101 Biggest Mistakes 3rd Year Medical Students Make

[jakstat33]

Has anyone read this book, and what did you think?

101 Biggest Mistakes 3rd Year Medical Students Make: And How to Avoid Them by Samir P. Desai

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[LovelyRita]

No, but let's hear the highlights. 3rd year is right around the corner!

 

[Samir Desai]

As the author of the book, I can certainly provide you with more information about the book. As its name suggests, the book focuses on the mistakes that students make during their 3rd year of med school. The impetus for the writing of the book came from my own experiences as a faculty member in the Department of Internal Medicine at the Baylor College of Medicine. There, I have had the great opportunity of working with students during their clinical years of medical school. In the five years that I have been there, I have seen students make the same mistakes year after year. When I look closely back at my own medical education at Wayne State University, I can recall making the same mistakes.

When I realized that my own students were repeating my mistakes, I thought that there might be a need for a resource that could educate students about their predecessors' mistakes. The idea being that once you are familiar with these mistakes, you can do everything in your power to avoid them, thereby becoming a student who is poised for clerkship success. By avoiding these mistakes, it was my hope that the book would help students earn better clerkship grades/evaluations, more favorable comments from evaluators, and stronger letters of recommendation. All of this, of course, is important when you are applying for residency. Another goal of the book (and no less important!) was to help students build the foundation needed for success during their career as physicians. After all, that's what the third year is all about.

The book was based not only my own experiences but also based on communications that I had with attending physicians and residents across the country. Since being published in 2002, I would like to share with you what this book does and doesn't do. Here's what it does do:

1) Identifies 101 biggest mistakes that students make during the 3rd year
2) These are mistakes made before the rotation starts, early in the rotation, when admitting patients, with residents and interns, during attending rounds, when presenting newly admitted patients, on write-ups, and when giving talks. Basically, these are the areas in which you will be evaluated.
3) It not only identifies the mistakes but offers suggestions and advice on how to avoid them

The book's information is generally applicable to all rotations. It does not, however, get into the specifics of a particular rotation. For specific information about rotations, you might want to consider First Aid for the Wards. This book was meant to complement books like First Aid for the Wards rather than replace it.

For those of you who are interested in mistakes made during the Internal Medicine clerkship, I recently coauthored a book called the "Internal Medicine Clerkship: 150 Biggest Mistakes And How To Avoid Them." This book provides very detailed information about the IM clerkship, offering advice about working up patients, prerounding, work rounds, attending rounds, write-ups, oral case presentations, etc., as it pertains to the IM clerkship.

Sorry for the long post but I hope that I have been helpful. I hope others will repond to your question as well. For those of you who have used the book and those of you who will, please feel free to provide me with feedback. Your feedback will be helpful to me in shaping future editions of the book.

Thanks,

Samir Desai, MD

 

[DRealDrZ]

I purchased the book and have gone through it. It is just like was posted...a very good addition to FA for the Wards. It doesn't walk you through everything, but rather helps you out and hopefully avoid some mistakes. I thought it was a pretty good book.

 

[Vincristine]

I think I got it cheap, but otherwise I'd recommend checking it out of the library. It's one of those quick reads that you're not likely to read again. However, it's certainly worth going through before you hit the wards especially if your sense isn't so common.

 

[Fermi]

I think I got it cheap, but otherwise I'd recommend checking it out of the library. It's one of those quick reads that you're not likely to read again. However, it's certainly worth going through before you hit the wards especially if your sense isn't so common.

I agree that much of it is "common sense." Another good book is
How To Be A Truly Excellent Junior Medical Student, which is in the same vein. The author of that book said that he always gave the book to his students before his rotation, and they usually returned it to him saying that everything in it is completely obvious. However, he noted that by the end of the rotation the students were back to making all the same mistakes they thought were so obvious in the book. Hence, he recommended keeping a copy and reviewing the tips every so often to make sure you're not slipping back into bad habits.

 

[Yosh]

I actually have both of them...and found them useful in general. Having both was a bit overkill....but if you can get them cheap or used...by all means

Again...I will not read them again....but it was good for a once over.

 

[Jaded Soul]

I have to add to the general sentiment here. I own Dr. Desai's book and also "How to be a Truly Excellent Junior Medical Student." Bought them both to quell the anxiety right before third year started. They did make me feel a better at the beginning, but now they don't have much use to me anymore.

If your library has them, that's the way to go. If your bookstore has them, they are so short you can sit in there, skim them, and get the gist. If you have to buy, try to get them used. The price especially for "101 Mistakes" is too high for the info it has.

 

[Samir Desai]

Fermi makes a really good point. I did receive feedback from an attending at UCSF who has his clerkship students read the book at the start of the rotation. He mentioned that the students consider some of the mistakes to be common sense. He then went on to tell me that they would make those same mistakes just 1-2 weeks later in the rotation. In particular, the students were making the same mistakes on their oral case presentations and write-ups. After encouraging his students to read those particular chapters every week, he noticed improvement.

I also agree that some of the mistakes are common sense. For example, mistake # 43 is titled "lack of enthusiasm". The point that I make here is that attending physicians and residents are more likely to be impressed with enthusiastic students. They are not expecting you to function at an intern or resident level (although you should always strive for that) but one way you can outshine residents is by being enthusiastic and showing a passion for learning.

That seems like common sense but for those of you who are on rotations, I encourage you to look at your fellow students during rounds to see how enthusiastic they come across. I am willing to bet that you will see some students who are very enthusiastic, some who seem interested, some who seem disinterested, and some that are off in their own world. Yet if you ask all of these students about the importance of enthusiasm, almost all will agree that it's important. The lack of enthusiasm may be due to any of a number of factors, including lack of interest in the subject matter/rotation, fatigue, lack of sleep, illness, etc. But the bottom line is the mistake is being made. Some of these students will realize (on their own) that they are not enthusiastic while others may be interested in rounds but they may be perceived as being disinterested because of the way they conduct themselves verbally and/or nonverbally (eg., poor posture, not asking questions, monotonous voice, lack of eye contact). The point here is that even though it makes sense to be enthusiastic, it's not always easy to practice it consistently and even when you think you are, it may not be perceived that way.

