A letter to my intern

[Tired]

You can learn valuable things from doing scut, even if it means just learning where things are kept, what materials you need, how a medical team functions. You do not want to be learning these things for the first time as an intern. You'll have other things to worry about, so scut has to be second nature by then.

Agreed 100%, but gosh, you're a much better intern than I am.

I don't ask my med students to get involved, I wait for them to be interested, or at least act like it. My first two months, I would push them to write notes, write orders, help out, but it was like pulling teeth. I don't know if it's just my institution, or if this is how most folks are in their 3rd year, but after a while it's just painful.

It takes extra time to teach people things, or critique notes, or cosign orders, but it's no problem. What is a problem is begging someone who is "just there to learn" to see patients in the morning, present patients, formulate a plan, and read up on their patient's conditions.

So pretty much, my attitude is that they can do whatever they want. If they want to practice their skills, they can do everything they want. If they want to stand around and leave early, that's cool too. I'm sure not going to beg.

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[drfunktacular]

Agreed 100%, but gosh, you're a much better intern than I am.

I don't ask my med students to get involved, I wait for them to be interested, or at least act like it. My first two months, I would push them to write notes, write orders, help out, but it was like pulling teeth. I don't know if it's just my institution, or if this is how most folks are in their 3rd year, but after a while it's just painful.

It takes extra time to teach people things, or critique notes, or cosign orders, but it's no problem. What is a problem is begging someone who is "just there to learn" to see patients in the morning, present patients, formulate a plan, and read up on their patient's conditions.

So pretty much, my attitude is that they can do whatever they want. If they want to practice their skills, they can do everything they want. If they want to stand around and leave early, that's cool too. I'm sure not going to beg.

I've seen many MS3's behave this way (I've probably even been guilty of it myself on services that aren't the most interesting to me... ).

But the funny thing is, when I have residents that treat me in the way you treat your students (i.e., like an adult who is responsible for his/her own education), I am MUCH MUCH more likely to be enthusiastic and want to participate. I guess it's some kind of reverse psychology thing.

 

[velo]

It's part of the job. You do scut, and maintain your place in the hierarchy. But all the while watching and listening and learning. Works the same way in most professions, actually. And it actually doesn't generate incompetent doctors. More often than not, the opposite.

I'm not sure what you are imagining you should be doing as a student. The first two years of med school teach you a lot of foundation, but very little that is helpful on the wards. So you spend your third year as the intern's sherpa, hoping to get to do some cool stuff along the way, ie hoping some table scraps fall off the table. The greatest physicians in history all apprenticed this way.

Interns are useless and stressed because they are barely removed from med school, not given the greatest hours for sleep, and yet suddenly are responsible for people's lives. And on top of this, the department expects them to give some teaching to med students "in their spare time". Some handle the task better than others.

Yeah there's a fine line between what is and is not scut. While I certainly agree that things like getting lunch/coffee, checking someone's schedule, or just being an "errand boy" are scut and not useful for a 3rd year, I found that during my clerkships my INTERNS actually had a much broader definition of what "scut" was than I did. When they would, apologetically, ask me to help with admission/discharge/orders paper work, or track down outside records, or make sure tests got done and results were followed up on I was usually more than happy to do it because, A: as a medical student I usually didn't have anything better to do, and B: If its something my intern has to do it is, therefore, something I will have to do in two years time and I might as well get a little practice with it.

Since the letter is too vague to comment specifically on what was being "scutted out" I will give the OP the benefit of the doubt that this intern was making inappropriate requests and (from the sound of it) copping an attitude that belied their position in life. However, I think sometimes people define scut to broadly and I don't think its out of bounds to politely ask a bored medical student to help out with a job that, if the medical student doesn't do it, the intern will have to do.

 

[velo]

You know, when i was a med student i actually hated it when my interns were so worried about "not scutting me out" that they wouldn't let me do anything. Medicine was my first rotation of MS3 and seriously, I needed to do those little things to learn the ropes, because even the smallest tasks showed me how the floors worked. Learning this was made harder when the "nice" interns my first medicine month would say "nah, you dont have to do that. . .it's scut". I also felt very left out when they would be like that. The 2nd month, my intern wasnt as nice, and I learned so much more.

Yeah here we go, here's a more articulate post saying what I was trying to get across. Agree 100%

 

[Tired]

I've seen many MS3's behave this way (I've probably even been guilty of it myself on services that aren't the most interesting to me... ).

But the funny thing is, when I have residents that treat me in the way you treat your students (i.e., like an adult who is responsible for his/her own education), I am MUCH MUCH more likely to be enthusiastic and want to participate. I guess it's some kind of reverse psychology thing.

I really ought to be better than I am. I mean, I don't know a ton, but I've picked up a few things the last six months.

But I think I still can't get over how I was as a med student versus how the students I have are. I used to get in early enough to finish all my notes before the intern. I knew what cases were going the next day and with which surgeons. I presented every patient I saw unless specifically told not to.

The students I have ask me what time they should come in. They'll see patients in the morning, but won't write a note unless told to. They ask me if anything happened with their patients overnight, and ask me what cases are going on that day. I have been told that they "didn't feel comfortable" seeing more than two patients a day. Most galling, they will cite "school policy" as a reason not do things (mainly writing notes on ICU patients, or writing orders for me to cosign later). [Granted, I have had three really excellent students who didn't do these things, but the other 8-10 were all like this.]

I'm willing to bet this is just a function of the school we're associated with, but it's frustrating when you have to negotiate with students to do things that I would assume are reflexive, especially half way through your MS3 year.

