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That schedule sounds pretty typical for inpatient medicine. As a resident I encouraged 3rd year students who are just starting out to take on 1 patient and know EVERYTHING about them. I’d rather you do a good job with 1 patient than a half-ass job with 3 patients.

As far as not getting specific feedback for your SOAP notes, don’t let it discourage you. There is SO MUCH to learn and maybe you won’t get a lot of feedback about SOAP notes, but you’ll be learning other things.

Learning during med school and residency and when you’re an attending doesn’t have a perfect curriculum. Take what you can from experiences, find some people you can trust and also take learning in to your own hands. Things will go much smoother for you with that type of attitude.

As far as competition among other students. I never had time for that non-sense. I did my own thing and kept it moving.
 
I got no feedback from anyone on my inpatient IM rotation. I was told to write notes daily and then was told they were too busy to look it over. (And I got assigned by my school to the same service for my sub-i as I did for my third year rotation...).

Your experience sounds about right for inpatient medicine though.

With SOAP notes, the only thing that really helps is to keep doing them. Seek out feedback. Talk to your attending or senior resident and just ask for feedback. It sometimes helps.
 
The best feedback that I have gotten about any of my stuff has come from 1 attending that is very hard on students (it means you learn a shat ton tho) and from an intern that I have become friends with on my current service who now takes time out of his day to go over stuff with me when the service stuff calms down in the afternoons. He points out junk in my notes that I would never know were a problem if he didn't point them out, because the attendings DGAF. The interns are usually the ones who were most recently med students, and are the ones most likely to be somewhat helpful IMO so see if you can ask for help from one of them.
 
Very rarely, anyone will comment or sit you down to go over your SOAP notes with you. It happened to me once and to be honest, I didn't find it too particularly helpful. I wrote daily SOAP note for all of my patients, cosigned to the attending, notes got signed but never gotten any feedback on them.

My trick to learn how to write a good SOAP note as a med student was to emulate and learn from the H and P that's already in for the patient, especially the HPI, ED course and A/P. Unless you are helping the resident doing an admission, the patients assigned to you will already have an H and P in. Don't mindlessly copy or paraphrase it, try to understand and follow the flow of the HPI- it tells you why the patient was admitted. The ED course and A/P teach you how to treat them. After reading a few of them, you'll realize there's a pattern to everything, same set of **** get ordered for the same stuff. Also don't forget the consult notes if there are any

Clarify things with your residents briefly before you present your patients prior to round. I don't mean that you have to do a full presentation with them but just bring up issues that you think are relevant: new labs, acute events overnight, consultant recommendations etc. and your plans to address them. They are expected to teach and guide you, only the asshats will get annoyed.

Ask questions during round, this part is tricky as the more questions you ask the longer round is and your residents will hate you. But who cares, you are there to learn. But there's a fine balance, don't ask the stupid questions that can be easily looked up or basics that you are already expected to know e.g. 'what is lasix and why are we giving lasix to this patient who was admitted for CHF exacerbation?' a better question would be 'why don't we just continue home PO dose? why 40mg instead of 80mg? why not a drip? Why Lasix and not Bumex? why give oral potassium and not IV and how much? why you care about Mg?' - the premise is you are expected to know the basic pathophysiology of CHF, the basic treatment from textbook, they need to teach you how much, in what form, what is being monitored, the whys and hows in the real clinical practice. Kind of a bad example but you get my point. This is how you do proactive learning and get the most out of rounds. You are a 3rd year med students, it's ok to look stupid. The worst you can do for your education is to just stand there for hours in silence wasting your time and not learning anything.
 
630-645am . Show up.
7-7:30- preround on 2-3 patients , do pertinent exams, ask them how they are doing, what happened overnight etc.
730-8: Feverishly generate SOAP notes for my patients while looking over , overnight tests/ morning labs.
8:00-8:10, ask management or plan questions and run by any changes with the senior resident or intern. (The interns are usually too busy or green to know some of the intricacies that may come up in the management piece, they are trying to keep afloat with their patient load and order entry etc.
810- varied (depending on round speeds) Round with attending. Ask a question or two on management that you have never seen or dont understand, or doesnt make sense.
varried to 12 - scut work , help the resident with any scut they need, supplies small procedures, orders, call consults.
12-1 lunch lectures
1:2 finish up scut, take on a new patient or get patient D/C /transfer ready.
2-3 round on your patients, check up to see how they are doing.
3-varied - shoot the **** with your residents, do any left over scut. finish any left over note. do some studying/ anki uworld etc.

if on long call
varied -8 pm . Get new patient , HPI, generate plan, etc.