In summary, mistakes that seem like common sense can and are repeated even when students are familiar with them. If you are on your guard and are in the habit of examining your performance regularly in different aspects of the rotation (attending rounds, oral case presentations), you will pick up on mistakes that you keep making. You can then focus your efforts on avoiding them.

Samir Desai, MD

 

[Anasazi23]

...they may be perceived as being disinterested because of the way they conduct themselves verbally and/or nonverbally (eg., poor posture, not asking questions, ....

I don't think I opened my mouth once on my ob/gyn rotation. If you hate something, you hate it. Sometimes fake enthusiasm can be worse than genuine over-enthusiasm.

 

[scootad.]

just wait till you get your grade

3rd year is ALL about fake enthusiasm.

 

[Wednesday]

Poor posture! I am as interested and enthusiastic as they come but sometimes my back just hurts!

Hmm, perhaps my back isn't as enthusiastic as it should be...

 

[Samir Desai]

I don't think I opened my mouth once on my ob/gyn rotation. If you hate something, you hate it. Sometimes fake enthusiasm can be worse than genuine over-enthusiasm.

Like Anasazi23, I too wasn't crazy about my ob/gyn rotation. But even in ob/gyn, there were things that I found enjoyable. Maybe an interesting disease or illness. Or picking up on a physical exam finding that I had only read about but never appreciated. When you are excited or interested about something, you can definitely share that with your team. After all, your attending, resident, and intern have decided to make that specialty their career. It seems natural that they would appreciate it when students take an interest or are enthusiastic about their field.

Now, I'm not an advocate of fake enthusiasm. I recognize that personalities differ. Some people have effervescent personalities while others are more reserved. But regardless of your personality type, if you are interested in something, by all means, show it. There are different ways to show you're interested - sometimes, it can be as simple as making eye contact with the attending during rounds while sitting up straight and leaning slightly forward. I know when I look at the students on my team during rounds, I do pay attention to what they are doing. They might be interested in what I'm saying but if they are not making eye contact or are lazily sitting in their chair, an attending like myself might conclude that the student is bored or disinterested. Don't forget the importance of how you communicate nonverbally.

Samir Desai, MD

 

[Masonator]

Fermi makes a really good point. I did receive feedback from an attending at UCSF who has his clerkship students read the book at the start of the rotation. He mentioned that the students consider some of the mistakes to be common sense. He then went on to tell me that they would make those same mistakes just 1-2 weeks later in the rotation. In particular, the students were making the same mistakes on their oral case presentations and write-ups. After encouraging his students to read those particular chapters every week, he noticed improvement.

I also agree that some of the mistakes are common sense. For example, mistake # 43 is titled "lack of enthusiasm". The point that I make here is that attending physicians and residents are more likely to be impressed with enthusiastic students. They are not expecting you to function at an intern or resident level (although you should always strive for that) but one way you can outshine residents is by being enthusiastic and showing a passion for learning.

That seems like common sense but for those of you who are on rotations, I encourage you to look at your fellow students during rounds to see how enthusiastic they come across. I am willing to bet that you will see some students who are very enthusiastic, some who seem interested, some who seem disinterested, and some that are off in their own world. Yet if you ask all of these students about the importance of enthusiasm, almost all will agree that it's important. The lack of enthusiasm may be due to any of a number of factors, including lack of interest in the subject matter/rotation, fatigue, lack of sleep, illness, etc. But the bottom line is the mistake is being made. Some of these students will realize (on their own) that they are not enthusiastic while others may be interested in rounds but they may be perceived as being disinterested because of the way they conduct themselves verbally and/or nonverbally (eg., poor posture, not asking questions, monotonous voice, lack of eye contact). The point here is that even though it makes sense to be enthusiastic, it's not always easy to practice it consistently and even when you think you are, it may not be perceived that way.

In summary, mistakes that seem like common sense can and are repeated even when students are familiar with them. If you are on your guard and are in the habit of examining your performance regularly in different aspects of the rotation (attending rounds, oral case presentations), you will pick up on mistakes that you keep making. You can then focus your efforts on avoiding them.

Samir Desai, MD

It always makes me shake my head when I see people being graded by how interested they appear to be rather then how interested they actually are. I guess 3rd year rewards acting skills as much as intellectual interest. I think this is a pretty sad state of affairs.

 

[GeddyLee]

you should all be so enthusiastic as to spontaneously orgasm at the very sight of your seniors. Not showing fake enthusiasm is the sure kiss of death on your third year rotations.

 

[VienneseWaltz]

It always makes me shake my head when I see people being graded by how interested they appear to be rather then how interested they actually are. I guess 3rd year rewards acting skills as much as intellectual interest. I think this is a pretty sad state of affairs.

The attendings can't read people's minds. I think the point was to pay attention to what you're communicating with body language, which is something you should be aware of with your patients, too. I'd call it people-skills rather than acting skills.

 

[kinetic]

Start humping his leg. That'll show him your enthusiasm.

 

[Masonator]

The attendings can't read people's minds. I think the point was to pay attention to what you're communicating with body language, which is something you should be aware of with your patients, too. I'd call it people-skills rather than acting skills.

I'm sorry but when you are being graded on eye contact, poise, posture, facial expressions, and smiling then you are being graded with the same criteria as contestants on the miss America pageant. I have a great idea, if you want to find out how interested a medical student is, how about talking to them!! It's a pretty novel concept I know, yet many attendings feel this is beneath them.

 

[irlandesa]

I think it is very difficult to demonstrate interest in certain situations; for example, when a PA student in your OB/GYN group is constantly opening her mouth just to hear herself talk so that no one else can get a word in edgewise, or in surgery rounds at 6 AM when the residents are running around with chickens with the head cut off and don't have time to listen to your questions..
I don't think getting sleepy during rounds once or twice will kill your performance (tho as random as the grading system can be I wouldn't eliminate the possibility). I even saw the Chairman of Surgery snoozing away during M&M rounds at 3:30 on a Friday afternoon; it was pretty funny.

