask you resident for a quick bite. They say sure and u run off. You come back 15 minutes later to guff and comments about your food break. Has anyone run into this situation before? Am I at fault for getting food? Is it rude for me to eat? Who is the a-hole here?

Click to expand...

Depends whether it was really "down time" or whether it was just your perception. Most residents are not going to say no when you ask to go eat, but if you run off and eat while they aren't able to because something is actually going on, or they are waiting on something/someone, you can expect a comment or two. The general rule is you eat when the residents eat, and if they end up too busy to eat, you miss a meal too. There will be times in medicine when you won't get 3 squares at regular intervals. Many many nights where I didn't get dinner until 2am. The right approach is to never ask to go eat. When they go to eat, you do too. If they don't go to eat, have a granola bar in your pocket you can wolf down.

Law2Doc said:

Depends whether it was really "down time" or whether it was just your perception. Most residents are not going to say no when you ask to go eat, but if you run off and eat while they aren't able to because something is actually going on, or they are waiting on something/someone, you can expect a comment or two. The general rule is you eat when the residents eat, and if they end up too busy to eat, you miss a meal too. There will be times in medicine when you won't get 3 squares at regular intervals. Many many nights where I didn't get dinner until 2am. The right approach is to never ask to go eat. When they go to eat, you do too. If they don't go to eat, have a granola bar in your pocket you can wolf down.

Click to expand...

Alternatively, if it seems like your residents are really too busy to eat and there is not much you can do to help them, you could always offer to grab them a bite to eat from the cafeteria. Some students might call this "scut" - but I think it's an easy way to help them out and make sure you get a chance to eat yourself. Plus some residents will pay for your food if you do this for them (they get a stipend for food).

Law2Doc said:

Many many nights where I didn't get dinner until 2am. The right approach is to never ask to go eat. When they go to eat, you do too. If they don't go to eat, have a granola bar in your pocket you can wolf down.

Click to expand...

Ditto this. Most night teams I've been on try to eat as a group, often multitasking by running the list while you do it.

It's a hierarchy this, unfortunately. Even if you have nothing going on, if the intern/resident is too busy to go eat, you shouldn't go eat. Everyone's hungry.

The a-hole is the resident. Honestly, if there's nothing you can do to help the resident you should eat. Even if there IS something you can do to help but you are starving, you CAN eat but understand that will affect their perception of you.

Even now as an intern, my seniors begin harping on me around noon as to whether I've eaten. I am constantly being reminded that as long as no one is crashing, all of this work can wait and that I will do it more efficently if I'm not hypoglycemic. I don't know if they harp on the other interns as much, though, because I become stupid, confused, and slow when I haven't eaten recently.

You'll get nothing and like it.

igottaquestion said:

You'll get nothing and like it.

Click to expand...

ROFL!

On the topic of eating, I only eat when I'm told to. Often the resident and/or attending is considerate enough to let us go, but on times when they forget, I subtly ask "what else can i do to help you?" and that often does the trick.

I can see where you're coming from...

The problem I've found with eating on rotations is that I often am not aware of how/when the residents eat for different rotations/residents, and if I'm not around them all the time but they give me a crapload of work/notes to do around 9 AM, I always wonder if they'd care if I just grab a bite or whatever. I remember in medicine, I'd often not eat until 2 PM for the first time going in at 7AM because I'd be busy. Then and when I'm around a resident all the time, I usually feel like I'm not doing anything because I can't but they might be working, etc. Then it's tough to ask to leave. Asking if you could grab them some food is a good idea. It's worst the first few days of the rotation when you don't know the schedule. Some residents eat before coming in, some grab food for rounds, some eat during morning conferences, etc.

But I digress... With your situation it's kinda dickish for the resident to give you too much crap if they were not busy and/or not filling out paper work, etc. Most usually try to ask and encourage me to eat.

Not eating on call is dangerous and stupid. It's part of a little victimhood game that some residents like to play.