Rinse and repeat.
 
Are you doing admissions? That's where you really learn to workup someone.
 
AnatomyGrey12 said:
Agreed. I had a week of nights on my IM teaching service month and I was the one the intern sent to the ER to do the H&P on every new patient while they did the consults and fielded the nursing calls. I loved it. Felt like I learned a crap ton.
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Yeah progress notes are supplementary. Admissions, seeing the orders and going through the workup thought process - is where you learn.
 
SOAP preferences change everywhere you go. Pay attention to resident and attending notes and stick with a style you like. You’ll develop your own, eventually.

Subjective- resident told me OPQRST- not just for medical aspects but billing purposes as well- anything else is superlative and physicians usually don’t care. Also was told no one will read this whole thing except maybe billing and medical students.. everyone else “might” do a quick skim.

Objective- nobody looks at it. It’s either negative or there are pertinent positives that any other physician will want to repeat for themselves.

A/P - so important and again was told this is the first thing most of them read. I list my diagnosis and then bullet each thought/orders and mdm under the dx. Have received many compliments on the format and summary from physicians across many various rotations.
 
Welcome to the IM Teaching service. No one tells you as a newly minted 3rd yr, your pretty much useless and many will avoid you as it takes time to get you up to speed. Having said that, didnt you learn how to write a SOAP note as a OMS2? It is highly emphasized at my school and many students put it on the back burner when studying for boards. In fairness, the HPI sets up the whole note, follow up questions and differential diagnosis. The rest is pretty much boiler plate. So work on the Who ,What, Where , When, questions as I call them, and your note will improve. Read other notes and critique them. Use what you like and drop less important information left for the formal H and P.
Being a 3rd yr is frustrating. Your knowledge gaps are huge and are publicly revealed on rounds daily. It's not easy to swallow as a competetive medical student. You'll get better, so hang in there. Good luck and best wishes.
 
phagocytosis41 said:
Just curious what constitutes an actual IM rotation 'inpatient' rotation.
I end up arriving early in the morning around 6 am, getting 1 patient, having to 'write a soap' and finally our attending meets us at 9:30 am and about 1 hour passes all the residents and students talk and the preceptor gives feedback.
Then from about 10:30 am-12:00 pm we round. Lunch 12 pm - 1pm then we review SOAP notes from 1 pm - 2 pm and sometimes give presentations on a topic.
Despite the fact I don't seem to be getting how to write a proper SOAP note or really understand anything, I am here. The other medical students seem also to be hard to talk to since they are all so desperate to do something that it becomes a 'competition' just to do anything or to get the attending's attention.
Idk how to view this experience, but something tells me there is something wrong.
I don't even get feedback on whether my assessment and patient encounter is any good. I just get told my SOAP note 'stinks' in essence. When I ask how to write a good one, I don't really get feedback, i just get told 'figure it out.'
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Idk if this is abnormal or normal but...

During my third year, I spent 1 month at the VA medical center whose IM service was run by the MD university medical center nearby.

We had 5-6 teams (green, blue). Each team was staffed by an attending, 1 senior resident, 2-3 interns, and 2-5 medical students (most MD, 1-2 DO). Each team covered 20 patients. Each intern covered 10. Each student saw 2-3 follow-ups and 1 admission if we had that many per day.

We arrived at 630, looked at charts for 1-1.5 hours. Then pre rounded from 730 - 9. From 9-12 we rounded with the attending where we presented the patient in a very formalized format. Attending/resident then asked us 1-5 questions regarding the differential, the reasoning behind our plan, or some tiny detail regarding labs or pathophysiology. It wasn't ever hostile. From 12-1 was lunch which was resident report, case report, grand rounds, something. 1-5 was then writing progress notes and H&P's as admissions came through. Residents almost always gave some sort of chalk talk during this time for the students and sometimes they'd do a reverse chalk talk (asking us to read up on a topic and "teach them").

We worked 6 days a week alternating the weekend with the other students and would get out early after rounding. My team helped in my ability to present, which again was a very formalized format but helped in not missing important details which down the road really helped during my electives and sub-i's. Notes were read over by residents and attending and commented over a few days on how to improve them mostly in the assessment and plan portion.

This was not an easy rotation but as @Angus Avagadro said, it's the first time where your knowledge gaps are exposed in front of a GIANT team of residents students pharmacists and nurses, and it sucks. But it def gets you in gear to study hard and be as prepared as much as possible.
 