Has anyone ever seen a book about the 100 top mistakes that residents (esp. interns) make? Someone should really write one; there is plenty of material out there, believe me. Here are a few of mine:
1)Thinking that a big gob of wax in your patient's ear constitutes otitis media.
2)Failing to read and consider the med student note (after signing it and NOT seeing the patient), then failing to check relevant labs (after the MD student pointed an abnormality out to you 3x) b/c you have "postpartum issues."
3)Yelling at med students over tiny mistakes in front of patients, nurses, and families.
4)Telling the med students to write down vitals for patients they don't know and are not responsible for, then proceed to read the vitals aloud off the sheet after the students went to all that trouble in addition to seeing their own patients before 5 am.
5)Lying to a student's face about how they performed then have the course director tell them the truth. how frickin cowardly, grow up Peds residents at NEMC!
6)Providing vague or no feedback at all. Yes, we should try to ask more, but it seems a little much for me to be constantly asking what I can do better and never expecting to hear about what I can do well for 40K tuition a year.
7)Talking about other residents and how terrible they are behind their back in the presence of students and patients.
8)Not showing up on the day the course director asks you to be present to fill out an evaluation form for all the students you supervised, and getting away with it. Ever heard of certain responsibilities going along with working in a teaching hospital?

anyone have any other good ones?

 

[scootad.]

I'm sorry but when you are being graded on eye contact, poise, posture, facial expressions, and smiling then you are being graded with the same criteria as contestants on the miss America pageant. I have a great idea, if you want to find out how interested a medical student is, how about talking to them!! It's a pretty novel concept I know, yet many attendings feel this is beneath them.

Bravo! You've hit the nail on the head. Many attendings couldnt be bothered to actually initiate coversation w/ a med student although this would be the most accurate way to assess their knowledge of a given topic. Instead its all about that fake smile, those lame winks and shameless attempts to say anything (even if not at all relevant to the topic) just to prove that one is not a mute. Its a ridiculous system.

 

[Masonator]

I think it is very difficult to demonstrate interest in certain situations; for example, when a PA student in your OB/GYN group is constantly opening her mouth just to hear herself talk so that no one else can get a word in edgewise, or in surgery rounds at 6 AM when the residents are running around with chickens with the head cut off and don't have time to listen to your questions..
I don't think getting sleepy during rounds once or twice will kill your performance (tho as random as the grading system can be I wouldn't eliminate the possibility). I even saw the Chairman of Surgery snoozing away during M&M rounds at 3:30 on a Friday afternoon; it was pretty funny.

Has anyone ever seen a book about the 100 top mistakes that residents (esp. interns) make? Someone should really write one; there is plenty of material out there, believe me. Here are a few of mine:
1)Thinking that a big gob of wax in your patient's ear constitutes otitis media.
2)Failing to read and consider the med student note (after signing it and NOT seeing the patient), then failing to check relevant labs (after the MD student pointed an abnormality out to you 3x) b/c you have "postpartum issues."
3)Yelling at med students over tiny mistakes in front of patients, nurses, and families.
4)Telling the med students to write down vitals for patients they don't know and are not responsible for, then proceed to read the vitals aloud off the sheet after the students went to all that trouble in addition to seeing their own patients before 5 am.
5)Lying to a student's face about how they performed then have the course director tell them the truth. how frickin cowardly, grow up Peds residents at NEMC!
6)Providing vague or no feedback at all. Yes, we should try to ask more, but it seems a little much for me to be constantly asking what I can do better and never expecting to hear about what I can do well for 40K tuition a year.
7)Talking about other residents and how terrible they are behind their back in the presence of students and patients.
8)Not showing up on the day the course director asks you to be present to fill out an evaluation form for all the students you supervised, and getting away with it. Ever heard of certain responsibilities going along with working in a teaching hospital?

anyone have any other good ones?

Right on sista!! We have some good resident hatin' goin' on!!! I have been through all of the same **** you have, and probably at some of the same hospitals. That is why I get pissed when some guy says how I need to improve my eye contact and posture in order to get honors.

I'm inferring that you are doing OB/GYN at NEMC. I did it there and it was a brutal rotation. Hang in there, it is only 6 weeks. Don't worry about your grade. It won't matter unless you want to do OB/GYN. Feel free to keep postin about your 3rd year hatin'. We all love to hear it.

I think I'm going to write a book called, the top 100 things that medical students hate about their clinical years!

 

[Al Pacino]

I have both of Dr. Desai's books, and I found them very helpful in shaping me to be a better doctor and person to my future patients; they show you what a PROFESSIONAL should do and act.

However, the books don't promise the readers that applying all the principles will guarantee HONORS. As I've stated in other threads, HONORS has SOME correlation with fund of knowledge, professionalism, or hard work. However, unless the evaluators deem you to fit the "profile" of an honors students, you probably won't honor. You may do all the things that someone with honors would do, but if you don't fit the prototypical image of an honors student, you won't honor.

An example is a rubber duck with yellow furry fur that may act with the grace and swim with the elegance of a white swan, but will never be fully accepted by the swan community because of the different appearance.

 

[spacetygrss]

I'm sorry but when you are being graded on eye contact, poise, posture, facial expressions, and smiling then you are being graded with the same criteria as contestants on the miss America pageant. I have a great idea, if you want to find out how interested a medical student is, how about talking to them!! It's a pretty novel concept I know, yet many attendings feel this is beneath them.

Basically. I actually have a brain..if one were to ask me a question I would atempt to answer with an intelligent response (and if one were to listen to me he/she might realize that I have a legitimate question pertaining to the case). Seems pretty straight forward.

I can't wait for the next few weeks to be over so that I can be done with this bs we all call third year!!

 

[scootad.]

An example is a rubber duck with yellow furry fur that may act with the grace and swim with the elegance of a white swan, but will never be fully accepted by the swan community because of the different appearance.

And of course the white swan who looks elegant but cant swim worth a lick still gets the honors.