 

[Blade28]

But I think I still can't get over how I was as a med student versus how the students I have are.
...
I'm willing to bet this is just a function of the school we're associated with, but it's frustrating when you have to negotiate with students to do things that I would assume are reflexive, especially half way through your MS3 year.

With very few exceptions, this has been my experience as well.

I just don't get it. What happened to writing notes before the resident? Reading up so you'll know at least some of the answers during pimping? Being excited to go to the OR (or at least showing up before the case starts)?

I've had a small handful of good med students, two or three that were exceptional...and the rest, not so good.

 

[SoCuteMD]

With very few exceptions, this has been my experience as well.

I just don't get it. What happened to writing notes before the resident? Reading up so you'll know at least some of the answers during pimping? Being excited to go to the OR (or at least showing up before the case starts)?

I've had a small handful of good med students, two or three that were exceptional...and the rest, not so good.

See, I have to say that I don't understand these med students. I always assumed that these things would be a given! Where I am on surgery, the med students arrive at the same time or before the interns. Everyone does their own thing for an hour or so before rounds, so you may see your patient before or after the intern but by the time rounds come you've written the note, looked at the official read AND the film of any studies, and collected any key lab values.

As for showing up before the case starts, we had some issues with this (like when our chief FORGOT TO ASSIGN CASES!) early in the rotation, but the only times I've arrived at a case after the start were when it was an urgent case and all the students were scrubbed when it began, or when I was with the chief and kept on saying "Should we go to the OR? Want me to go to the OR and page you when the patient comes in?" and he wouldn't let me leave! Boy did I feel like a ***** when we walked in and the first port was already placed for the lap chole!!!

The interesting thing is that I know for a fact that all of the med students I'm currently rotating with do these things as well! I've certainly observed a few lackadaisical (spelling?) med students so far this year, but I would venture to say they are the minority thus far!

 

[Blade28]

Where I am on surgery, the med students arrive at the same time or before the interns. Everyone does their own thing for an hour or so before rounds, so you may see your patient before or after the intern but by the time rounds come you've written the note, looked at the official read AND the film of any studies, and collected any key lab values.

Not only do you pre-round correctly and go to the OR in advance, but you ALSO check up on your patients' films? God you're better than 99% of the med students and 80-90% of the IM/OB/Peds junior residents here!

 

[OrnotMajestic]

Not only do you pre-round correctly and go to the OR in advance, but you ALSO check up on your patients' films? God you're better than 99% of the med students and 80-90% of the IM/OB/Peds junior residents here!

That's ridiculous. Half the time the interns defer to me when the attending asks for lab results/rads results because I have all the values on hand by the time rounds start. Hell, the interns told me they are going to miss me, because they love the fact that they can copy/past 90% of my note (I'm at a VA right now, with EMR), hence saving them work due to the fact that mine are done by 8am rounds.

Now, before anyone thinks I'm off tooting my own horn...I'd say 95% of my class is like this. We have a few boneheads, and word of their laziness and worthlessness has spread to most of the residents/attendings already. So yeah, too bad you have to deal with such low-watt bulbs. I assure you, we aren't all like that...and I live in Tennessee, so it's not a regional thing. What school rotates with your program, if you don't mind me asking?

 

[Blade28]

That's ridiculous. Half the time the interns defer to me when the attending asks for lab results/rads results because I have all the values on hand by the time rounds start.

I was actually referring to YOUR interpretation of the film, not the official radiology read (which can take 1-4 days).

 

[OrnotMajestic]

I was actually referring to YOUR interpretation of the film, not the official radiology read (which can take 1-4 days).

Well, the residents never defer to me about MY interpretation (THAT would be a bit silly) of the films, but I usually tell the attending what i think I saw (before an official reading is on file), then I bring it up on the computer and we all look at it.

But yeah, I look at the films first as well.

 

[smq123]

Not only do you pre-round correctly and go to the OR in advance, but you ALSO check up on your patients' films? God you're better than 99% of the med students and 80-90% of the IM/OB/Peds junior residents here!

Not to belittle your frustration, but you sound like someone from the extreme countryside of a third-world country who comes to America for the first time. "You can have rice AND potatoes! At the same time! What kind of wonderful country is this?!"

Seriously, it sounds like your school is not preparing your med students adequately. Even on gyn at my school, we were expected to have the notes signed before the residents arrived, have lab values ready, and then meet the patient before they went to the OR. (Actually, the expectations on gyn were stricter than they have been on surgery!)

Maybe you should direct your students to SDN on their first day of the rotation....

 

[Ypo.]

I don't ask my med students to get involved, I wait for them to be interested, or at least act like it. My first two months, I would push them to write notes, write orders, help out, but it was like pulling teeth. I don't know if it's just my institution, or if this is how most folks are in their 3rd year, but after a while it's just painful.

It takes extra time to teach people things, or critique notes, or cosign orders, but it's no problem. What is a problem is begging someone who is "just there to learn" to see patients in the morning, present patients, formulate a plan, and read up on their patient's conditions.

So pretty much, my attitude is that they can do whatever they want. If they want to practice their skills, they can do everything they want. If they want to stand around and leave early, that's cool too. I'm sure not going to beg.

I think that's a great approach. I've noticed that most residents/interns take this approach with me and other medical students. At first, I was waiting for invitations to do stuff and was clueless and cautious/afraid to take actions without prior permission. But now I've learned to be proactive, talk to the residents, do research, stick my neck in there, and let them know I'm interested. I wish I had figured out how to do this on my first rotation, but it seems I'm just now starting to get the hang of it. My presentations and note writing skills have improved greatly, and I think I'm functioning as part of the team.