AlteredScale said:
Idk if this is abnormal or normal but...

During my third year, I spent 1 month at the VA medical center whose IM service was run by the MD university medical center nearby.

We had 5-6 teams (green, blue). Each team was staffed by an attending, 1 senior resident, 2-3 interns, and 2-5 medical students (most MD, 1-2 DO). Each team covered 20 patients. Each intern covered 10. Each student saw 2-3 follow-ups and 1 admission if we had that many per day.

We arrived at 630, looked at charts for 1-1.5 hours. Then pre rounded from 730 - 9. From 9-12 we rounded with the attending where we presented the patient in a very formalized format. Attending/resident then asked us 1-5 questions regarding the differential, the reasoning behind our plan, or some tiny detail regarding labs or pathophysiology. It wasn't ever hostile. From 12-1 was lunch which was resident report, case report, grand rounds, something. 1-5 was then writing progress notes and H&P's as admissions came through. Residents almost always gave some sort of chalk talk during this time for the students and sometimes they'd do a reverse chalk talk (asking us to read up on a topic and "teach them").

We worked 6 days a week alternating the weekend with the other students and would get out early after rounding. My team helped in my ability to present, which again was a very formalized format but helped in not missing important details which down the road really helped during my electives and sub-i's. Notes were read over by residents and attending and commented over a few days on how to improve them mostly in the assessment and plan portion.

This was not an easy rotation but as @Angus Avagadro said, it's the first time where your knowledge gaps are exposed in front of a GIANT team of residents students pharmacists and nurses, and it sucks. But it def gets you in gear to study hard and be as prepared as much as possible.
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This has been my exact experience. Except for lunch we get free lunch every day in the doctor's lounge 😀
 
Generally it's 6am start to 5pm finish at my program. 6 days a week. 2 golden weekends w/ home call from 7am to 5pm.
 
Last edited:
I did 8 am to 4 pm, saw new patients by myself and wrote notes. I loved my preceptor!

edit: no weekends
 
AMEHigh said:
That schedule sounds pretty typical for inpatient medicine. As a resident I encouraged 3rd year students who are just starting out to take on 1 patient and know EVERYTHING about them. I’d rather you do a good job with 1 patient than a half-ass job with 3 patients.

As far as not getting specific feedback for your SOAP notes, don’t let it discourage you. There is SO MUCH to learn and maybe you won’t get a lot of feedback about SOAP notes, but you’ll be learning other things.

Learning during med school and residency and when you’re an attending doesn’t have a perfect curriculum. Take what you can from experiences, find some people you can trust and also take learning in to your own hands. Things will go much smoother for you with that type of attitude.

As far as competition among other students. I never had time for that non-sense. I did my own thing and kept it moving.
Click to expand...
i do have ways to learn but its through friends i had before who are residents now.
the only reason i got a thumbs up for my presentation and soap note was through the help of someone who isn't even a part of my IM rotation. so yeah.. im learning, but its not through the actual rotation. but i guess in the end i found a way. not very happy the least though. I expect at least if i spent a min 9 hrs at a rotation someone can give me any feedback. but nope. But its fine, I never expect anyone to help me wherever i am, I expect to do work myself.
 
MedicineZ0Z said:
Yeah progress notes are supplementary. Admissions, seeing the orders and going through the workup thought process - is where you learn.
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that isn't taught to us at all. we're just expected to look up patient info, see a patient (Do an H&P as much as we can) and then present and write a brief SOAP note.
 
Angus Avagadro said:
Welcome to the IM Teaching service. No one tells you as a newly minted 3rd yr, your pretty much useless and many will avoid you as it takes time to get you up to speed. Having said that, didnt you learn how to write a SOAP note as a OMS2? It is highly emphasized at my school and many students put it on the back burner when studying for boards. In fairness, the HPI sets up the whole note, follow up questions and differential diagnosis. The rest is pretty much boiler plate. So work on the Who ,What, Where , When, questions as I call them, and your note will improve. Read other notes and critique them. Use what you like and drop less important information left for the formal H and P.
Being a 3rd yr is frustrating. Your knowledge gaps are huge and are publicly revealed on rounds daily. It's not easy to swallow as a competetive medical student. You'll get better, so hang in there. Good luck and best wishes.
Click to expand...
oh i'm learning, its not through their help, its through help outside.
 
ciestar said:
I got no feedback from anyone on my inpatient IM rotation. I was told to write notes daily and then was told they were too busy to look it over. (And I got assigned by my school to the same service for my sub-i as I did for my third year rotation...).