 

[Masonator]

Hang tough everybody! I'm about to start residency this July and the medical student thing is over really quick. Soon you will be on the other side of the evaluation. You as residents can do your part to be fair. Take some extra time, get to know the students. Figure out their stories. I'm going to be an extremely easy grader, purely because I think the system is seriously flawed. I'll be grading on what they say, what they do, and how hard they work. Showboating "enthusiasm" in front of attendings won't be effective for me. Guys who are quiet but know what they are doing will get as many points as the outgoing, inquisitive, eager to learn student who likes to fawn over their residents and attendings. When all of you are residents you can evaluate however you want.

 

[Masonator]

I have both of Dr. Desai's books, and I found them very helpful in shaping me to be a better doctor and person to my future patients; they show you what a PROFESSIONAL should do and act.

However, the books don't promise the readers that applying all the principles will guarantee HONORS. As I've stated in other threads, HONORS has SOME correlation with fund of knowledge, professionalism, or hard work. However, unless the evaluators deem you to fit the "profile" of an honors students, you probably won't honor. You may do all the things that someone with honors would do, but if you don't fit the prototypical image of an honors student, you won't honor.

An example is a rubber duck with yellow furry fur that may act with the grace and swim with the elegance of a white swan, but will never be fully accepted by the swan community because of the different appearance.

What do you think that intangible difference is? I think it is purely how much the residents and attendings like you. It has nothing to do with clinical performance.

 

[kinetic]

1)Thinking that a big gob of wax in your patient's ear constitutes otitis media.

Hey, your first mistake is looking in the ear in the first place. And stay away from the eye, too. That's for the optho guys!

 

[Samir Desai]

If you ask doctors what the highlight of their medical education was, they'll often tell you that it was their clinical years. With that being said, I don't know any current or former third year medical students who haven't had some bad experiences during years 3 and 4.

I hate to say it but there are some attendings and residents who don't carry themselves with the degree of professionalism that you would expect from these individuals. Irlandesa did a great job of providing us with some examples. Like irlandesa, I too had some bad experiences with residents and attendings when I was a student. But I also had some great experiences as a student. I was fortunate to have some attendings and residents that took an active interest in myself and the other students on my team. They were dedicated to teaching and committed to making our experience a positive one. I would be interested in hearing from irlandesa and the others who have replied about some of the good attendings and residents they have come across. I think it's important to make mention of this because there's a lot of people reading this thread who are going to start third year in a month or two.

An important part of third year is to pay close attention to how your attendings and residents conduct themselves. When you have good ones, ask yourself why they're good. Is it because of the way they interact with their patients? Is it something about the way they conduct rounds? Is it because they give frequent, specific feedback? Is it their teaching style? Maybe there's something there that you would like to take away and perhaps adopt as your own when you become a resident or attending.

When you have bad attendings and residents, ask yourself why they're bad. Then make a point of it to not make the same mistakes. Sometimes, attendings and residents lose track of what it's like to be a medical student. But even if you've lost track, there's simply no excuse for some of the behaviors exhibited by the attendings and residents irlandesa has worked with.

There's a certain standard of behavior that students, residents, and attendings should hold themselves too. As a student, you'll come into contact with individuals that adhere to this code but you'll also run into those who don't, like irlandesa described. If you conduct yourself with the highest degree of professionalism, you can take that with you to your residency and career. And that's behavior that you can model for future students and residents.

Samir Desai, MD

 

[GeddyLee]

My favorite evaluation faux pas, after working on the surgery service and hardly being spoken to by ANY attending, and only having contact with them in the OR, I was told the attendings provide the evaluations, not the residents. Boy am I glad I was at the hospital at 4AM everyday seeing as many patients as I could and doing everything to help out the residents.

Lesson: Know who's evaluating you before you waste your energy on people who's opinions don't matter.

 

[Masonator]

If you ask doctors what the highlight of their medical education was, they'll often tell you that it was their clinical years. With that being said, I don't know any current or former third year medical students who haven't had some bad experiences during years 3 and 4.

I hate to say it but there are some attendings and residents who don't carry themselves with the degree of professionalism that you would expect from these individuals. Irlandesa did a great job of providing us with some examples. Like irlandesa, I too had some bad experiences with residents and attendings when I was a student. But I also had some great experiences as a student. I was fortunate to have some attendings and residents that took an active interest in myself and the other students on my team. They were dedicated to teaching and committed to making our experience a positive one. I would be interested in hearing from irlandesa and the others who have replied about some of the good attendings and residents they have come across. I think it's important to make mention of this because there's a lot of people reading this thread who are going to start third year in a month or two.

An important part of third year is to pay close attention to how your attendings and residents conduct themselves. When you have good ones, ask yourself why they're good. Is it because of the way they interact with their patients? Is it something about the way they conduct rounds? Is it because they give frequent, specific feedback? Is it their teaching style? Maybe there's something there that you would like to take away and perhaps adopt as your own when you become a resident or attending.

When you have bad attendings and residents, ask yourself why they're bad. Then make a point of it to not make the same mistakes. Sometimes, attendings and residents lose track of what it's like to be a medical student. But even if you've lost track, there's simply no excuse for some of the behaviors exhibited by the attendings and residents irlandesa has worked with.

There's a certain standard of behavior that students, residents, and attendings should hold themselves too. As a student, you'll come into contact with individuals that adhere to this code but you'll also run into those who don't, like irlandesa described. If you conduct yourself with the highest degree of professionalism, you can take that with you to your residency and career. And that's behavior that you can model for future students and residents.

Samir Desai, MD

That is a good message. In my case the bad definitely outweighed the good. I think part of the problem is that residents and attendings don't want to waste anytime with a student unless they think the student is going into their specialty. Very few teach for the sake of teaching. Thus the students that do well are the ones who lie in every rotation and say how interested they are in this specialty to garner more teaching, attention, and maybe that benefit of the doubt when evaluation time comes.

