3rd year unwritten rules?

[DrOwnage]

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Hey guys,

I recently started 3rd year on my pediatric rotation. Usually the schedule is that I have two afternoons free a week (white space time), so those days I usually go from around 7am-12pm (scheduled). The rest of the days are like 7am-6pm with one 8-hour ER shift on the weekend. So mostly 6 day weeks. I usually stay an extra hour or so on the white space days if there are some cool patients or I haven't seen all of the cases on the floor. I would honestly rather have that free time to study, do patients logs, and relax. However some of my classmates are like "zomg" I stayed an extra 4 hours on my 9 hour ER shift after being told I could leave. Some go in on days off and stay there the whole morning and afternoon.

Is this like an unwritten rule? Or is it just people being overzealous and staying to just to look good, even if they aren't being productive? Probably shouldn't being worrying about what other people are doing, but I'm obviously being compared to them for grading purposes. People who have gone through 3rd year chime in?

 

[Brain Bucket]

In the tradition of SDN, I'm going to offer my advice without actually having gone through the experience. As an MS2, I can tell you with confidence that ... It depends. If you're hoping to match at a program in your school, it might behoove you to show interest. If not, it depends on how you're graded. If it's a shelf exam, focus on crushing it instead of wasting time at the hospital.

Sent from my SM-N9005 using Tapatalk

 

[evilbooyaa]

If the resident tells you to leave, LEAVE.

If you're supposed to be in 'white space time', don't complain or ask to leave if the resident hasn't dismissed you. This whole "stay after the resident tells you to leave" thing is frowned upon (at least that's what they tell me) by all of the residents when I was a MS3.

At the same time, try not to leave hints you want to leave, like "So..... do you need me to do anything else?". If the resident hasn't dismissed you, either find something useful to do (or ask the resident if you can do a specific task to help him/her out) or sit quietly. Unfortunately, sometimes the resident will get caught up in his/her work and completely forget that you exist. That last part can only be summarized by saying 'welcome to 3rd year'.

 

[link2swim06]

If the resident tells you to leave, LEAVE.

If you're supposed to be in 'white space time', don't complain or ask to leave if the resident hasn't dismissed you. This whole "stay after the resident tells you to leave" thing is frowned upon (at least that's what they tell me) by all of the residents when I was a MS3.

At the same time, try not to leave hints you want to leave, like "So..... do you need me to do anything else?". If the resident hasn't dismissed you, either find something useful to do (or ask the resident if you can do a specific task to help him/her out) or sit quietly. Unfortunately, sometimes the resident will get caught up in his/her work and completely forget that you exist. That last part can only be summarized by saying 'welcome to 3rd year'.

That was my go to line during 3rd year. Granted I didn't use it at 10am but if its 3pm and there is clearly nothing left for the day it is a subtle way of occasionally reminding them I was still there. I never got dinged for it in my evals, but also I was always proactive about finding stuff to do to help the resident/team out.

For a lot of schools your grade is determined by your shelf score. The vast majority of people get similar clinical evals. Therefore, studying during downtime or at home is how you improve your grade. Not by coming in on off days.

 

[mvenus929]

So I agree with evilbooyaa on most points. My ED attending once dismissed the intern when we were having an impossibly slow day. When she protested, the attending said 'learn this now, when you are dismissed, don't question it, just say thank you and go enjoy the rest of your day.' If you are scheduled the time off, then use it to study. The person who stays an extra four hours for no apparent reason will be looked at with a raised eyebrow.

The point I sorta disagree with is the hint to leave, if you are not given a specific time to stay until. On my peds rotation, we were required to stay until evening sign-out, so the question was useless, but on medicine, we could leave at some point in the afternoon after the work for the day had been done and we had no other educational obligations. But when that point was varied a lot. So, if you aren't doing something, and aren't sure what you can be doing, and have already checked up on your patients, asking the resident, 'Is there anything I can help with?' may make the resident remember that you are there, and in turn, have them tell you to go home. That said, you should have a book to study with (not rely on the computer) in cases of downtime like that.