Your experience sounds about right for inpatient medicine though.

With SOAP notes, the only thing that really helps is to keep doing them. Seek out feedback. Talk to your attending or senior resident and just ask for feedback. It sometimes helps.
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i got help from outside the rotation, it was from a friend whose a resident now.
 
Im going to say this nicely while still getting the point accross. You are an adult. You are in a new workplace. For better or for worse you have learn how to do things yourself, and you are not going to be spoon fed anything. You were smart enough to complete the first two years of medical school, you should be smart enough to figure things out by yourself. The team you are rotating with isnt getting paid to teach you. The attendings are doing so because they like to teach. Make the best of the situation you are in, look up resources, videos to go over basic skills and try to emulate the residents who are doing things well.

You are not learning new medical basic science facts at this point in the game. You should be learning about management, and learning how to find the information you need.

All of medical school is an activity in self directed learning. Your current mindset is not conducive to self directed learning. Change your mind set.
 
libertyyne said:
Im going to say this nicely while still getting the point accross. You are an adult. You are in a new workplace. For better or for worse you have learn how to do things yourself, and you are not going to be spoon fed anything. You were smart enough to complete the first two years of medical school, you should be smart enough to figure things out by yourself. The team you are rotating with isnt getting paid to teach you. The attendings are doing so because they like to teach. Make the best of the situation you are in, look up resources, videos to go over basic skills and try to emulate the residents who are doing things well.

You are not learning new medical basic science facts at this point in the game. You should be learning about management, and learning how to find the information you need.

All of medical school is an activity in self directed learning. Your current mindset is not conducive to self directed learning. Change your mind set.
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My mindset is one in which I believe in learning something that can not be taught from books. However, when I do everything in my power to learn and I still am not learning, there is something wrong.
When others say they will help and then fail to do so, there is something wrong.
I am not blaming everyone or everything, there are merits to my rotation , but sometimes the situation is not conducive to one's learning. And again, you are wrong when you say 'Your current mindset is not conducive to self directed learning.' It is, but there needs to be a level of direction that I can build of that is geared for me. That is not to say its possible everywhere, but I need to find it for my own sake. The level of direction I was getting was not good enough for me. It is not up to you to decide whether the direction was/is good for me unless you have telepathic powers and you can figure out for yourself.
I also disagree with you that you believe the team is not there to teach me anything, imo that is the purpose of a rotation. And while you my not looking for a team that will you teach, I Will, so lets just agree to disagree.
So I appreciate you trying to give me advice and I like a little bit of what you said. But fyi, for you to be a little more credible and try not to take this personally, fix your grammar mistakes (i.e: first sentence). Sometimes when you do not know how to type, the reader tends to lose faith in whatever the writer has to say.
Thank you for your response.
 
phagocytosis41 said:
i do have ways to learn but its through friends i had before who are residents now.
the only reason i got a thumbs up for my presentation and soap note was through the help of someone who isn't even a part of my IM rotation. so yeah.. im learning, but its not through the actual rotation. but i guess in the end i found a way. not very happy the least though. I expect at least if i spent a min 9 hrs at a rotation someone can give me any feedback. but nope. But its fine, I never expect anyone to help me wherever i am, I expect to do work myself.
Click to expand...
phagocytosis41 said:
that isn't taught to us at all. we're just expected to look up patient info, see a patient (Do an H&P as much as we can) and then present and write a brief SOAP note.
Click to expand...
phagocytosis41 said:
oh i'm learning, its not through their help, its through help outside.
Click to expand...
phagocytosis41 said:
i got help from outside the rotation, it was from a friend whose a resident now.
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phagocytosis41 said:
My mindset is one in which I believe in learning something that can not be taught from books. However, when I do everything in my power to learn and I still am not learning, there is something wrong.
When others say they will help and then fail to do so, there is something wrong.
I am not blaming everyone or everything, there are merits to my rotation , but sometimes the situation is not conducive to one's learning. And again, you are wrong when you say 'Your current mindset is not conducive to self directed learning.' It is, but there needs to be a level of direction that I can build of that is geared for me. That is not to say its possible everywhere, but I need to find it for my own sake. The level of direction I was getting was not good enough for me. It is not up to you to decide whether the direction was/is good for me unless you have telepathic powers and you can figure out for yourself.
So I appreciate you trying to give me advice and I like some of what you said. By fyi, to be a little more credible and try not to take this personally, fix your grammar mistakes (i.e: first sentence). Sometimes when you do not know how to type, the reader tends to lose faith in whatever the writer has to say.
Thank you for your response.
Click to expand...