I always get pissed off when I hear people say that their worst day of 3rd year is better then their best day of the 1st and 2nd years. Is this some kind of trite joke!!!! YES!!!! Being abused by some narcissistic resident who hates the specialty I'm interested in is so much cooler then studying interesting material at a coffee shop!! Hell Yeah!!

 

[Masonator]

My favorite evaluation faux pas, after working on the surgery service and hardly being spoken to by ANY attending, and only having contact with them in the OR, I was told the attendings provide the evaluations, not the residents. Boy am I glad I was at the hospital at 4AM everyday seeing as many patients as I could and doing everything to help out the residents.

Lesson: Know who's evaluating you before you waste your energy on people who's opinions don't matter.

Those attending may still talk to the residents to get an idea of your performance. It is a safe bet to try and please/be nice to everyone you encounter as they can all potentially affect your grade. This includes nurses, techs, patients, patients families, etc. Gossip in hospitals travels far and fast. It is pretty sad, I was always brought up that you should be nice to people for its own sake. Them being nice back is your reward. During third year it turns into a political popularity contest. Being polite isn't enough, it becomes "who is the nicest medical student". The funny thing is the people who win this contest usually were not the nicest to their peers in the pre-clinical years. In fact many of them were downright cutthroat. But wow, low and behold they've become so personable during 3rd year.

 

[Febrifuge]

It always makes me shake my head when I see people being graded by how interested they appear to be rather then how interested they actually are. I guess 3rd year rewards acting skills as much as intellectual interest. I think this is a pretty sad state of affairs.

I see the point, but it's an equally sad state of affairs when medical providers don't take an interest in how they come across in communications with their supervisors, their peers, or their patients.

Every other job in the world involves dealing with co-workers and bosses. Why shouldn't medicine? Also, our "customer service" skills are particularly important, so we should use the opportunity to sharpen them. 3rd year is partly for working on the "acting skills" that can make the difference between a patient who works with you and one who doesn't. One who understands instructions, and helps you to help them, or one that walks out of your office/ward/department confused, apathetic, or even downright hostile toward their treatment plan.

There is a lot more to medicine than bedside manner, true. But without a decent bedside manner, the smartest physician in the world can't be truly effective in front of the patient.

-Feb
(BA in theatre, 1998. Postbac premed now.)

 

[Febrifuge]

Hang tough everybody! I'm about to start residency this July and the medical student thing is over really quick. Soon you will be on the other side of the evaluation. You as residents can do your part to be fair. Take some extra time, get to know the students. Figure out their stories. I'm going to be an extremely easy grader, purely because I think the system is seriously flawed. I'll be grading on what they say, what they do, and how hard they work. Showboating "enthusiasm" in front of attendings won't be effective for me. Guys who are quiet but know what they are doing will get as many points as the outgoing, inquisitive, eager to learn student who likes to fawn over their residents and attendings. When all of you are residents you can evaluate however you want.

A fair point. Nobody likes the brown-nosing, uber-enthusiastic little Doc-bots. They're like Stepford students, and speaking as an ancillary worker in an academic setting, they creep me right out. (Also, residents joke about them behind their backs... "well, I guess I better go make sure the student isn't killing anybody.")

On the other hand, socially maladjusted brainiacs who can memorize well, even if they're good with procedures, need to pay attention to interpersonal skills or they just plain won't become good doctors. We need to be able to look, sound, and act like we know what we're doing, and we need to know what we're doing.

Anybody who perfects one half of that skill set and then calls it good is as ridiculous as a person who perfects only the other half.

Go forth, and be an awesome resident. It sounds like you have a good attitude. Remember us pathetic wannabes!

 

[Masonator]

Febrifuge, it sounds like you have some clinical experience and you've seen it from the other side. I want to tell you something though, the showboating you see as a 3rd year is not the same skill set as being an empathic person who communicates well with patients. It has more to do with hierarchy and attendings being told what they want to hear. You'll have to see it for yourself once you do your clinical years in medical school.

Patients care more about: whether you listen, know what you are doing, and take time with them. Patients do not really care about posture, eye contact, smiling, and how upbeat you are. I've had some patients react negatively when I tried to be too upbeat. After all they are in the hospital with a potentially lifethreatening illness, what is there to be upbeat about. Sometimes solemn respect and listening go much further here. However solemn respect and listening don't get you very far with attendings. If you are in an outpatient setting with healthiar patients, you can be as upbeat as you want. Feel free to flex all those social skills you want. However again, these things are pretty superficial. In primary care the relationship is a longterm thing that is deeper then good eye contact and poise. It again revolves around listening, taking time, and knowing what you are doing.

Patients are smart and many recognize substance over style.

 

[Febrifuge]

Yep, I work as a Tech in an ED that crawls with EM residents, IM/FP/OB/Ortho residents, staff who acutally like to teach, and a boatload of medical, nursing, and PA students. When I see students, I notice much of what the staff notices. And I notice them noticing it (if that makes any sense).

I can tell you are coming from a basis of respect for the patients, and I would hope that the residents and attendings are going to see that. Absolutely, that should shine through in a genuine way, not a fake one; and it should be your own style, not someone else's idea of a perfect student. On the other hand, your instructors and preceptors will be busy enough that they might not notice all the good things you do -- so why not make sure your good habits are being recognized?

I don't mean anything fake, I just mean being self-aware enough to manage interactions with the people grading you in a way that's similar to how you manage the way you present yourself to patients. I bet there are a hundred things you're already doing right; this is about knowing what they are, and improving the other things you don't realize you're doing, the things that don't let your actual dedication and ability show through. It's little stuff that matters, like Dr. Desai is talking about: do you look people in the eye; make sure they're focused on you before you launch into a report; ask questions that show your thought process.

You're right that nobody will be fooled by an act for long. I think a student who believes they can excel on the "all style, no substance" basis is going to get a rude awakening at some point. I also think that students who feel they have the substance, so they are free to ignore the style, do themselves a disservice. You can't afford to shrug off the superficial stuff just because you have the deeper stuff covered. Instructors don't get to know you well enough to realize that you're good without a little help. You're providing them a clue.