Case in point; today I got to assist on a delivery, suture a grade 2 perineal tear, wrote 3 SOAP notes, admitted three patients and do full write ups. I stayed late today (which is how I got the delivery) and the residents were thanking me for my hard work on the admissions because we got slammed tonight and they were busy. The benefit is that I got to appreciate how hard the interns work, they did some teaching because they could see my interest, and I've started to learn to function like an intern, which will help me out when I start residency.

But man, was I clueless on my first two rotations. I was lucky that I had nice residents who weren't too hard on me. Don't really know what I would have done differently, though. I just had to get over my inhibitions and figure out my role.

 

[secretwave101]

One of the things I disliked most about MSIII and IV was how truly irrelevant I was. It was so clear that I was extra baggage on the team. And while I was paying my school for the rotation, I knew the intern wasn't seeing any added benefit by having to drag my worthless a** around. So, for me, whatever I could do to be genuinely helpful, I was willing to do. Even pick up food or clothes or whatever. Made me feel better about myself, and I learned more than I realized I was learning about the life, about time management, about the often overwhelming burden of patient care.

Also, it should be remembered how much scut EVERYONE does. Thanks to things like lawsuits, there's more than enough scut to go around. If you can't even - by law - contribute to actual patient care...you should be prepared for scutwork. Nobody gets to do just patient care anymore.

Example: Made my MSIV do a discharge summary. We HATE d/c summaries. You could argue that residency is really just a many-year seminar on how to trick other people into doing d/c summaries without making them mad (until you're off shift). But the truth is that of all the scutty paperwork we do, the d/c summary is THE most relevant to patient care. All further outpatient care totally pivots off that document. I was terrible at them when I started residency, but I wish I'd been given more of that 'scutwork' because facility with them is a huge skill to have.

 

[group_theory]

I don't mind if the medical student's note is not in before mines. When I have 12-15 patients and the MS3 has 2-3, I'm usually in way before the students anyway, and I tend to see my patients/write my notes on my patients who are on the same floor/unit. There is no need for them to come in the same time I come in so that they can see their 2-3 patients and then just wait for rounds to begin.

Plus the added benefit of having their notes after mine is that the attending can see their notes (hopefully with more recent numbers and lab results). And if there is any questions, my note is right before hand (if the student forgets to write down swan readings, med list, I/Os, etc)

One time a student, after seeing her patients, followed me and helped me out with my notes (reading off the vitals, lab results, etc) while I was writing .... that was AWESOME and a luxary

 

[Blade28]

Not to belittle your frustration, but you sound like someone from the extreme countryside of a third-world country who comes to America for the first time. "You can have rice AND potatoes! At the same time! What kind of wonderful country is this?!"

Seriously, it sounds like your school is not preparing your med students adequately.

Yes, sometimes it feels that way.

 

[Law2Doc]

Yes, sometimes it feels that way.

Interesting that this thread has swung full circle and is now a letter from residents to med students. In defense of the other side: Part of the problem though is that every resident and rotation has different expectations, and many schools/hospitals impart different requirements. You sometimes do have to ask the resident/intern when you should get in and a little bit of what is expected of you because the rules change from person to person, place to place. For example if you are at a school with multiple hospitals, there may be a hospital where med students are not even allowed to write notes into the chart (legal reasons), others where the intern still has to write their own note AFTER you and thus the window of opportunity to write a note closes at a particular hour, and a third option where interns can co-sign. Until the med student knows the rules of the particular rotation/intern, asking questions is totally appropriate. Once the rules have been imparted, if the med student still doesn't comply, only then you can be annoyed. Most med students want to do what is expected of them. If 99% of med students aren't living up to your expectations, then you haven't conveyed the expectations very well. It's a two way street.

 

[Blade28]

Well, the residents never defer to me about MY interpretation (THAT would be a bit silly) of the films, but I usually tell the attending what i think I saw (before an official reading is on file), then I bring it up on the computer and we all look at it.

But yeah, I look at the films first as well.

It's not that your interpretation will be used as gospel - it's that you took the initiative to follow up on your patient's studies.

Trust me, this is much rarer than you'd think (even among residents). I can't tell you how many times a simple CXR will be ordered, and the next day on rounds, when asked what the film showed, person X will answer, "Oh, I don't know - the read hasn't been dictated yet."

 

[velo]

One of the things I disliked most about MSIII and IV was how truly irrelevant I was. It was so clear that I was extra baggage on the team. And while I was paying my school for the rotation, I knew the intern wasn't seeing any added benefit by having to drag my worthless a** around. So, for me, whatever I could do to be genuinely helpful, I was willing to do. Even pick up food or clothes or whatever. Made me feel better about myself, and I learned more than I realized I was learning about the life, about time management, about the often overwhelming burden of patient care.

Also, it should be remembered how much scut EVERYONE does. Thanks to things like lawsuits, there's more than enough scut to go around. If you can't even - by law - contribute to actual patient care...you should be prepared for scutwork. Nobody gets to do just patient care anymore.

Example: Made my MSIV do a discharge summary. We HATE d/c summaries. You could argue that residency is really just a many-year seminar on how to trick other people into doing d/c summaries without making them mad (until you're off shift). But the truth is that of all the scutty paperwork we do, the d/c summary is THE most relevant to patient care. All further outpatient care totally pivots off that document. I was terrible at them when I started residency, but I wish I'd been given more of that 'scutwork' because facility with them is a huge skill to have.