 

[sakata8242]

Hey guys,

I recently started 3rd year on my pediatric rotation. Usually the schedule is that I have two afternoons free a week (white space time), so those days I usually go from around 7am-12pm (scheduled). The rest of the days are like 7am-6pm with one 8-hour ER shift on the weekend. So mostly 6 day weeks. I usually stay an extra hour or so on the white space days if there are some cool patients or I haven't seen all of the cases on the floor. I would honestly rather have that free time to study, do patients logs, and relax. However some of my classmates are like "zomg" I stayed an extra 4 hours on my 9 hour ER shift after being told I could leave. Some go in on days off and stay there the whole morning and afternoon.

Is this like an unwritten rule? Or is it just people being overzealous and staying to just to look good, even if they aren't being productive? Probably shouldn't being worrying about what other people are doing, but I'm obviously being compared to them for grading purposes. People who have gone through 3rd year chime in?

If you are told you can leave, LEAVE. There's no reason to sit around and do nothing while your resident does work. You'll just 1) get in the way and 2) be labeled as "that annoying med student who won't ****ing go home".

Again, if you are told you can go home, GO THE **** HOME AND SLEEP/STUDY/WHATEVER.

 

[evilbooyaa]

I was unclear. Regarding the question asking to leave, I meant don't ask the resident multiple times that question in a short period of time (say like 5x in 30 mins like one of my classmates). I routinely asked it once or twice over the course of an afternoon just to remind the resident that I was still there.

Carry some study materials (casefiles, UWorld questions on a phone, etc.) for any obvious downtime.

 

[dpmd]

I like the "is there anything I can help with" phrasing a little better, but it is all in the delivery really. Multiple times during the day, or every freaking day from the same person while the others are occupying themselves would get on my nerves though. That said the invitation to leave is all about delivery too. "Thanks for your help today, see you tomorrow" means you should say thanks and goodbye then go away. "I guess you guys are supposed to be off now" is probably code for "you would stay if you really cared" particularly if something particularly educational is going on or if there is still stuff that you could be helping with.

As for unwritten rules, never get caught eating if your team hasn't been able to eat yet. Exception could be made if you bring food for the team (and of course if you were told to go eat). Not that you can't eat, just don't be obvious about it.

 

[ChessMaster3000]

to the OP: your classmates are gunners. residents arent stupid--they remember when they told you to leave. if youre still around for hours, theyre probably going to think less of you than if you had just left when they told you to.

as for coming in on off days--NOBODY cares about you enough that they will appreciate that you are coming in on an off day. they dont even know its your off day so they'll just assume you are coming in on a scheduled day. therefore you wont earn "brownie points" since in their mind, you're coming in for a schedule shift.....unless you drop the hint that you are not scheduled today, in which case they'll probably just think youre a loser.

 

[SouthernSurgeon]

I like the "is there anything I can help with" phrasing a little better, but it is all in the delivery really. Multiple times during the day, or every freaking day from the same person while the others are occupying themselves would get on my nerves though. That said the invitation to leave is all about delivery too. "Thanks for your help today, see you tomorrow" means you should say thanks and goodbye then go away. "I guess you guys are supposed to be off now" is probably code for "you would stay if you really cared" particularly if something particularly educational is going on or if there is still stuff that you could be helping with.

Yeah this is true. Unfortunately we sometimes get busy and totally forget to send the student(s) home. In that case, I have no issue with a polite reminder. However, if you do ask the classic "is there anything else I can help with?" - Don't act like someone kicked your puppy if there is actually something they want you to help with.

And yes, it is very different for a student to ask at 4pm on a slow Saturday...than every freaking day, usually by lunchtime...which some students do. Or there are the ones who just manage to ghost and aren't even around enough to ask if it's ok to leave...

 

[styphon]

As for unwritten rules, never get caught eating if your team hasn't been able to eat yet. Exception could be made if you bring food for the team (and of course if you were told to go eat). Not that you can't eat, just don't be obvious about it.