And it's partly a status thing, too, as much as that's unfair and lame. It's like that scene in Bull Durham with Tim Robbins' skanky shower shoes. "When you can hit .400 in the show, you can have fungus on your shower shoes, and the press will think you're colorful. Until then, it just makes you a slob." When you're an attending, you can shuffle in your clogs, mumble, interrupt people, avoid eye contact, and hog the reference books, and people will think you're an eccentric genius. Until then, even if you're a brilliant, dedicated, and capable student... it just makes you a weirdo.

 

[Masonator]

Yep, I work as a Tech in an ED that crawls with EM residents, IM/FP/OB/Ortho residents, staff who acutally like to teach, and a boatload of medical, nursing, and PA students. When I see students, I notice much of what the staff notices. And I notice them noticing it (if that makes any sense).

I can tell you are coming from a basis of respect for the patients, and I would hope that the residents and attendings are going to see that. Absolutely, that should shine through in a genuine way, not a fake one; and it should be your own style, not someone else's idea of a perfect student. On the other hand, your instructors and preceptors will be busy enough that they might not notice all the good things you do -- so why not make sure your good habits are being recognized?

I don't mean anything fake, I just mean being self-aware enough to manage interactions with the people grading you in a way that's similar to how you manage the way you present yourself to patients. I bet there are a hundred things you're already doing right; this is about knowing what they are, and improving the other things you don't realize you're doing, the things that don't let your actual dedication and ability show through. It's little stuff that matters, like Dr. Desai is talking about: do you look people in the eye; make sure they're focused on you before you launch into a report; ask questions that show your thought process.

You're right that nobody will be fooled by an act for long. I think a student who believes they can excel on the "all style, no substance" basis is going to get a rude awakening at some point. I also think that students who feel they have the substance, so they are free to ignore the style, do themselves a disservice. You can't afford to shrug off the superficial stuff just because you have the deeper stuff covered. Instructors don't get to know you well enough to realize that you're good without a little help. You're providing them a clue.

And it's partly a status thing, too, as much as that's unfair and lame. It's like that scene in Bull Durham with Tim Robbins' skanky shower shoes. "When you can hit .400 in the show, you can have fungus on your shower shoes, and the press will think you're colorful. Until then, it just makes you a slob." When you're an attending, you can shuffle in your clogs, mumble, interrupt people, avoid eye contact, and hog the reference books, and people will think you're an eccentric genius. Until then, even if you're a brilliant, dedicated, and capable student... it just makes you a weirdo.

I think you have a good perspective, you will probably do well clinically. However there is a lot of bull**** you don't see in the ED. For example, let's say you are working up a patient with CHF. You've read about it the night before and your understand everything that is being discussed about it. The attending turns to you and asks if you have any questions. You don't have any burning questions, as what they are discussing is fairly obvious. You'll have to ask something anyway just to show how interested you are. Furthermore if you ask something esoteric you might look like you are suspecting a zebra rather then a horse, so often you'll ask questions that you already know the answer to. You wouldn't want to look unenthusiastic would you? Repeat this a few hundred times. It gets very old.

I like that bull durham reference, I found it very amusing. However, you are being a realist whereas I'm being an idealist. Why grade people on artificial habits that they are likely going to drop once they become attendings.

Don't even get me started about all the lying and game playing about specialty choice. This has nothing to do with bed side manner or professionalism. It is pure BS.

 

[deleted4401]

I've had similar troubles as the rest of the students, as a third year. It's 9 months in, and I still can't figure it out. My best rotation was surgery, and I was hardly there and acted no different than on any other rotation. And, I don't want to do anything that involves surgery! Man, I've had some doozies. I've had the intern who's evaluated me meet me for 5 minutes and grade me. When I told the attending that was the case, he said he'd have someone who spent more time evaluate me. When I looked in my folder, it was the same damn eval, with the other intern's name rubbed off!

And I also hate that attendings grades matter the most when they spend so little time with you. That's the worst - some guy who spends 10 minutes every other day with you ends up being responsible for 25% of your grade, ridiculous.

But, I don't agree that patients don't care. I'm the most enthusiastic around them, smiling and laughing, asking about family and where they like to eat around town, and what the military was like, etc. I feel like if the patients had some say in the evals, I'd do a heck of a lot better. It's funny - most of the interns/residents seem to be forgotten, but the patients always ask about me (or other students) and refer to us as 'my doctor'. Maybe they should have them fill out some surverys/evals when they get discharged as a 'quality assurance' mechanism.

I don't know how to change it - if they base it heavily on shelfs, then the poor test takers complain. If they do it pure subjective, then the actors/cutthroats do better. I guess this is the best possible way - a near 50/50 split, and you just hope for the best.

Simul

 

[Masonator]

I've had similar troubles as the rest of the students, as a third year. It's 9 months in, and I still can't figure it out. My best rotation was surgery, and I was hardly there and acted no different than on any other rotation. And, I don't want to do anything that involves surgery! Man, I've had some doozies. I've had the intern who's evaluated me meet me for 5 minutes and grade me. When I told the attending that was the case, he said he'd have someone who spent more time evaluate me. When I looked in my folder, it was the same damn eval, with the other intern's name rubbed off!

And I also hate that attendings grades matter the most when they spend so little time with you. That's the worst - some guy who spends 10 minutes every other day with you ends up being responsible for 25% of your grade, ridiculous.

But, I don't agree that patients don't care. I'm the most enthusiastic around them, smiling and laughing, asking about family and where they like to eat around town, and what the military was like, etc. I feel like if the patients had some say in the evals, I'd do a heck of a lot better. It's funny - most of the interns/residents seem to be forgotten, but the patients always ask about me (or other students) and refer to us as 'my doctor'. Maybe they should have them fill out some surverys/evals when they get discharged as a 'quality assurance' mechanism.

I don't know how to change it - if they base it heavily on shelfs, then the poor test takers complain. If they do it pure subjective, then the actors/cutthroats do better. I guess this is the best possible way - a near 50/50 split, and you just hope for the best.