Yeah I feel the exact same way during my med school rotations. Anything I can do as a medical student someone else can to faster and better it seems, so anytime someone seemed to really want and appreciate me helping out I jumped on the opportunity. Case in point, just as in your example, when I was a sub-I I dictated as many discharge summaries as I could. The interns seemed to regard them as the height of scut, but as you said its actually a very important note. By the end of the rotation I was coming around to their way of thinking that it was a bit of a pain in the ass, but still the more I did the more efficient I became and that (I hope) will serve me well next year.

 

[velo]

I don't mind if the medical student's note is not in before mines. When I have 12-15 patients and the MS3 has 2-3, I'm usually in way before the students anyway, and I tend to see my patients/write my notes on my patients who are on the same floor/unit. There is no need for them to come in the same time I come in so that they can see their 2-3 patients and then just wait for rounds to begin.

Plus the added benefit of having their notes after mine is that the attending can see their notes (hopefully with more recent numbers and lab results). And if there is any questions, my note is right before hand (if the student forgets to write down swan readings, med list, I/Os, etc)

One time a student, after seeing her patients, followed me and helped me out with my notes (reading off the vitals, lab results, etc) while I was writing .... that was AWESOME and a luxary

Yeah I agree, I never understood residents who get angry and their students for not being in before them. As a student you're almost NEVER carrying more than 3-4 patients (usually 1-2) and if you're reasonably efficient it just doesn't take you as long as the residents (who are carrying many more patients) to do your work in the morning. If you're getting done with enough time to spare before rounds to go over your notes with the resident and maybe help them out if they're running behind I don't see the problem.

 

[getunconcsious]

As an MS3, I think that the importance of just being nice and pleasant and sympathetic to what your intern/resident is going through is a huge part of the battle! They work way more than us, so I am happy to try to help them out. I've been fortunate in that with the exception of a few terrible biotches on OB/Gyn, all of my interns and residents have been pleasant, reasonable human beings. I would say try to make friends with them and then think of them as your friend...if your friend was in a tight spot and needed some food but didn't have time to get it, why not help them out? I can see how it would be different if they asked you to pay for it or if they asked simply out of a power trip, but I don't think this is the case in the majority of instances. As far as getting things such as equipment for the interns I'm not sure what the big beef is. And looking up lab values is similarly not that difficult. I was treated way worse as a waiter and when i worked at Petsmart.

But from the other side, residents, PLEASE make your expectations clear. I can't read minds. I can't tell you how many times someone has gotten irritated with me and I'm standing there thinking, Just tell me what to do and I'll DO IT! Even if it's November, I've never done a rotation in this specialty or at this hospital, so we're going to be starting from square one. Sorry but that's just the way it is. So if you want me to do something, just ask and show me how (the first time, anyways).

 

[OddNath]

But from the other side, residents, PLEASE make your expectations clear. I can't read minds.

I have to second this. Part of the reason that my last rotation went well (peds) is that our resident sat down with us and told us exactly what she expected. Even gave us a written handout. "See your 3-5 pts in the morning, have your notes done before the intern's, make sure all d/c paperwork has been started" etc etc. And on surgery, we were told to have all vitals and labs for the team (and our notes) done before the interns/residents got there at 5:30. We actually felt somewhat useful.

 

[Tired]

I have to second this. Part of the reason that my last rotation went well (peds) is that our resident sat down with us and told us exactly what she expected. Even gave us a written handout. "See your 3-5 pts in the morning, have your notes done before the intern's, make sure all d/c paperwork has been started" etc etc. And on surgery, we were told to have all vitals and labs for the team (and our notes) done before the interns/residents got there at 5:30. We actually felt somewhat useful.

Before I started 3rd year, I read that book "150 Biggest Mistakes Medical Students Make & How to Avoid Them". I also read the opening pages of Surgical Recall. I also read my school's handbook for 3rd year clerkships. And First Aid for the Wards. Every single one of these said exactly what you Chief told you. The advice is repetitive, every source says the same thing.

So you guys didn't read any of these, and this was all news to you until your Chief wrote out that handout?

 

[velo]

Before I started 3rd year, I read that book "150 Biggest Mistakes Medical Students Make & How to Avoid Them". I also read the opening pages of Surgical Recall. I also read my school's handbook for 3rd year clerkships. And First Aid for the Wards. Every single one of these said exactly what you Chief told you. The advice is repetitive, every source says the same thing.

So you guys didn't read any of these, and this was all news to you until your Chief wrote out that handout?

Whoa, easy killer. I found that residents expectations of exactly what they wanted us to help out with and how they wanted us to do it varied widely from roation to rotation. I always appreciated residents taking a bit of time at the start of a rotation to go over a few expectations. Its not easy having a 'first day of work' experience every 2wks to 1 month...

 

[Tired]

Whoa, easy killer. I found that residents expectations of exactly what they wanted us to help out with and how they wanted us to do it varied widely from roation to rotation. I always appreciated residents taking a bit of time at the start of a rotation to go over a few expectations. Its not easy having a 'first day of work' experience every 2wks to 1 month...

Appreciate it? Yes. Need it? No. You start working, they tell you if you're doing too much. It's not hard.

Seriously, you make it sound like every rotation varies enormously. It doesn't. It's the same crap over and over again with different labels thrown in under the "diagnosis" section in the chart. You come in, see the patient, do a heart/lung/abdomen exam, read the note from the day before, do the note today, come up with a general plan based on previous documentation. That's it. It's not rocket science.

If you walk into a rotation assuming they want you to see patients, write notes, and present, then generally you'll do okay.

If you walk into a rotation assuming you can show up right when rounds start, don't need to write notes, don't need to present, and wait to be told what to do . . . well, then you'll probably come home and start a thread on SDN titled "A Letter to My Intern".

 

[Ypo.]