I like this one...

-On a similar note, and from a different thread, don't bring in food for the team unless you warn the other 3rd years first - otherwise feelings of competition and bitterness can occur.
-If a resident looks very busy -offer to help
-If a procedure is about to occur, ask if you can be involved
-If there is an interesting/puzzling case - offer to do a presentation
-If there are new admits - offer to help out with the H&P

 

[TooMuchResearch]

1. If your boss tells you to go, then go.
2. If you have nothing to do and the normal hours you work are done, ask your resident "what can i do for you?" Expect work. If you are told to leave, see (1) above.
3. Be useful. Do stuff for people on your team. Be proactive, but don't do anything recklessly.
4. If it's go home time, but something cool or new to you is about to happen, don't go home.
5. If someone was following you around at work, and they told you to go home, would you like it if they continued to follow you around? I wouldn't. Don't do it.

 

[DermViser]

Hey guys,

I recently started 3rd year on my pediatric rotation. Usually the schedule is that I have two afternoons free a week (white space time), so those days I usually go from around 7am-12pm (scheduled). The rest of the days are like 7am-6pm with one 8-hour ER shift on the weekend. So mostly 6 day weeks. I usually stay an extra hour or so on the white space days if there are some cool patients or I haven't seen all of the cases on the floor. I would honestly rather have that free time to study, do patients logs, and relax. However some of my classmates are like "zomg" I stayed an extra 4 hours on my 9 hour ER shift after being told I could leave. Some go in on days off and stay there the whole morning and afternoon.

Is this like an unwritten rule? Or is it just people being overzealous and staying to just to look good, even if they aren't being productive? Probably shouldn't being worrying about what other people are doing, but I'm obviously being compared to them for grading purposes. People who have gone through 3rd year chime in?

And don't make them.

 

[maxxor]

And don't make them.

I also like Success on the Wards by the same authors. It's the revised version of 250 mistakes.

 

[Raryn]

Let me write the rules down for you:

1) Eat when you can
2) Sit when you can
3) Leave when you can
4) Don't poke the pancreas

 

[Xenoblade]

to the OP: your classmates are gunners. residents arent stupid--they remember when they told you to leave. if youre still around for hours, theyre probably going to think less of you than if you had just left when they told you to.

as for coming in on off days--NOBODY cares about you enough that they will appreciate that you are coming in on an off day. they dont even know its your off day so they'll just assume you are coming in on a scheduled day. therefore you wont earn "brownie points" since in their mind, you're coming in for a schedule shift.....unless you drop the hint that you are not scheduled today, in which case they'll probably just think youre a loser.

I feel like if I follow my gut, normal protocols in a work environment, and common sense, I think I would be good.

People tell you to go to, then go home.

If you are not scheduled, don't show up.

Be respectful and expect to work long hours.

Be buddy buddy with people but don't brown nose.

 

[mimelim]

Maybe this only applies to surgery, but this is what I tell the MS3s that come onto our service:

When things are going on and we are busy, you should want to be in the hospital as much as possible. You learn by participating in patient care, anything you get from studying for the shelf is gravy. When things aren't busy, get the **** out. Have a life, go lift, take your significant other out, have fun. You are going to be working your ass off for the rest of your training and possibly the rest of your life.

 

[Anastomoses]

Maybe this only applies to surgery, but this is what I tell the MS3s that come onto our service:

When things are going on and we are busy, you should want to be in the hospital as much as possible. You learn by participating in patient care, anything you get from studying for the shelf is gravy. When things aren't busy, get the **** out. Have a life, go lift, take your significant other out, have fun. You are going to be working your ass off for the rest of your training and possibly the rest of your life.

this sounds like a death threat.

 

[PL198]

Maybe this only applies to surgery, but this is what I tell the MS3s that come onto our service:

When things are going on and we are busy, you should want to be in the hospital as much as possible. You learn by participating in patient care, anything you get from studying for the shelf is gravy. When things aren't busy, get the **** out. Have a life, go lift, take your significant other out, have fun. You are going to be working your ass off for the rest of your training and possibly the rest of your life.