Law2Doc said:

The general rule is you eat when the residents eat, and if they end up too busy to eat, you miss a meal too... The right approach is to never ask to go eat.

Click to expand...

Man that's complete crap.

vir0n said:

I am curious if others have run into a similar situation. You are on call and hungry. There is some down time so you ask you resident for a quick bite. They say sure and u run off. You come back 15 minutes later to guff and comments about your food break. Has anyone run into this situation before? Am I at fault for getting food? Is it rude for me to eat? Who is the a-hole here?

Click to expand...

You are not the a hole. You asked to go eat and he said yes. It's his dumb fault for being passive aggressive and complaining after he let you do so. If he didnt want you to eat and suffer hungrily then he should have at least had the balls to say so.

There are some people who love to make others miserable. They were made miserable during their rotations and thus their perception is that you should be miserable during yours.

Ask the first day about the eating rules. It goes right along with "where are the bathrooms" question. You can't function if you don't eat. Basic life necessities.

Now that being said, during surgery rotation I kept granola bars in my pocket and often that's all I would have. There was just too much stuff to see and do to be bothered to take time to eat. OBGyn I missed a few meals. All other rotations there was nothing truly pressing that I couldn't take the time to go sit and eat. However, if you're the only one going, always offer to bring back a sandwich or beverage for the rest of the team.

surrender903 said:

You are not the a hole. You asked to go eat and he said yes. It's his dumb fault for being passive aggressive and complaining after he let you do so. If he didnt want you to eat and suffer hungrily then he should have at least had the balls to say so.

Click to expand...

You don't get the culture at many places. No resident is going to say "no you can't go eat". That would be being an "a hole", and very few would do that. But clearly asking to go eat in this case was the wrong call under the culture based on the result. Speaking from my own experience, it's definitely annoying when you are busy and the med students say "is it okay if I go off to eat, study", etc, while you still have a ton to do before you are going to be able to take anything resembling a food break. So it's not going to be well received when the med student runs off for food, leaving you to plow on with the work. I agree with the others that offering to pick something up for the resident might have softened the blow, but again this depends on the culture as well. This is why med students really should carry a granola bar or something in their pockets, and wait until the residents eat to eat something more substantial. Maybe this is "complete crap", but if you are perceived as the person who always runs off for three squares while there is work to be done (in the resident's opinion, not yours), you aren't going to get a great eval to the extent the resident gets input.

And no it's not "dangerous" to miss a meal during call, unless you are severely nutritionally deprived. Many of us have missed or delayed meals on every call. The human body can go well over 24 hours without food.

Law2Doc said:

You don't get the culture at many places. No resident is going to say "no you can't go eat". That would be being an "a hole", and very few would do that. But clearly asking to go eat in this case was the wrong call under the culture based on the result. Speaking from my own experience, it's definitely annoying when you are busy and the med students say "is it okay if I go off to eat, study", etc, while you still have a ton to do before you are going to be able to take anything resembling a food break. So it's not going to be well received when the med student runs off for food, leaving you to plow on with the work. I agree with the others that offering to pick something up for the resident might have softened the blow, but again this depends on the culture as well. This is why med students really should carry a granola bar or something in their pockets, and wait until the residents eat to eat something more substantial. Maybe this is "complete crap", but if you are perceived as the person who always runs off for three squares while there is work to be done (in the resident's opinion, not yours), you aren't going to get a great eval to the extent the resident gets input.

And no it's not "dangerous" to miss a meal during call, unless you are severely nutritionally deprived. Many of us have missed or delayed meals on every call. The human body can go well over 24 hours without food.

Click to expand...

Whatever. I may be mired in crap, but that doesn't mean that people who are a) paying for the privilege of being there and who b) more importantly, don't have the power to help with my work should be forced to suffer. Sure, those granola bars will hold them for an hour or two, but I wholly endorse them running to the cafeteria if they have time to actually eat a meal.