Before I started 3rd year, I read that book "150 Biggest Mistakes Medical Students Make & How to Avoid Them". I also read the opening pages of Surgical Recall. I also read my school's handbook for 3rd year clerkships. And First Aid for the Wards. Every single one of these said exactly what you Chief told you. The advice is repetitive, every source says the same thing.

So you guys didn't read any of these, and this was all news to you until your Chief wrote out that handout?

Tired-not everyone is as proactive or as smart as you at figuring out how things work. It doesn't mean they are necessarily lazy. You should remember that most of us came from two years of lectures and being fed everything we needed to learn. Even for proactive people, adjusting to third year can be hard. If it was a piece of cake for you and you were born knowing how to ace all your rotations, then great for you. But I'm sure there is a resident's forum where you can go bitch about how annoying third and fourth year students are, isn't there? Or perhaps you just don't find it as satisfying as coming in here and getting on our cases about how lame we are?

I like you, don't get me wrong. But if I want advice from the residents I'll come visit one of those forums, okay? None of us really need the antagonism; we get reminded that we are an vestigial appendage to the team everyday.

 

[OddNath]

If you walk into a rotation assuming they want you to see patients, write notes, and present, then generally you'll do okay.

Yes, that part is obvious. But idiots like me need a few more details flushed out before we know we're on track. Is there a specific form we need to be filling out with all the VS to give to the residents in the morning? Is there a cap on the # pts we see/present? Should we type or hand write our notes? Is this a team which is picky about d/c paperwork being filled in on a daily basis?

I didn't think I needed to type all that to make my point in the first place, but whatever, you're right, all that stuff was probably in one of the myriad of books that I should've read in the week between Step 1 and start of MS3.

 

[Blade28]

But I'm sure there is a resident's forum where you can go bitch about how annoying third and fourth year students are, isn't there? Or perhaps you just don't find it as satisfying as coming in here and getting on our cases about how lame we are?

I like you, don't get me wrong. But if I want advice from the residents I'll come visit one of those forums, okay? None of us really need the antagonism; we get reminded that we are an vestigial appendage to the team everyday.

I don't think that was his point. I think Tired was just trying to point out some ways to prepare for each rotation - read the first few chapters of recommended handbooks (e.g. Recall), for example.

This forum is aimed at discussing MS-III and MS-IV issues - which doesn't necessarily exclude those who aren't junior or senior med students from posting. If a resident, MS-I, MS-II, pre-med, etc. has something relevant to contribute, it's their right.

As an example, it's perfectly legitimate for a new MS-I to post a thread in here asking about future away rotations.

I do agree, however, that the intern/resident/team needs to sit down with the med students at the beginning of the rotation and outline some expectations/goals. Too often a muttered "okay you guys see three patients each, pre-round daily, check all labs" during the course of team rounds during the first week is all you get.

 

[Law2Doc]

I do agree, however, that the intern/resident/team needs to sit down with the med students at the beginning of the rotation and outline some expectations/goals.

That would certainly be more helpful than not doing this and then complaining that med students aren't proactive enough. Truth of the matter is that if you are complaining about med students not doing what they are supposed to, some of the blame falls on the person doling out the work. Most med students are eager to be of help, just ignorant as to how.

And contrary to Tired's suggestion, the rules really do change hugely from rotation to rotation, hospital to hospital, attending to attending, and med students often find themselves getting scolded by one attending for doing exactly what got them praise from another (I sure know I have). So each new person needs to be pretty clear about their expectations and pet peeves.

 

[Ypo.]

This forum is aimed at discussing MS-III and MS-IV issues - which doesn't necessarily exclude those who aren't junior or senior med students from posting. If a resident, MS-I, MS-II, pre-med, etc. has something relevant to contribute, it's their right.
As an example, it's perfectly legitimate for a new MS-I to post a thread in here asking about future away rotations.

I agree mostly with what you are saying, and I'm not saying that residents or others are not welcome or do not have a right to post in the clinical forum (on the contrary). But the purpose of these forums isn't for us to talk down to each other; it's for education. It is appropriate for a 1st or 2nd year student to ask questions in this forum regarding the clinical years, just as it is appropriate for us to ask questions about residency in the residency forums, just as it is appropriate for a resident to answer a question that they can help with in these forums. And most of the posts I read from residents in this forum have been helpful. However some of them seem to have been based on venting frustration about their students, without any constructive component. I'm just suggesting that there is a more appropriate forum for that. No one needs the antagonism here, and it can be discouraging to read.

I really like to hear input from the residents on how I can be a better student. I like to see the advice and thoughts from residents who post in here, as long as it is helpful and nonantagonistic. But, if I were looking specifically for advice from residents, I would go to a resident forum. I don't want to come in here reading antagonistic comments between residents and students. I'm not the first person to comment on this.

I do agree, however, that the intern/resident/team needs to sit down with the med students at the beginning of the rotation and outline some expectations/goals. Too often a muttered "okay you guys see three patients each, pre-round daily, check all labs" during the course of team rounds during the first week is all you get.

Nice to hear that you don't feel this is unreasonable. Sometimes it can really save a lot of trouble!

 

[Blade28]

I really like to hear input from the residents on how I can be a better student. I like to see the advice and thoughts from residents who post in here, as long as it is helpful and nonantagonistic. But, if I were looking specifically for advice from residents, I would go to a resident forum. I don't want to come in here reading antagonistic comments between residents and students. I'm not the first person to comment on this.

I totally agree. I just wanted to point out that the Clinical Rotations forum is aimed at issues brought up during the clinical years, which may or may not involve residents, PA students, nurses, etc. It's actually not meant for a strictly MS-III/MS-IV audience.