But really? As much as possible? Someone should be planning their life around having as much time as possible to be in the hospital?

 

[Siggy]

But really? As much as possible? Someone should be planning their life around having as much time as possible to be in the hospital?

"When things are happening" are the key words. If you're about to leave your EM shift, and hear that a code (especially the rare one that has ROSC)/septic/stroke/critical trauma/etc is coming in, then you should stay and help out when/if you can. If there's nothing new/exciting going on, then yes, leave when told to leave.

 

[PL198]

"When things are happening" are the key words. If you're about to leave your EM shift, and hear that a code (especially the rare one that has ROSC)/septic/stroke/critical trauma/etc is coming in, then you should stay and help out when/if you can. If there's nothing new/exciting going on, then yes, leave when told to leave.

I feel like an ER is pretty busy much more often than not, with very few actual slow times, so to me that statement is basically like saying, " be in the hospital as much as possible."

 

[mimelim]

I feel like an ER is pretty busy much more often than not, with very few actual slow times, so to me that statement is basically like saying, " be in the hospital as much as possible."

I do trauma at the busiest level 1 center in the US and yes, it does slow down and people go home.

And yes, as much as possible. Your medical education is ultimately up to you. It is also finite in length. Part of it is seeing the rare things. Part of it is repetition. I am disappointed with myself if my MS4s can't put in central lines by themselves. I would never leave one by themselves to do it, but I want them to have seen me do enough and the done enough with me supervising that they can show up as an intern with a solid foundation and the confidence to use it. This requires time, patience and availability. I know this sentiment isn't shared by everyone, but I take my medical education seriously and know that I have opportunities now that I won't later to learn when not solely responsible for a patient. The same is true in med school.

 

[PL198]

I do trauma at the busiest level 1 center in the US and yes, it does slow down and people go home.

And yes, as much as possible. Your medical education is ultimately up to you. It is also finite in length. Part of it is seeing the rare things. Part of it is repetition. I am disappointed with myself if my MS4s can't put in central lines by themselves. I would never leave one by themselves to do it, but I want them to have seen me do enough and the done enough with me supervising that they can show up as an intern with a solid foundation and the confidence to use it. This requires time, patience and availability. I know this sentiment isn't shared by everyone, but I take my medical education seriously and know that I have opportunities now that I won't later to learn when not solely responsible for a patient. The same is true in med school.

Are you implying those that have a different viewpoint don't take their education seriously? Not saying you did, just wanted to figure that out first. How do you feel about a balance with trying to learn as much as possible in a clinical setting and the rest of life's facets? At what point is it actually debilitating function-wise for a physician or student to stay and practice/train more and neglect other aspects of their life?

 

[mimelim]

Are you implying those that have a different viewpoint don't take their education seriously? Not saying you did, just wanted to figure that out first. How do you feel about a balance with trying to learn as much as possible in a clinical setting and the rest of life's facets? At what point is it actually debilitating function-wise for a physician or student to stay and practice/train more and neglect other aspects of their life?

I am not implying that. I suggest that you re-read my initial post in this thread that you quoted given that I advocate people leaving the hospital to do other things.

At the same time, medicine is hard. The content is vast and ever expanding. The government and society have decreased resident learning by increasing the paperwork burden of everyone (no judgement, just a fact). It is going to take a time commitment to learn what is necessary to be a good physician. And yes, the vast majority of future physicians and physicians will need to sacrifice other parts of their life in order to do their profession well. Do not misunderstand. I am in no way advocating forgoing everything else in life and being a physician monk. But, I am saying that during your training years, you have to take advantage of what you can. It is for a finite time and the resources and opportunities that you will have are only available then. There is a saying in Vascular Surgery, "The first scary experience you will encounter: when you look across the table and realize you are the most experienced surgeon in the room." Training takes time. Taking shortcuts IS dangerous, not at that moment, but an education full of shortcuts will leave you deficit when it counts later. Things are never so busy that you can't do other things. I'm married and I rock climb 3-4 days a week and compete in endurance competitions, never mind that I find time to post on SDN and do other random stuff on the internet. Yes, I would have more free time for "other aspects of life" if I wasn't learning a profession. But, if you can't invest in your education and sacrifice at least a little bit in the pursuit of it, you are going to have a hard time in this field.