I’ll be more blunt than that @libertyyne The residents and attendings aren’t there for your learning. They are there for about 50 other things and at the very bottom of their list of things to do is an asterisk that says “give instruction to medical student.” The vast majority of the time they aren’t going to get that far down their list. It’s probably time you realized the ONLY person who is there for your education is you.

If you feel like you aren’t learning anything then that’s 100% your problem and no one else’s.
 
phagocytosis41 said:
My mindset is one in which I believe in learning something that can not be taught from books. However, when I do everything in my power to learn and I still am not learning, there is something wrong.
When others say they will help and then fail to do so, there is something wrong.
I am not blaming everyone or everything, there are merits to my rotation , but sometimes the situation is not conducive to one's learning. And again, you are wrong when you say 'Your current mindset is not conducive to self directed learning.' It is, but there needs to be a level of direction that I can build of that is geared for me. That is not to say its possible everywhere, but I need to find it for my own sake. The level of direction I was getting was not good enough for me. It is not up to you to decide whether the direction was/is good for me unless you have telepathic powers and you can figure out for yourself.
So I appreciate you trying to give me advice and I like some of what you said. By fyi, to be a little more credible and try not to take this personally, fix your grammar mistakes (i.e: first sentence). Sometimes when you do not know how to type, the reader tends to lose faith in whatever the writer has to say.
Thank you for your response.
Click to expand...
Once again, instead listening to the message because you didnt like it you are criticizing my grammar, while making grammatical mistakes yourself.

You need to figure out the goal or "direction" of your learning yourself. No one is going to spoon feed you information now or when you are an intern.

Instead of actually listening to what I am saying you are arguing with me. Instead of looking towards your own actions and taking responsibility for them you are once again blaming other people. This is the mindset problem.
 
phagocytosis41 said:
My mindset is one in which I believe in learning something that can not be taught from books. However, when I do everything in my power to learn and I still am not learning, there is something wrong.
When others say they will help and then fail to do so, there is something wrong.
I am not blaming everyone or everything, there are merits to my rotation , but sometimes the situation is not conducive to one's learning. And again, you are wrong when you say 'Your current mindset is not conducive to self directed learning.' It is, but there needs to be a level of direction that I can build of that is geared for me. That is not to say its possible everywhere, but I need to find it for my own sake. The level of direction I was getting was not good enough for me. It is not up to you to decide whether the direction was/is good for me unless you have telepathic powers and you can figure out for yourself.
I also disagree with you that you believe the team is not there to teach me anything, imo that is the purpose of a rotation. And while you my not looking for a team that will you teach, I Will, so lets just agree to disagree.
So I appreciate you trying to give me advice and I like a little bit of what you said. By fyi, to be a little more credible and try not to take this personally, fix your grammar mistakes (i.e: first sentence). Sometimes when you do not know how to type, the reader tends to lose faith in whatever the writer has to say.
Thank you for your response.
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I was with you until the grammar dig. A physician has to have a great deal of intellectual curiosity to be a lifelong learner. Physicians of my generation received little to zero instruction on SOAP note writing, H and P skills, etc., during pre clinical as compared to students today. We somehow managed to figure it out. Your frustration is understandable . We all felt inadequate as third years, because we were. Pre clinical is the basic science behind medicine and mastering the language of medicine. Clinical rotations are a whole different ball game and require necessary adjustments. Your comments at the end of your post come off as judgemental and whiny. Not a good look when you come to the forum with questions.
 
libertyyne said:
Once again, instead listening to the message because you didnt like it you are criticizing my grammar, while making grammatical mistakes yourself.

You need to figure out the goal or "direction" of your learning yourself. No one is going to spoon feed you information now or when you are an intern.