I get really stupid/slow/confused when I approach 8 consecutive hours without a food break. Even the healthy meal bars I like to eat only bring me back to normal for couple hours. After that, it's back to stupid, slow, and confused. But then again, I guess that's not dangerous in your opinion. Certainly not a problem for my patients if the physician evaluating them is feeling that way.

Law2Doc said:

Speaking from my own experience, it's definitely annoying when you are busy and the med students say "is it okay if I go off to eat, study", etc, while you still have a ton to do before you are going to be able to take anything resembling a food break.

Click to expand...

I love how quickly some people forget what it was like to be a med student. Didn't you just graduate? You've been a resident for 1 or 2 months and suddenly you have experience.


The med student is there for one thing and one thing only: to learn. They are not there to make your workload easier. I hate when people make them stay up because they have to. In the OP's situation, nobody is an A-hole, the resident is just a whiny b**** who should have said something to your face, not behind your back.

Law2Doc said:

You don't get the culture at many places. No resident is going to say "no you can't go eat". That would be being an "a hole", and very few would do that. But clearly asking to go eat in this case was the wrong call under the culture based on the result. Speaking from my own experience, it's definitely annoying when you are busy and the med students say "is it okay if I go off to eat, study", etc, while you still have a ton to do before you are going to be able to take anything resembling a food break. So it's not going to be well received when the med student runs off for food, leaving you to plow on with the work. I agree with the others that offering to pick something up for the resident might have softened the blow, but again this depends on the culture as well. This is why med students really should carry a granola bar or something in their pockets, and wait until the residents eat to eat something more substantial. Maybe this is "complete crap", but if you are perceived as the person who always runs off for three squares while there is work to be done (in the resident's opinion, not yours), you aren't going to get a great eval to the extent the resident gets input.

And no it's not "dangerous" to miss a meal during call, unless you are severely nutritionally deprived. Many of us have missed or delayed meals on every call. The human body can go well over 24 hours without food.

Click to expand...

We're going to have to agree to disagree. If the resident said yes in the first place then he should have kept his mouth shut when the student returned. If the student made a mistake by asking, then the resident, doesnt need to make an equal mistake by being passive agressive. There is no culture there, its being professional. If the student was unprofessional, the resident being unprofessional and griping about it after the fact does nothing but breed animosity.

If there was work to be done, why didnt the resident say anything? We re all adults, we re all professionals just tell the damn student yes or no.

Yea I'm going to eat at appropriate/down times when I'm hungry. On a rotation my only real job is to learn. I'm not getting paid nor am I responsible for any real work. I could care less what the resident or 'the team' thinks. I'm not going to play their game.

Hey OP, the only mistake you made was asking if you were allowed to eat or not. Next time don't ask.

How bitter do I sound? I swear when I started med school I wasn't like this.

There are a few unknowns here:

1) we will never know if there really was work to do that the resident wanted the OP's help with

2) what the culture is at that program.

What we can, or perhaps should agree upon, is that if you are with a colleague, friend or family member who is working hard and you mention that you are going to get some food (or ask permission - the way it is presented isn't important here), it is basic good manners to ask if you can bring them something as well. When my SO gets up to get a drink, he asks if I would like something and I have two good legs and am usually just lazing about. It would be doubly important if I was swamped with work.

I don't see this situation as any different. Perhaps he was pissed because you didn't ask if you could bring something, perhaps he was pissed because he's a passive aggressive arse, or perhaps you read too much into his response. I'd suggest next time you offer to bring your overworked colleagues something - as others have noted, he might have paid for both of you.

ZagDoc said:

Ditto this. Most night teams I've been on try to eat as a group, often multitasking by running the list while you do it.

It's a hierarchy this, unfortunately. Even if you have nothing going on, if the intern/resident is too busy to go eat, you shouldn't go eat. Everyone's hungry.

Click to expand...

I disagree.

If you have not eaten in over 6 hours, go eat. If they want to make a comment to you or hold it against you, so be it.