In the same way, threads are started in the General Residency forum not because the OP is trying to attract the attention of residents, per se, but because the topics are relevant to residency. Anyone is free to respond. Subtle difference.

That's why pre-meds who post threads in Allo on asking "which school is better?", or "what are the secrets when applying to med school?", etc., find that their threads get moved to Pre-Allo, where they belong. Their intent was to seek advice from med students, but the issue is one belong in Pre-Allo (as it pertains to the process of applying to med school).

 

[getunconcsious]

Before I started 3rd year, I read that book "150 Biggest Mistakes Medical Students Make & How to Avoid Them". I also read the opening pages of Surgical Recall. I also read my school's handbook for 3rd year clerkships. And First Aid for the Wards. Every single one of these said exactly what you Chief told you. The advice is repetitive, every source says the same thing.

So you guys didn't read any of these, and this was all news to you until your Chief wrote out that handout?

Yes, and I also read the relevant chapter of First Aid for the Wards before I start a rotation. I also read 150 Biggest Mistakes 3rd Year Medical Students Make before I started MS3. As OddNath said, the devil is in the details. Do you want us to write notes? (at some hospitals we aren't allowed). Computer or paper? What time are rounds? Does the attending value brevity or thoroughness in presentations? etc, etc. First aid for the wards provides pretty lame advice re expectations if you ask me. All it's good for is providing the physical exam template for each rotation, which contrary to your assertion is actually DRASTICALLY DIFFERENT for each rotation:

OB/Gyn: Ask about vaginal bleeding, fluid leakage, contractions, and fetal movement. This constitutes a history. I've also never had to feel for the fundus of the uterus on any other rotation and its location is WAY more important than the heart/lung/abd exam to your attendings/residents.

Psych: Didn't even have to bring a stethoscope (Thus disproving your assertion re 'heart lung abd on everyone, that's it'). On no other rotation will you need to ask about neurovegetative sx, hallucinations, manic sx, etc. Also thought content and process are the meat of your note. The attending could give 2 $hits what the crazy guy's heart sounds like.

IM: The only rotation thus far that actually follows your ridiculously simplistic paradigm, though I'm sure surgery will too. Oh wait...I don't recall you mentioning "wound incision c/d/i" on your note so maybe not.

Family: They really don't care about anything on your exam, just get in and out as fast as possible.

Neuro: Another one where you won't listen to heart lungs or abdomen (That's 3/5 rotations thus far where they don't care about these exams which were proposed as the only thing that matters). The neurologic exam is complicated and burdensome and long and requires practice to learn. You can't get it out of a book.

I'm just glad my residents thus far have been much more understanding than you in terms of explaining their expectations. I can see why you've given up on your students; it's cuz you're a horrible teacher! As someone else said, if a huge proportion of your students 'suck' it's because you can't teach effectively. I simply don't buy that the vast majority of students are totally worthless.

 

[Tired]

Yes, and I also read the relevant chapter of First Aid for the Wards before I start a rotation. I also read 150 Biggest Mistakes 3rd Year Medical Students Make before I started MS3. As OddNath said, the devil is in the details. Do you want us to write notes? (at some hospitals we aren't allowed). Computer or paper? What time are rounds? Does the attending value brevity or thoroughness in presentations? etc, etc. First aid for the wards provides pretty lame advice re expectations if you ask me. All it's good for is providing the physical exam template for each rotation, which contrary to your assertion is actually DRASTICALLY DIFFERENT for each rotation:

So let me get this straight. Because rounds are at different times for different rotations, psych doesn't want a physical exam, and you have to feel the fundus on Ob/Gyn, you shouldn't have to try to do anything on your own until the residents "sit you down and give you their expectations"?

Your lack of initiative may explain why your residents take so much to spell things out for you. Generally the better students take off running from day 1, while the slower ones get their hands held the entire block.

 

[Law2Doc]

So let me get this straight. Because rounds are at different times for different rotations, psych doesn't want a physical exam, and you have to feel the fundus on Ob/Gyn, you shouldn't have to try to do anything on your own until the residents "sit you down and give you their expectations"?

Your lack of initiative may explain why your residents take so much to spell things out for you. Generally the better students take off running from day 1, while the slower ones get their hands held the entire block.

The street goes two ways. Crummy residents beget crummy med students (who then go on to become crummy residents). I suspect a lot of the residents on this board are not clearly remembering how truly clueless they were when they were med students. (And yes, all med students are clueless at times, even the stellar ones). But they probably got hand held a whole lot more than they recall. A lot of selective memory going on here. A good resident will give directions and feedback; help you to succeed, a lousy one will not and then b!tch about how bad students are now compared to the good old days. Some attendings are good at fostering this by actually blaming residents when med students seem unprepared or confused -- while I don't envy the residents on this (and I suspect it breeds a lot of contempt for med students), it does create a situation where the resident actually has incentive to help the med student become better, not just gripe about how he isn't..

 

[surrender903]

lack of initiative?

who are you, emperor palpatine?

 

[DoctorFunk]

who are you, emperor palpatine?

Yeah, but you can call him "Sir".

 

[getunconcsious]

So let me get this straight. Because rounds are at different times for different rotations, psych doesn't want a physical exam, and you have to feel the fundus on Ob/Gyn, you shouldn't have to try to do anything on your own until the residents "sit you down and give you their expectations"?

Your lack of initiative may explain why your residents take so much to spell things out for you. Generally the better students take off running from day 1, while the slower ones get their hands held the entire block.