Simul

It is a totally flawed system. You are one of those guys who really values patient interaction. I've been chewed out by residents on Medicine for taking too long of a time with a patient. This makes all of the small talk harder. The people who do well only sweet talk patients when there are attendings watching. Then when the attendings leave it is on to other ways to impress the residents, leaving the patient interaction by the wayside.
It is such bull****.

If I had one positive bit of advice I would say hang in there. Once you get through it and look back on it, you realize it is much worse when your doing it. Once you match, you'll see that despite all of the trials and hassles, things will work out in the end. Most people are pretty happy with their residency match.

 

[kinetic]

You guys miss the point. Don't you think every medical student in history has felt this way? OK, fine - about 80% ...I'll grant you that about 20% of medical students are douches. But these same medical students become residents and what happens? They become what they hated. Why? Because 1) you are too busy to teach (so you become "that ******ed resident that doesn't say a word to me or talks to me without eye contact") and 2) you have to evaluate the medical students so you need to ask them dumb questions in order to differentiate.

And medical students are messed in the head, too. You can't win with them. I always told my students "listen, I hated residents who made me follow them around like ducks so I don't want to do that to you". They love this. Then they disappear for hours at a time and later complain that they missed all the action - since they expected me to page them everything I saw a new patient or something. But if I page them a lot, I'm "that dumb resident that won't leave me alone; he's using my pager like a leash". Or they start sticking around me like flies on meat and complain about THAT. You can't be expected to tailor yourself to every medical student on every service.

 

[Masonator]

You guys miss the point. Don't you think every medical student in history has felt this way? OK, fine - about 80% ...I'll grant you that about 20% of medical students are douches. But these same medical students become residents and what happens? They become what they hated. Why? Because 1) you are too busy to teach (so you become "that ******ed resident that doesn't say a word to me or talks to me without eye contact") and 2) you have to evaluate the medical students so you need to ask them dumb questions in order to differentiate.

And medical students are messed in the head, too. You can't win with them. I always told my students "listen, I hated residents who made me follow them around like ducks so I don't want to do that to you". They love this. Then they disappear for hours at a time and later complain that they missed all the action - since they expected me to page them everything I saw a new patient or something. But if I page them a lot, I'm "that dumb resident that won't leave me alone; he's using my pager like a leash". Or they start sticking around me like flies on meat and complain about THAT. You can't be expected to tailor yourself to every medical student on every service.

Kinetic, you so bitter...they could pickle your balls and sell them as sour grapes.

 

[j_sde]

although i think my 3rd yr has been pretty benign so far.. i've had my share of frustrating experiences with kiss-ass students and non-teaching residents/attendings... i brought up the teachin issue to a resident, and she said the reisdents should not be responsible for teaching med students.. rather attendings should be the ones to spend time during rounds showing physical findings and generally pimping.

in retrospect, i totally agree with that. residents really have alot of scut/manageing work to do to carry their patient list. teaching from them is really bonus and much appreciated.

anyways, my point was just that attendings really need to spend more time/engery teaching. i dont care if they are nice and friendly... as long as they teach. thats part of what they're supposed to do and get paid for anyways.

 

[kinetic]

Kinetic, you so bitter...they could pickle your balls and sell them as sour grapes.

Probably, but they'd be pretty big grapes.

Anyway, I'm being serious. You guys think you're the first two people to every say, "man, those attendings ignore us" or "man, those residents hardly acknowledge our presence"? In the history of residency training, everyone else was all happy and fine with things? Obviously not. The question is: if that's the case, why does nothing ever change? Answer: because people are all the same.

You think attendings know they are acting distant and pompous? Maybe, but if they do they don't care. And most of the residents who act that way are the same. And by the way, most medical students are pompous jackasses, too - take them into the general population and all they do is brag about how smart they are, how they are "future doctors", flash the bling, etc.

Do I support the way things are? No. In fact, I tried to be different. I actually followed through on the promise that every medical student makes ("I won't act like this when I become a resident."). But students just find other things to complain about. It's human nature.

And if I am bitter, I have reason to be: medicine has taught me to follow the lock step rather than to follow your dreams.

 

[menemotxi]

You think attendings know they are acting distant and pompous? Maybe, but if they do they don't care. And most of the residents who act that way are the same. And by the way, most medical students are pompous jackasses, too - take them into the general population and all they do is brag about how smart they are, how they are "future doctors", flash the bling, etc.

And if I am bitter, I have reason to be: medicine has taught me to follow the lock step rather than to follow your dreams.

Kinetic, what exactly has made you so bitter? Is it your school? It may be naive of me to think this since I haven't started med school yet, but all the med students I've met aren't pompous at all. Please elaborate on your opinions.

 

[kinetic]

Kinetic, what exactly has made you so bitter? Is it your school? It may be naive of me to think this since I haven't started med school yet, but all the med students I've met aren't pompous at all. Please elaborate on your opinions.

Don't let me sour you on things; go through medical school and you'll see what I mean (or you'll say that I'm nuts - either way). It's sorta tough to explain to someone who hasn't started medical school. Like, a lot of people have stories about people telling them "don't become a doctor" before they entered medical school. A number of physicians told that to me. I thought they were bitter old dolts, or worse - that they were people who wanted to chase people away from the medical field so they could keep it selective and great. So I went through the rigamarole and afterwards I would have to say they were about 80% right. I still like medicine, but there's a lot of crap you have to deal with - from patients and from other physicians. Talk to me in a few years if you remember to (your mind may be too full of meaningless minutae to remember).

 

[avendesora]

Man, every time I pop into this forum, I think to myself Where the Hell to these people go to school? Seriously -- Are you guys at uber-competitive top-10 places, or what?

I LOVED 3rd and 4th year, while 1st and 2nd year were really tough for me. I personally hated sitting and memorizing all that crap. Maybe it's a persoanlity thing -- I learn best though experience, so seeing a patient with disease X is a hundred times better for me than reading about it. I had my share of poor residents and attendings, don't get me wrong. Sometimes you just have to let the crap slide off your back, though. For me, learning how to do that was part of the experience because I know that I'll have to deal with it for the rest of my life -- from attendings during residency, and from administration later on.