Instead of actually listening to what I am saying you are arguing with me. Instead of looking towards your own actions and taking responsibility for them you are once again blaming other people. This is the mindset problem.
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I said I agreed with some of what you said. And I disagreed with some of what you said. I do not get where you are getting the 'looking towards your own actions and taking responsibility for them you are once again blaming other people.' I do admit I am not good at writing SOAP notes and writing presentations and that I had to get help. I am always looking to get help from others and I still am working on how to be a better 3rd year medical student, I never said I was perfect. I do look at my actions and take responsibility for what I do, I never said I do not, so again you are wrong. However when I feel I am not learning from my rotations or I am getting a lack of feedback, I have the right to admit others are not doing their job. I always do what is in my best interest, and when I need to look elsewhere for help, I have the right to criticize what is being done.
Again it is your opinion, whatever you are saying and I thanked you for your answer. Instead you got angry and now you are making personal attacks. Your grammar/spelling mistakes were mistakes and sorry if you are too sensitive to having them pointed out. Everything I said what my opinion, feel free to disagree, but being butt hurt at what I said is also a mindset problem.
 
Angus Avagadro said:
I was with you until the grammar dig. A physician has to have a great deal of intellectual curiosity to be a lifelong learner. Physicians of my generation received little to zero instruction on SOAP note writing, H and P skills, etc., during pre clinical as compared to students today. We somehow managed to figure it out. Your frustration is understandable . We all felt inadequate as third years, because we were. Pre clinical is the basic science behind medicine and mastering the language of medicine. Clinical rotations are a whole different ball game and require necessary adjustments. Your comments at the end of your post come off as judgemental and whiny. Not a good look when you come to the forum with questions.
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Well I guess you agreed with most of what I said 😉. Sorry if those comments offended you, I guess thats an attending thing to be hurt at any small criticism. You can't satisfy everyone i guess.
I was not being judgmental or whiny, again your opinion.
Thank you for your response.
 
AnatomyGrey12 said:
I’ll be more blunt than that @libertyyne The residents and attendings aren’t there for your learning. They are there for about 50 other things and at the very bottom of their list of things to do is an asterisk that says “give instruction to medical student.” The vast majority of the time they aren’t going to get that far down their list. It’s probably time you realized the ONLY person who is there for your education is you.

If you feel like you aren’t learning anything then that’s 100% your problem and no one else’s.
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I never said I was not learning anything, I am learning things, but there are certain things that are not being addressed. I agree with you that they have to do many other things, but If there is a problem, I have the right to have it addressed. If not fine, but that does not make it right. I think my problems should be addressed. I think its wrong not to have the mentality of having my problems addressed. Again thats me and some may disagree, but thats my opinion.
 
phagocytosis41 said:
I said I agreed with some of what you said. And I disagreed with some of what you said. I do not get where you are getting the 'looking towards your own actions and taking responsibility for them you are once again blaming other people.' I do admit I am not good at writing SOAP notes and writing presentations and that I had to get help. I am always looking to get help from others and I still am working on how to be a better 3rd year medical student, I never said I was perfect. I do look at my actions and take responsibility for what I do, I never said I do not, so again you are wrong. However when I feel I am not learning from my rotations or I am getting a lack of feedback, I have the right to admit others are not doing their job. I always do what is in my best interest, and when I need to look elsewhere for help, I have the right to criticize what is being done.
Again it is your opinion, whatever you are saying and I thanked you for your answer. Instead you got angry and now you are making personal attacks. Your grammar/spelling mistakes were mistakes and sorry if you are too sensitive to having them pointed out. Everything I said what my opinion, feel free to disagree, but being butt hurt at what I said is also a mindset problem.
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1566670818084.png
 
As an attending I actually do feel like it’s my responsibility to make sure the students know the expectations, are included in the daily work, and are being educated. After all one of my titles is in fact Clinical Professor. Although learning how to learn on the job in a self directed manner is part of the expectation of adjustment to clinical rotations. Libertyyne’s daily schedule looks about right although I might retitle “scut” to “teamwork for patient care.”

This is my expectations blurb for MS3s on wards:
Follow 1-3 patients

Take comprehensive history and physical on all new patients (1 new per admitting day)

Prepare H&P, developing assessment and plan with assistance from residents

Present to me in standard H&P/SOAP format as appropriate (use Maxwells)

Be aware of developments in patient status, consult results, vitals and labs throughout the day. Visit patients and their nurses min x2/day and report updates and patient needs to team. Have an update for afternoon list run.

Be attentive to and learn from all patients on service - be fully present for your colleagues’ presentations, ask questions, remain engaged

Keep a list of questions, learning needs, points to look up after rounds. Research one for yourself each day and report your learning to the team.