What I was trying to say, Sir, is that your description of the exam as universal was incorrect. You can think I'm a crap student all you want, but I have all H's and HP's for my first 5 rotations and glowing evals so I assume I must be doing something right. I don't think it's too much to ask for minimal direction. I never said that residents are obligated to "Sit students down and explain everything", we just need a little guidance here and there. You talk like a freakin old person saying "kids today..." Are you one of those pushy non-trads that went to med school at 30+ to assuage your midlife crisis?

 

[Tired]

What I was trying to say, Sir, is that your description of the exam as universal was incorrect. You can think I'm a crap student all you want, but I have all H's and HP's for my first 5 rotations and glowing evals so I assume I must be doing something right. I don't think it's too much to ask for minimal direction. I never said that residents are obligated to "Sit students down and explain everything", we just need a little guidance here and there. You talk like a freakin old person saying "kids today..." Are you one of those pushy non-trads that went to med school at 30+ to assuage your midlife crisis?

If you have all H's and HP's, then what the hell are you whining about?

 

[Corker]

What I was trying to say, Sir, is that your description of the exam as universal was incorrect. You can think I'm a crap student all you want, but I have all H's and HP's for my first 5 rotations and glowing evals so I assume I must be doing something right. I don't think it's too much to ask for minimal direction. I never said that residents are obligated to "Sit students down and explain everything", we just need a little guidance here and there. You talk like a freakin old person saying "kids today..." Are you one of those pushy non-trads that went to med school at 30+ to assuage your midlife crisis?

All good points...but go easy on the non-trads...we're not all like that! I know what type you mean, though.

By the way, the "I hear ya" is for getunconscious!!! Congrats on your great clinical grades!!! I hope someone gives me direction during my rotations so I can channel my energies in the right direction!!!

 

[Law2Doc]

You talk like a freakin old person saying "kids today..." Are you one of those pushy non-trads that went to med school at 30+ to assuage your midlife crisis?

Agree with Corker -- nontrads at a group are actually more willing to explain things, because they have some experience working with underlings and assistants, and know what needs to be spelled out. IMHO, it's the folks coming right out of med school into residency, their first job, that are going to lack some of the management skills you only pick up once you've been in the rate race for a while, in a "boss" capacity. In the beginning, residents will not be good with med students just as med students won't be particularly adept at mind reading the residents' expectations. That's a problem of a system that puts two groups of people with no experience being boss and employee respectively, together on the wards. It works itself out but there is a learning curve on both sides of the fence. But I actually think the nontrad thing goes counter to what you are asserting.

 

[UndeadHeart]

I think that there is sometimes a difference between 1. helping the patient, 2. helping the team, and 3. helping an individual resident or intern.


I think we all enjoy helping the patient, be it through learning more, or taking a good history or doing good daily exams to figure out what direction the patient's care is taking, or just geting a blanket or a juice for a patient.

Helping out the team is often a no-brainer as well, i.e. helping to answer pages, helping getting a chart, . . . I love doing this stuff by nature as I was a volunteer in a hospital for a while and simply having an extra pair of hands is helpful. If you don't like helping out the team with little things, then maybe you should go into a practice where teamwork is less required, i.e. radiology where no one cares how nice you are as long as you read films well and on time.

I think the grey area is helping out an individual intern, often I do this as it falls under the category of helping out the team, i.e. if you help the intern be more productive, then the team is more productive and the patient wins. However, interns and residents do take this for-granted, and feel entitled to ask the student to do almost anything that comes to mind, . . . most (all maybe) of the time I do this without asking as it saves everybody time.

I think the worst situation I've been in is when there is a resident who expects work to be done that we (students) don't know needs to be done or how to do it and WORSE complains about us the students like we are the "help" and aren't doing things right. Well, . . . again I love to help the team, but I think all medical students don't feel indebted at all to residents to be their personal servants, after all residents are just a couple years ahead of us, and just learning medicine as alot of what they do must go by the attending, regardless . . . residents (some) feel that they can talk to students in a very condescending manner and abuse them for trying to basically fill a temp position for which we are not paid, . . . in such as a case I think it is hard to respect the attending/resident as a physician, but play along just to pass/get a good grade and help the team which helps the patient, . . . which I think residents and attendings misinterpret as respect for them or their perceived status, when really it is just rule by fear. Having said that I have worked with mostly excellent residents and attendings that I do respect, and would glady do alot of "scut work" for them if it helps the team . . .


I think that when working with your intern it is good to remember that alot of these people were medical students just a year or so ago, and that residents similarly also were medical students at one point, . . .

At some it becomes ridiculous as the resident treats some students like pompus Hollywood stars treat their personal assistants who then go on the write books about them, . . .

 

[Corker]

Agree with Corker -- nontrads at a group are actually more willing to explain things, because they have some experience working with underlings and assistants, and know what needs to be spelled out. IMHO, it's the folks coming right out of med school into residency, their first job, that are going to lack some of the management skills you only pick up once you've been in the rate race for a while, in a "boss" capacity. In the beginning, residents will not be good with med students just as med students won't be particularly adept at mind reading the residents' expectations. That's a problem of a system that puts two groups of people with no experience being boss and employee respectively, together on the wards. It works itself out but there is a learning curve on both sides of the fence. But I actually think the nontrad thing goes counter to what you are asserting.

Don't always agree with Law2Doc, but he's exactly right on this one...especially the 30+ group! Generally, this group has had a great deal of "leadership" experience and has a lot more maturity (just inherent in grinding through several more years of life.) For example, the mature sound of baditude's posts would lead me to believe he's older than most traditional students (which he confirmed in one of his posts on this thread, I think.)

and it's a mid-life "awakening"....