My classmates are cool for the most part, with only a few willing to sell their own children for honors. Maybe that's a function of where I go to school as well.

I hope that you truly did not like preclinical years better than clinicals, because unless you're going into research or pathology, clinical medicine is what you're doing for the rest of your life. If you absolutely hate it, get out now while the getting is good

 

[Masonator]

Man, every time I pop into this forum, I think to myself Where the Hell to these people go to school? Seriously -- Are you guys at uber-competitive top-10 places, or what?

I LOVED 3rd and 4th year, while 1st and 2nd year were really tough for me. I personally hated sitting and memorizing all that crap. Maybe it's a persoanlity thing -- I learn best though experience, so seeing a patient with disease X is a hundred times better for me than reading about it. I had my share of poor residents and attendings, don't get me wrong. Sometimes you just have to let the crap slide off your back, though. For me, learning how to do that was part of the experience because I know that I'll have to deal with it for the rest of my life -- from attendings during residency, and from administration later on.

My classmates are cool for the most part, with only a few willing to sell their own children for honors. Maybe that's a function of where I go to school as well.

I hope that you truly did not like preclinical years better than clinicals, because unless you're going into research or pathology, clinical medicine is what you're doing for the rest of your life. If you absolutely hate it, get out now while the getting is good

Maybe you could spare us the self righteous drivel about how we are going to be ****ty doctors because we didn't have good third year experiences. On second thought, maybe you are right. Maybe we had bad experiences because we are uber gunners who care more about pathology then patients. Gee, I wish we could all follow your shining example of clinical acumen and empathy. I guess we will all have to settle with being hacks. I think ?'m going to refer all my patients to you since you are such a paragon of what a doctor should be.

 

[Seaglass]

Masonator, I didn't think he was hatin' on you. I had a similar experience as "the A". Speaking of which, what service are you on in July "A", I start on medicine.

C

 

[avendesora]

Maybe you could spare us the self righteous drivel about how we are going to be ****ty doctors because we didn't have good third year experiences. On second thought, maybe you are right. Maybe we had bad experiences because we are uber gunners who care more about pathology then patients. Gee, I wish we could all follow your shining example of clinical acumen and empathy. I guess we will all have to settle with being hacks. I think ?'m going to refer all my patients to you since you are such a paragon of what a doctor should be.

Wow, I think you took that the wrong way. Go back and read it one more time. I didn't say anything about your abilities or drive or whatever. All I'm saying is if you don't like clinical rotations, then you may not like the clinical practice of medicine. If you enter a clinical field (IM, Surgery, Peds, subspecialties there of) residency and eventually practice will involve similar activities to what you are doing now. The responsibility changes, but the idea is the same. You don't flip a switch when you put on the long white coat that makes daily progress notes, H&P's on gomers, or nasty wound debridements go away.

If you don't like it, it's really OK. They can't expel you for that. I know several people with similar attitudes from my class that eventually decided on Path or Rads, etc. In the mean while, chill a bit. You can't graduate if your head explodes from stress.

Seaglass, I have no idea where I'm starting. I've gotten approximately no communication from the IM department after I mailed back my contract. I need to call that lady...

Seeing as I now have finished any and all clinical rotations forever and always, I think I will now refrain from getting my head chewed off in this forum forever as well

 

[Masonator]

Wow, I think you took that the wrong way. Go back and read it one more time. I didn't say anything about your abilities or drive or whatever. All I'm saying is if you don't like clinical rotations, then you may not like the clinical practice of medicine. If you enter a clinical field (IM, Surgery, Peds, subspecialties there of) residency and eventually practice will involve similar activities to what you are doing now. The responsibility changes, but the idea is the same. You don't flip a switch when you put on the long white coat that makes daily progress notes, H&P's on gomers, or nasty wound debridements go away.

If you don't like it, it's really OK. They can't expel you for that. I know several people with similar attitudes from my class that eventually decided on Path or Rads, etc. In the mean while, chill a bit. You can't graduate if your head explodes from stress.

Seaglass, I have no idea where I'm starting. I've gotten approximately no communication from the IM department after I mailed back my contract. I need to call that lady...

Seeing as I now have finished any and all clinical rotations forever and always, I think I will now refrain from getting my head chewed off in this forum forever as well

I'm going to track you down on the other forums too! Then I will chew your head off there! There isn't a goddamn thing you can do about it! BAHAAHAHAHAHAHAAHA!

 

[supercut]

As a surgery intern, who is interested in teaching, I've been getting wind that I'm developing a reptutation among students as one who's willing to teach. This has come about pretty much only by my own interest. I'm often not sure how effective I am, but I do try to make some effort.

Have any of you med students had any sessions in med school on how to be an effective teacher? I doubt it. Neither did I. Don't think you'll get any sessions about that in residency, either. Also don't think you'll get any information on how to be an effective evaluator. Nope, we are all pretty much on our own in learning how to teach.

My teaching style, such that it is, has been formed pretty much from my experince as a med student. I had some residents who were great teachers, and I had some mean a$$holes who didn't care anything about teaching. Each had a valuable lesson (even if that lesson was how I want to be sure NOT to behave as a resident). I try to emulate those residents whose teaching styles I liked.

Consequently, my teaching style is also directed towards how I like to learn (and is biased towards those who share my learning style). I do not know yet how effective it is. I know I make an effort, and I know that sometimes my own feelings of inadequacy as an intern has affected it. (ie somtetims I think I don' t have much to offer students).

Good teaching requires several things: interest, effort, time among them.

However, being a good learner requires many of the same things.

And remember that evenually we will all be attendings and no one will be teaching us any more. We will be responsible for self directed education.

So for those rotations where the residents can't/don't teach, perhaps you can use those rotations to help develop your self directed learning skills.

And recall that each rotation has some value no matter what field you go into. For example, I have had to rely on what I learned in psych a lot more than I ever dreamed during my surgery internship (depression, suicide attempts, acute psychois and just the other day found my POD 1 pt manic!).