Attend didactics, prepare assignments and submit to me timely for feedback (I give one on one feedback for each H&P, residents do for daily notes when possible)

Key: gather and report data, begin to interpret data/form ddx and understand the why of the plan. Try to be the most up to date on your patient - their data but also their experience, needs and concerns. Share this info with the team.
*end document discussed verbally day 1”

I or the resident teach them how to gather data from the EMR and organize it into standard presentation format on day 1 when they’re picking up their first patients. Understanding that we’ll need to continue to refine and give feedback along the way and that’s okay.
 
phagocytosis41 said:
You seem very angry, is it the whole spelling/grammar mistake your not over?
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Lol. good luck. You have some distance to go. One way or the other you will learn this, it might just take a little longer in your instance with your mindset.
 
siliso said:
As an attending I actually do feel like it’s my responsibility to make sure the students know the expectations, are included in the daily work, and are being educated. After all one of my titles is in fact Clinical Professor. Although learning how to learn on the job in a self directed manner is part of the expectation of adjustment to clinical rotations. Libertyyne’s daily schedule looks about right although I might retitle “scut” to “teamwork for patient care.”

This is my expectations blurb for MS3s on wards:
Follow 1-3 patients

Take comprehensive history and physical on all new patients (1 new per admitting day)

Prepare H&P, developing assessment and plan with assistance from residents

Present to me in standard H&P/SOAP format as appropriate (use Maxwells)

Be aware of developments in patient status, consult results, vitals and labs throughout the day. Visit patients and their nurses min x2/day and report updates and patient needs to team. Have an update for afternoon list run.

Be attentive to and learn from all patients on service - be fully present for your colleagues’ presentations, ask questions, remain engaged

Keep a list of questions, learning needs, points to look up after rounds. Research one for yourself each day and report your learning to the team.

Attend didactics, prepare assignments and submit to me timely for feedback (I give one on one feedback for each H&P, residents do for daily notes when possible)

Key: gather and report data, begin to interpret data/form ddx and understand the why of the plan. Try to be the most up to date on your patient - their data but also their experience, needs and concerns. Share this info with the team.
*end document discussed verbally day 1”

I or the resident teach them how to gather data from the EMR and organize it into standard presentation format on day 1 when they’re picking up their first patients. Understanding that we’ll need to continue to refine and give feedback along the way and that’s okay.
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Thank you for the advice. I am still learning how to learn and its a learning curve for me, but I think I am slowly getting the hang of it.
 
I got 2 patients at 9, saw them, wrote notes, rounded at 11:30 and got sent home at 12 with a reading assignment. Took me 2 hours at home to do.

5 hour days. Pretty sweet. Mostly learned at home.
 
Just pull out the maxwells if you’re not sure on note/presentation format. Subjective: what the patient reports to you, events reported overnight. Objective: Vitals, exam, I/o, new labs, new images/diagnostics. Assessment/plan: problem based, from most important problem to least active problem. For each problem give an assessment: why we think the problem exists and is it getting better, worse, or same. And a plan: what are we going to do to figure out what’s going on or get the problem better. Common pitfall - reporting what’s already been done without assessing whether it’s working or planning what we need to do next (this part you will need input from intern/resident). Take a pause at the end of each problem for intern/resident/attending comments. Finally dispo: what are the current barriers to discharge (continue in location x pending improvement of y), or can the person be transferred to a lower level of care or discharge? (Also intern/resident input appropriate here).

It’s hard to write a decent note if you haven’t sorted out all the above before you do it, so make a skeleton of what you do know and then add in the details/new plans after rounds.
 
Ps consultant recommendations and their outcome belong in assessment/plan. And it’s expected that you don’t know wtf you’re doing when you start out. If you already knew you could just go ahead and hang out your shingle. It’s possible/probable that we forget how much you don’t know yet (things seem obvious to us after years in practice which actually are not at all obvious), which is why pertinent and well timed questions are appropriate and welcome.
 
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phagocytosis41 said:
I never said I was not learning anything, I am learning things, but there are certain things that are not being addressed. I agree with you that they have to do many other things, but If there is a problem, I have the right to have it addressed. If not fine, but that does not make it right. I think my problems should be addressed. I think its wrong not to have the mentality of having my problems addressed. Again thats me and some may disagree, but thats my opinion.
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phagocytosis41 said:
Thanks, good luck with your anger problems.
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A little self reflection is in order methinks.
 
LOL. Still blows my mind how so many students go into IM after experiences like this that are pretty much the standard IM experience.
 
DNC127 said:
LOL. Still blows my mind how so many students go into IM after experiences like this that are pretty much the standard IM experience.
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OP hasnt really told us if there are residents or interns at the rotation site. It might just be a poor clinical rotation site. But people go into IM for the most part because it is the default and leaves options open.
 