There is a balance that everyone has to find, but every medical student should be chomping at the bit to see and be involved in patient care when it is happening. And yes, when there isn't anything to be learned from, people should get the **** out of the hospital and go live.

 

[Bacchus]

If the resident is precepting a newborn nursery exam with the attending, do not interrupt to begin your proctored mock physical exam.

This goes for anything... unless a patient is coding or negligence is about to be committed, wait for the upper-level conversation to stop. If not, don't expect anyone to be listening to you.

 

[Bacchus]

But really? As much as possible? Someone should be planning their life around having as much time as possible to be in the hospital?

Sorry to rip into you. But, if something valuable to your education is going on, you should find a way to stay a bit longer if there aren't extenuating circumstances: you need to pick your kid up from daycare; if you don't give mom her sinemet soon she'll be stuck in a chair for the next 4 hours; if you don't visit a loved one in the hospital you might not get to say goodbye.

Just going through the motions will get you to graduation. However, these opportunities, such as what Siggy suggests: Cardiac arrest (and an actual spontaneous return of circulation, which I have yet to see), you should stick around. It is beneficial to your training. Not just medically, but socially as well. Not only did you (the team) bring someone back to life, but now you get to deliver good news (hopefully). You can't learn that from a book.

As a resident, and even occasionally as a student (to use OB/GYN as an example) I would stay late for imminent deliveries. Did I have to? No, signout was over. But, again, I'm not going to get that experience anywhere else.

You're not an MA, PA, DNP. You're a medical student and soon to be physician. You should be staying longer if interesting cases are going on.

This of course is all within reason. If you're on surgery and you've been in the hospital for 14 hours then you shouldn't stay around for the Whippel. But, if its 4 or 5 pm, for example, and a "relatively short" case is added on (this may not be realistic) then you should stay around. Its for your own benefit. Same goes if you're on an FM or IM service and you have an actively dying patient. If death is imminent, you should stick around to experience the process.

You no longer have a 9-5 schedule. You shouldn't be staying until midnight, but you should be showing interest REGARDLESS of rotation and if something is interesting going on, don't have one foot out the door.

 

[Siggy]

I feel like an ER is pretty busy much more often than not, with very few actual slow times, so to me that statement is basically like saying, " be in the hospital as much as possible."

First, it really depends on the hospital. One hospital I rotated through has 12 hour shifts with sign out. The others had staggered shifts and it was expected that you wouldn't look at picking up long cases near the end of your shift. Also, just because there are patients in the waiting room doesn't mean it's "busy" from a student's perspective. Quantity is important, but not nearly as important as quality. There really is only so many non-STEMI chest pain workups to do before it gets old. There's really only so many vague abdominal pain or pelvic pain work ups to do before it gets old. There will always be more of those just outside in the waiting room.

Those aren't the patients you should be sticking around to see.

Combative trauma patient with a possible head bleed? Stick around for the CT at least.

Cardiac arrest 5 minutes out? Stick around. During 4th year, I got to see a ROSC patient receive therapeutic hypothermia, got to see a sine wave hypermagnesium arrest, got to pace a new-onset heart block in a patient with muscular dystrophy, got to see a couple caths for STEMIs, and a bunch of other interesting things that tend to be a 'right place, right time' situation. No one is saying to camp out in the call rooms so that when these patients are coming in, you're there. We're saying that if you know they're coming in, then stick around. The 15th vague abdominal patient that day who is in the waiting room? Unless there's something setting off your spidey sense, don't wait for them to be seen when told to go home.