AmoryBlaine said:

Not eating on call is dangerous and stupid. It's part of a little victimhood game that some residents like to play.

Click to expand...

Exactly.

IF YOU'RE HUNGRY GO EAT. It is as simple as that.

If they complain, speak to the Dean of Students and let them know the resident is not allowing you to eat.

Problem solved.

UnderdogMD said:

Hey OP, the only mistake you made was asking if you were allowed to eat or not. Next time don't ask.

Click to expand...

Exactly.

If you're hungry, go eat.

If the resident wants to dock me points, so be it.

vir0n said:

I am curious if others have run into a similar situation. You are on call and hungry. There is some down time so you ask you resident for a quick bite. They say sure and u run off. You come back 15 minutes later to guff and comments about your food break. Has anyone run into this situation before? Am I at fault for getting food? Is it rude for me to eat? Who is the a-hole here?

Click to expand...

You were right to eat but it's probably a good idea to bring a cookie or a small treat next time. Residents are moody creatures.

It sounds like your program's culture is that you should eat at the same time of the resident. That's the same with mine... if we're not eating together, we're eating only when the resident takes off to eat, or we just eat at the computer while working. My hospital basically never has food past 3 pm anyway... It's the same with going home--we don't usually leave until the residents are done.

sprinkibrio said:

It sounds like your program's culture is that you should eat at the same time of the resident. That's the same with mine... if we're not eating together, we're eating only when the resident takes off to eat, or we just eat at the computer while working. My hospital basically never has food past 3 pm anyway... It's the same with going home--we don't usually leave until the residents are done.

Click to expand...

Yeah, meal times are usually with the residents but it depends on the situation. The resident may be just as hungry but can't eat due to the workload, so it's a good idea to bring a small snack or maybe a styrofoam container filled with food next time. The resident should give the student money or meal tickets with which to purchase his or her own meal.

When I was a resident, the students and I would all order food from outside and then eat in the lounge or in the cafeteria. It's a good time to unwind and socialize with the rest of the team or maybe go over a few short topics on whatever interests the students.

If it's busy, I wouldn't ask to get food
If it's not busy and you're hungry, I would ask if anyone else wants anything to eat so that you're being a team player; I would also ask if anyone wants to go down to get food; I would also ask if it would be OK to go grab something to eat
If you're hungry and have nausea, just stating you have nausea and you need something to eat will be accepted as a good enough reason

If you get food, bring it back to the call room to eat. That way you can run off with the team if necessary
If you bring food to the call room but noone else is eating, ask if anyone wants a piece

Just ask yourself? Am I being a team player?
If you think everything is fine but come back to a nasty group of complaining residents, it's not your fault. They should have said something earlier.

Things that nobody who isn't a crashing patient can stop me from doing, regardless of heirarchy:

1. Ingesting nutrients and water
2. Urination
3. Defication
4. Sleep

Medical students have one primary function, and that is to learn. Hanging off the butt of a disenfranchised resident as he hums and haws about stuff you cannot participate in isn't learning, its inefficient time wasting.

Screw the hierarchy. If he had the "respect" to not eat and crap when he was a med student and expects the same from you, that's his problem, not yours.

Heck, I'd give you props if you were to call him on his BS.

Originally Posted by UnderdogMD
Hey OP, the only mistake you made was asking if you were allowed to eat or not. Next time don't ask.

Click to expand...

Truer words were never spoken.

First of all, if it was truly downtime, I doubt the resident would have any ill feeling. Odds are she wasn't surfing facebook when you asked. She was probably doing important tasks for her patients, and you weren't doing anything to help. If your resident is doing work, and you are standing around, just assign yourself a role. For example, I'm going to fill out this urology consult for Mr. Smith, I'm going to go check labs for the list, I'm going to look up that chemo protocol for Ms. Jones, etc, etc. I think a lot of people on this thread are overestimating the number of activities which are resident-only. If they are busy, there is probably plenty you can and should be helping with.