DNC127 said:
LOL. Still blows my mind how so many students go into IM after experiences like this that are pretty much the standard IM experience.
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Consult services aren't as bad, more 8 to 4 M-F.
I think that it's really worth noting that IM is kind of a cesspool. Very few people are going into it because they want to be a generalist. Most are doing it because it validates a means to an end. For a lot of people it's a fellowship for others it's adult primary care.
 
phagocytosis41 said:
My mindset is one in which I believe in learning something that can not be taught from books. However, when I do everything in my power to learn and I still am not learning, there is something wrong.
When others say they will help and then fail to do so, there is something wrong.
I am not blaming everyone or everything, there are merits to my rotation , but sometimes the situation is not conducive to one's learning. And again, you are wrong when you say 'Your current mindset is not conducive to self directed learning.' It is, but there needs to be a level of direction that I can build of that is geared for me. That is not to say its possible everywhere, but I need to find it for my own sake. The level of direction I was getting was not good enough for me. It is not up to you to decide whether the direction was/is good for me unless you have telepathic powers and you can figure out for yourself.
I also disagree with you that you believe the team is not there to teach me anything, imo that is the purpose of a rotation. And while you my not looking for a team that will you teach, I Will, so lets just agree to disagree.
So I appreciate you trying to give me advice and I like a little bit of what you said. But fyi, for you to be a little more credible and try not to take this personally, fix your grammar mistakes (i.e: first sentence). Sometimes when you do not know how to type, the reader tends to lose faith in whatever the writer has to say.
Thank you for your response.
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Really trying to empathize with you. But this is a stunning lack of self-awareness. You can’t claim to be a self-directed learner while complaining about inadequate direction in your learning.

It sounds like you had you’re hand held at the beginning of third year but now that you’ve had a rotation or two the gloves have come off. You’re motivation to not fail the rotation so you can be a doctor should be guiding how your doing things.

If you react anywhere close to this irl to criticism then its no mystery as to why your having problems.

***The grammatical errors are intentional since that’s what this thread has become.
 
Ho0v-man said:
Really trying to empathize with you. But this is a stunning lack of self-awareness. You can’t claim to be a self-directed learner while complaining about inadequate direction in your learning.

It sounds like you had you’re hand held at the beginning of third year but now that you’ve had a rotation or two the gloves have come off. You’re motivation to not fail the rotation so you can be a doctor should be guiding how your doing things.

If you react anywhere close to this irl to criticism then its no mystery as to why your having problems.

***The grammatical errors are intentional since that’s what this thread has become.
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Dont feed the Troll!!!
 
siliso said:
Idk for sure who’s a troll but I figure a heartfelt response may be helpful to someone, even if not the OP. Troll hunting can be as derailing to discussion as trolling, sometimes :shrug:
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No one can argue with this. My empathy evaporated for the OP when they lashed out and tried to denigrate other Posters for their grammar and intellect. Certainly a failure on my part. The luke warm and or complete lack of responses by OP to the very well written suggestions you offered suggested the OP seems to be more interested in venting and sniping rather than learning. OP barely acknowledged your thoughtful, and detailed approach to their question. This and the numerous snarky comments by OP led me to the Trolling remarks. Not trying to justify, just explaining my thought process.
 
libertyyne said:
630-645am . Show up.
7-7:30- preround on 2-3 patients , do pertinent exams, ask them how they are doing, what happened overnight etc.
730-8: Feverishly generate SOAP notes for my patients while looking over , overnight tests/ morning labs.
8:00-8:10, ask management or plan questions and run by any changes with the senior resident or intern. (The interns are usually too busy or green to know some of the intricacies that may come up in the management piece, they are trying to keep afloat with their patient load and order entry etc.
810- varied (depending on round speeds) Round with attending. Ask a question or two on management that you have never seen or dont understand, or doesnt make sense.
varried to 12 - scut work , help the resident with any scut they need, supplies small procedures, orders, call consults.
12-1 lunch lectures
1:2 finish up scut, take on a new patient or get patient D/C /transfer ready.
2-3 round on your patients, check up to see how they are doing.
3-varied - shoot the **** with your residents, do any left over scut. finish any left over note. do some studying/ anki uworld etc.

if on long call
varied -8 pm . Get new patient , HPI, generate plan, etc.

Rinse and repeat.
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Word for word this^^^
Except we rounded in the afternoon with the attending and we had morning and noon lectures. But other than that, this was my exact experience
 
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