 

[Baditude]

I guess I am busted as one of "those non-traditional" Students
I am hoping my years in management will be an asset to my team because I know what I need to do to be of some kind of help. At 25 there is no way I could have performed the way I do now with patients. My depth of understanding of people in general has come from 10 years of dealing with the public.

**I did not have a mid-life crisis that made me go to med-school!***

 

[Corker]

I guess I am busted as one of "those non-traditional" Students
I am hoping my years in management will be an asset to my team because I know what I need to do to be of some kind of help. At 25 there is no way I could have performed the way I do now with patients. My depth of understanding of people in general has come from 10 years of dealing with the public.

**I did not have a mid-life crisis that made me go to med-school!***

Your management skills will definitely be an asset. I am counting on this, as well. Best of luck. Glad I'm not the only one.

Mine's not a crisis either...I've just had to wait this long for the opportunity.

 

[getunconcsious]

Sorry! I didn't mean to rip on non-trads as a group, I'm sure in many cases the experience is an asset. Some of them can be rather pushy, but definitely most of them are nice, pleasant people. I guess what I was talking about was that Tired sounded like an old fart complaining about "kids today!" I didn't mean to be whining, I've done pretty well on the wards. I just was saying that a little more guidance would be nice. I know that interns and residents usually don't have time to sit us down, make handouts, etc. but I did have some bad experiences with OB/Gyn residents getting annoyed with me for not knowing how to do stuff they never taught me how to do! And I'm not talking about pre-rounding, etc. but more technical aspects of the job. It's also probably worth noting that OB/Gyn was my first rotation, so I was pretty damn clueless.

I have gotten along with 90+ percent of nontrad students and also residents and interns. I suppose my recent posts are probably going counter to my original position of "being nice to your teammates goes a long way". I guess I took Tired's posts too personally, but I hate being accused of being a lazy/stupid med student when I do take the time to prepare and get the work done! I think he's complaining about people who don't do ANYTHING and just stand around until instructions are made clear. What I was talking about was that I would TRY to write notes, help out, etc. but then would get criticized later for doing it wrong b/c the expectations were not made clear. Luckily for me, most people have been very understanding and good about explaining stuff.

So yeah what I'm trying to say is that I stand by my original advice to MS3's...just be really nice and it's a rare person who will insist on hating you, even if you ARE totally clueless.

 

[Tired]

I think he's complaining about people who don't do ANYTHING and just stand around until instructions are made clear.

Yes, this is exactly what I'm complaining about.

What I was talking about was that I would TRY to write notes, help out, etc. but then would get criticized later for doing it wrong b/c the expectations were not made clear. Luckily for me, most people have been very understanding and good about explaining stuff.

Dude, this crap will happen to you well into your Chief Resident year. It's just how the educational process functions. But if you're busting your ass, getting yelled at for stupid ****, and then getting glowing evals, then you're absolutely doing your job 100%. Getting ripped on isn't a putdown as a med student (or intern, or resident, or Chief). Being ignored or having responsibility taken away from you are the real punishments, and that's when you know you're doing something wrong.

 

[Ashers]

I do agree, however, that the intern/resident/team needs to sit down with the med students at the beginning of the rotation and outline some expectations/goals. Too often a muttered "okay you guys see three patients each, pre-round daily, check all labs" during the course of team rounds during the first week is all you get.

I totally agree. I felt so much more prepared and actually a part of the team after 2 days on ortho with an explanation than after 6 weeks of OB/gyn and "you're a med student, so sit in the corner, and write your notes."

On my ortho elective, the chief resident basically told me since I'm an M3, he didn't expect me to know much of anything. Then the PGY-2 and 4 took about 30 min after the first day to explain the general expectations, the routine of the day, how they like notes, that I didn't have to preround, I wasn't required to dress up in anything other than scrubs except on certain conference days etc. It was awesome, and when the teams switched halfway through the month, it was kinda funny that the residents were asking me questions about how the service functioned, what time to be where, etc.

That's ridiculous. Half the time the interns defer to me when the attending asks for lab results/rads results because I have all the values on hand by the time rounds start. Hell, the interns told me they are going to miss me.

My ortho team from Nov told me they missed me while I was on the other side of the curtain for my anesthesia rotation. One even asked if I could scrub in for a case because they were short-staffed, and there were a bunch of us just sitting around for anesthesia stuff.

I didn't think I did that much aside from look up labs and carry around a gas-mask bag full of dressing changing supplies. And one resident really liked my really sharp bandage scissors.

 

[Blade28]

I totally agree. I felt so much more prepared and actually a part of the team after 2 days on ortho with an explanation than after 6 weeks of OB/gyn and "you're a med student, so sit in the corner, and write your notes."

The "let's sit down and talk for 15 minutes" bit at the beginning of every rotation is key, I've found.

 

[Friendly]

Dear Intern:

For some bizarre reason, you appear to think that I am your secretary. Ahem. I AM NOT YOUR SECRETARY. The difference between us is that I am paying to learn, whereas you are being paid to do scut. Therefore, you must answer your own pager, do your own paperwork, check your own daily schedule, fetch and carry your own instruments, and manage your own lunch. If you would like my help with a task that directly contributes to patient care, try saying please and/or thank you.

And, while the lines of communication are wide open, I suggest that you get over yourself. You're arrogant enough to be an attending right now, but you have a few more years of training to endure before you can make everyone around you miserable.

Sincerely,

Your Medical Student

Respectfully, your opinion of yourself seems very over-inflated. Approach your work with humility, and you'll find that the only person who changes will be you.

 

[SoCuteMD]

The "let's sit down and talk for 15 minutes" bit at the beginning of every rotation is key, I've found.

I've yet to have one of these...