That said, some residents do need to do a better job taking care of their med students. It is much appreciated when a resident confirms that you got a chance to eat or gives you a break if there is truly nothing going on.

Remember, this isn't about you you you. This is about patients, then team, then you. You may feel entitled by your tuition dollars, but believe me, the resident who is making minimum wage to work double your hours, and is struggling to pay off that same tuition will have little sympathy for you. Some missed meals and sleep are a part of this.

Yes, but the resident is getting PAID, while the medical student is PAYING. The resident is there to work AND learn, while the primary purpose of the medical student should be to learn, not ease the workload of the resident.

SeminoleFan3 said:

Yes, but the resident is getting PAID, while the medical student is PAYING. The resident is there to work AND learn, while the primary purpose of the medical student should be to learn, not ease the workload of the resident.

Click to expand...

Actually no. The primary role of BOTH the residents and the students is to take care of the patients on the service. The secondary role of BOTH the residents and the students is to learn. Remember, they are in training too. Tertiary problems are figuring out when to eat and worrying about who is getting a paycheck. Asking for food when patient care is going on just shows that you don't have your priorities correctly aligned.

cpants said:

Remember, this isn't about you you you. This is about patients, then team, then you. You may feel entitled by your tuition dollars, but believe me, the resident who is making minimum wage to work double your hours, and is struggling to pay off that same tuition will have little sympathy for you. Some missed meals and sleep are a part of this.

Click to expand...

I've had an ATTENDING tell me the order is YOURSELF then patients with the reasoning of if you aren't healthy you can't make your patients healthy. Best advice ever.

SeminoleFan3 said:

Yes, but the resident is getting PAID, while the medical student is PAYING. The resident is there to work AND learn, while the primary purpose of the medical student should be to learn, not ease the workload of the resident.

Click to expand...

Nah, medicine is an apprenticeship type field. You learn by doing work as much as anything else. The whole point of rotations is to get med students some quasi residency experience. Don't expect it to somehow be cushy because you are paying for it. Expect it to be hard or you aren't getting your money's worth. I mean on a slow night where the team is sitting around eating and BSing, it's only the med students who are getting cheated.

Don't get me wrong, I understand that it should be hard. But, that by no means should translate into not eating if you can find a second (even if your resident can't). By virtue of the M.D. initials after their name, they can do significantly more than you can, which means they'll have more to do. At MY school, it's clearly stated that the medical student's primary goal is to learn and be taught, not to be some workhorse for the resident. Is there work involved? Yes. Is that our primary job? No. I realize that you learn by doing, but doing something just because your resident is is pointless.

sprinkibrio said:

It sounds like your program's culture is that you should eat at the same time of the resident. That's the same with mine... if we're not eating together, we're eating only when the resident takes off to eat, or we just eat at the computer while working. My hospital basically never has food past 3 pm anyway... It's the same with going home--we don't usually leave until the residents are done.

Click to expand...

Yeah, it sounds like a lot of people on here aren't familiar with this kind of culture, which isn't all that uncommon. A culture where you simply never should ask as a med student, can I go eat, can I go home, etc. The residents in such a culture get to be magnanimous and let you go early, or tell you when to go eat, but it's sort of considered against culture for you to ask. Right or wrong this is the longstanding culture at some places. Don't underestimate, or think you can unilaterally change a program's culture.

EM2BE said:

I've had an ATTENDING tell me the order is YOURSELF then patients with the reasoning of if you aren't healthy you can't make your patients healthy. Best advice ever.

Click to expand...

It is indeed good advice. I'm sure that attending would find your interpretation interesting, however. Trust me, his advice did not mean take your lunch when you feel like it and worry about patient care duties later.

cpants said:

It is indeed good advice. I'm sure that attending would find your interpretation interesting, however. Trust me, his advice did not mean take your lunch when you feel like it and worry about patient care duties later.

Click to expand...

I'm not sure that's what the poster was advocating (although, who knows, it very well could be). Instead, I think he was trying to say that if he gets a chance to eat (even though everyone else may not), he should go *quickly* grab a bite to eat while he has the time before that time passes him by and he has much more work to do. Just because you get hungry at 11 o'clock doesn't mean you should drop everything to go eat lunch. It may be more like 1 or 2 before you get anything, but I think the attending was trying to get across the point that you do no one any good (as a medical student) if you wait until 4 or something to eat when YOU could have eaten sooner.

SeminoleFan3 said:

I'm not sure that's what the poster was advocating (although, who knows, it very well could be). Instead, I think he was trying to say that if he gets a chance to eat (even though everyone else may not), he should go *quickly* grab a bite to eat while he has the time before that time passes him by and he has much more work to do. Just because you get hungry at 11 o'clock doesn't mean you should drop everything to go eat lunch. It may be more like 1 or 2 before you get anything, but I think the attending was trying to get across the point that you do no one any good (as a medical student) if you wait until 4 or something to eat when YOU could have eaten sooner.

Click to expand...

Exactly the point. And applies to much more than just eating.

sprinkibrio said:

It sounds like your program's culture is that you should eat at the same time of the resident. That's the same with mine... if we're not eating together, we're eating only when the resident takes off to eat, or we just eat at the computer while working. My hospital basically never has food past 3 pm anyway... It's the same with going home--we don't usually leave until the residents are done.

Click to expand...

cpants said:

It is indeed good advice. I'm sure that attending would find your interpretation interesting, however. Trust me, his advice did not mean take your lunch when you feel like it and worry about patient care duties later.

Click to expand...

Yeah,and you will also come to realize that attendings come in and say lots of things like that, but will rely on the senior resident to run things, and will be quick to back that person over you. This attendings only really dictate the rules while they are in the room.

EM2BE said:

Exactly the point. And applies to much more than just eating.

Click to expand...

Out of curiosity, to what else besides eating does it apply? Sleep? Study needs?

If that's your philosophy, go with it. Just know that many residents won't think highly of the my-needs-first attitude. Obviously, no one cares if you excuse yourself to the bathroom for a few minutes, or eat a quick snack that you have in your white coat pocket. Realize, however, that excusing yourself for a lunch break while the team is working will not look good to a lot of people. Grabbing a couple hours of sleep on call while the residents are doing consults-- the same thing. If you want to be considered part of the team, you should act like it.

cpants said:

First of all, if it was truly downtime, I doubt the resident would have any ill feeling. Odds are she wasn't surfing facebook when you asked. She was probably doing important tasks for her patients, and you weren't doing anything to help. If your resident is doing work, and you are standing around, just assign yourself a role. For example, I'm going to fill out this urology consult for Mr. Smith, I'm going to go check labs for the list, I'm going to look up that chemo protocol for Ms. Jones, etc, etc. I think a lot of people on this thread are overestimating the number of activities which are resident-only. If they are busy, there is probably plenty you can and should be helping with.

That said, some residents do need to do a better job taking care of their med students. It is much appreciated when a resident confirms that you got a chance to eat or gives you a break if there is truly nothing going on.

Remember, this isn't about you you you. This is about patients, then team, then you. You may feel entitled by your tuition dollars, but believe me, the resident who is making minimum wage to work double your hours, and is struggling to pay off that same tuition will have little sympathy for you. Some missed meals and sleep are a part of this.

Click to expand...

This is the entirely wrong martyr attitude that has plagued medicine for decades.

First of all, the medical student's primary role is to LEARN MEDICINE. It is NOT patient care. Think about it for a second - med students are legally unable to provide true patient care, and they are too inexperienced to do it anyway.

While on call, if a medical student is evaluating a patient's complaint, he is doing so to LEARN about medicine. He is DEPENDING on the RESIDENT to provide the true patient care and to TEACH the medical student the correct way to do things. If a patient is crashing, the medical student is making ZERO decisions on that patient's management if there is a true doctor within a reasonable radius.

Medical student learning goes something like this, in simple terms: the student READS SOMETHING, and then the student applies the readings to clinical and diagnostic situations in the presence of a supervisor. Doing it the other way around is learning by dogma, not by principles.

If a medical student is too busy wasting time getting overly verbose histories from fibromyalgics, filling out lab/consult requisitions for myriad patients(and other paperwork), pleading with nurses to put in patient lines, pleading with pharmacy to give TPN on the weekends, and pleading with the OR booking nurse that patient X needs an urgent surgery, all on no sleep or food, then that student WILL NOT HAVE TIME TO READ and will NOT KNOW ANY PRINCIPLES OF MEDICINE. God help the poor patients when that student becomes a resident and actually has to KNOW STUFF.

It's the residents job to treat patients. It's the medical students duty to learn about medicine. It's nobody's duty to become martyrs.

During my GS/trauma rotation, I regularly sent the students to sleep, eat, or read if I was babysitting in the ER. When something wasn't capturing my attention as a student, I would become acutely aware of how miserable call was. It's those moments I'd like to avoid for the students now. If there's work to be done, they'll do it. But if it's scut or waiting for a dispo, then I cut 'em loose. It'll be them in my shoes (Crocs) soon enough. Why make them miserable for no reason now?

Substance said:

This is the entirely wrong martyr attitude that has plagued medicine for decades.

First of all, the medical student's primary role is to LEARN MEDICINE. It is NOT patient care. Think about it for a second - med students are legally unable to provide true patient care, and they are too inexperienced to do it anyway.

While on call, if a medical student is evaluating a patient's complaint, he is doing so to LEARN about medicine. He is DEPENDING on the RESIDENT to provide the true patient care and to TEACH the medical student the correct way to do things. If a patient is crashing, the medical student is making ZERO decisions on that patient's management if there is a true doctor within a reasonable radius.

Medical student learning goes something like this, in simple terms: the student READS SOMETHING, and then the student applies the readings to clinical and diagnostic situations in the presence of a supervisor. Doing it the other way around is learning by dogma, not by principles.

If a medical student is too busy wasting time getting overly verbose histories from fibromyalgics, filling out lab/consult requisitions for myriad patients(and other paperwork), pleading with nurses to put in patient lines, pleading with pharmacy to give TPN on the weekends, and pleading with the OR booking nurse that patient X needs an urgent surgery, all on no sleep or food, then that student WILL NOT HAVE TIME TO READ and will NOT KNOW ANY PRINCIPLES OF MEDICINE. God help the poor patients when that student becomes a resident and actually has to KNOW STUFF.

It's the residents job to treat patients. It's the medical students duty to learn about medicine. It's nobody's duty to become martyrs.

Click to expand...

I agree with you to a certain extent. It's no one's job to be a martyr. I guess I just don't agree that missing lunch once in a while turns one into a martyr.

Having students spend all their time doing scut work is obviously inappropriate. Doing some work of this sort is valuable to the students both as learning experience in how to operate as a resident and also as a way to free up more time for the residents to teach them and help them to learn the trade. While you may not expect or demand it, I'm sure you appreciate it when a student does get something done for their patient or to help the team.

You are basically trying to paint it as two extremes, one in which the student functions as somewhere below an intern, essentially running errands for the team with no breaks, the other in which the student is in a pure learning environment, observing and learning at their leisure with no real responsibilities other than to learn. The reality should be somewhere in between. The student should be learning as much as possible while trying to be an asset to the team and to their patients.

It sounds like you care about your students, and they are lucky to have you. However, I think your attitude is on the more liberal side of the spectrum. I stand by the fact that in most cases it is inappropriate to take a requested lunch break when your team is running the list. I have heard the same from most attendings, residents, and more senior students. The advice is usually stuff like: "On call, when your intern is up, you should be up." and "You don't belong drinking coffee and reading in the library while your team is working". Active attendance for most of the resident work day is a pretty universal expectation, at least at my hospital.

tkim said:

During my GS/trauma rotation, I regularly sent the students to sleep, eat, or read if I was babysitting in the ER. When something wasn't capturing my attention as a student, I would become acutely aware of how miserable call was. It's those moments I'd like to avoid for the students now. If there's work to be done, they'll do it. But if it's scut or waiting for a dispo, then I cut 'em loose. It'll be them in my shoes (Crocs) soon enough. Why make them miserable for no reason now?

Click to expand...

I totally agree that if you have nothing for them to do, as a resident, you should cut them loose. Be magnanimous. But it's you as resident (or whoever is the most senior around) who makes that call. It's absurdly inappropriate (at least under the culture of the several programs I have worked at) for the med student to come to the resident and ask. I'm sure other places have different cultures, but know that this one is out there and probably not rare.

Substance said:

...
First of all, the medical student's primary role is to LEARN MEDICINE. It is NOT patient care. Think about it for a second - med students are legally unable to provide true patient care, and they are too inexperienced to do it anyway.

While on call, if a medical student is evaluating a patient's complaint, he is doing so to LEARN about medicine. He is DEPENDING on the RESIDENT to provide the true patient care and to TEACH the medical student the correct way to do things. If a patient is crashing, the medical student is making ZERO decisions on that patient's management if there is a true doctor within a reasonable radius.

Medical student learning goes something like this, in simple terms: the student READS SOMETHING, and then the student applies the readings to clinical and diagnostic situations in the presence of a supervisor. Doing it the other way around is learning by dogma, not by principles.
...

Click to expand...

Actually the whole point of switching from lecture/book learning to the more apprenticeship style clerkship in third year is that learning from real life is more useful than book learning at this point. You spend the first two years getting a background/foundation, and then third year is where you get clinical exposure. So being there when the patient is crashing, or when residents and attendings are talking about patient management, or even writing SOAP notes where you try to glean the plan for the patient, is going to be important learning opportunities. The reading phase was largely accomplished, or should have been, during the first two years of med school, so you will never be in your situation where the student is learning by dogma, not principles. He has the principles somewhere in his/her head already simply from passing two years of med school and passing Step 1. Now it's about seeing it in application, and in his/her spare time refreshing things in prep for the day to day patients and the shelf. So by the time you get to third year, the real value is going to be being on the wards, seeing what goes on, following the residents and trying your had at writing H&Ps, notes, discharge documentation, scrips, talking to patients, and various procedures. All of these are important, and you learn from all of them. Don't get into the whole -- I'm paying $200k for med school so I don't want to waste my time writing notes or trying to get social work on the phone -- attitude. This IS what you are paying for. It's useful medical education to see what residents do, and help the team get stuff done, related to patient care. Even if it doesn't always seem like it. It's an apprentice system, a kind of educational system that started back in the middle ages. You learn a trade by being the peon for someone in that trade. It's a tried and true educational system that works, and something medicine adopted years ago.

Law2Doc said:

I totally agree that if you have nothing for them to do, as a resident, you should cut them loose. Be magnanimous.

Click to expand...

It's astonishing that even when you begrudgingly make the most obvious concession, you act as if that would be "magnanimous" behavior by the resident.

It is ridiculous to keep a med student from eating lunch. They can eat in 15 minutes or less, and they can be following up on labs/consults/nursing notes on the computer while doing it.

I think the culture of medical education at institutions such as Law2Doc's is backward, stupid, and breeds bitterness and arrogance. There is no way that anyone can argue that programs where students aren't given equal rights put out better students that those who treat students with basic respect.

I'm not saying that getting lunch will necessarily make a med student a better physician, but I bet it will make the student less bitter about their medical education, and with burnout being such an issue in medicine, I guess I'd rather have people start hating medicine later rather than eariler.