Aggressive classmates - advice, please!

[kcrd]

I'm 1 1/2 weeks into my second medicine rotation right now, and I've been having a really hard time dealing with the other student on my team. We get along socially, but when we are on rounds (work rounds and attending rounds), he constantly interjects his own ideas about my patient, asks questions about their condition, etc. He'll also make suggestions before I get the chance to so that it looks like I haven't thought of drawing a certain lab, starting a certain med or the like. He does this to such an extent that it has started to confuse the intern and resident, so that they think he is following my patients, and they address him instead of me.

I have been trying to assert myself by reminding the resident and intern in the morning which patients I follow, but during rounds everything gets so busy that they just forget. Today, the resident started updated my classmate on my patient while I was standing right in front of him (resident made zero eye contact with me, 100% with him), so I interrupted him, and reminded him that I was following this patient, NOT classmate. the resident got flustered and apologized, but then later kind of teased me about it. I did talk to him later about it during a scheduled performance review, but I know that it really is not his fault, but rather my classmate's (and mine for letting him do this).

Anyway, I don't know what to do. I actually have to share an apartment with this student, because I'm at a satellite hospital, so I can't have things be tense at the hospital and at home.

Any advice for a medical student who must be wearing a "please walk all over me" sign on her back?

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[Xsherv]

Here is some realistic, albeit cynical, advice. Don't kid yourself into thinking that people who do this on the wards mean well but just get overzealous. People who do this know what they're doing--'nuff said. This sort of pattern is what makes the practice of medicine so unpalatable: getting ahead by stepping on others and being rewarded for it.

So what should you do...
1) Before going over the other student's head, you should always confront the person directly--this is the only dignified way for human beings to resolve problems. However, confronting the person directly the first time does not mean you have to keep doing so the second and third time the issue comes up. So let the student know this is the only time the conversation is going to happen, and that in the future, the resident will be involved.
2) If (1) doesn't work, talk to the resident--have some balls, look the resident in the eye and say "Do you have a moment to discuss an issue that's been bothering me" and do so genuinely, directly, and sincerely. Mention that you spoke with the student first and ask for intervention. I promise that if you do this right, it will not be construed as whining. On the other hand, if you approach the issue like you have hyperthyroidism ("um...do you think we could...uh...if you have time...discuss something"), then just forget about it.
3) As a last resort, you could fight fire with fire. I don't recommend this because it means engaging in a behavior that disgusts you. And that's always a tragedy.

The bottom line is that people turn sour during careers in medicine because they feel that they have to take abuse in order to get ahead. That may be true for those with hyperthyroidism, but for the rest of us, it always pays to address problems with confidence and integrity. Mature problem solving looks good too.

PS I have nothing against people with hyperthyroidism; I just find it to be an illustrative way to describe a certain type of nervous, insecure medical student.

 

[Darth Vader]

I'd just pull that student aside and tell him what he's doing. If he's cool, he should stop. He probably just doesn't realize what he's doing. If he doesn't stop, he's an ass and you should fight fire with fire by looking up stuff on his patients and interjecting on his patients IMO. You should also be more aggressive about talking about your patients. Don't air your dirty laundry to your resident, you never know how that will be interpreted, and they often have total to significant say in your grade.

 

[8744]

I've said it once and I'll say it again: Why do you care what your resident thinks about you? His evaluation of you, when taken together with the other evaluations you will get will probably have a negligable impact on your grade.

It is rude of your fellow student to "step on your toes" but as long as you are doing your job, keeping up with your patients, and learning what you are supposed to then you should have no worries.

I have a somewhat ambivalent attitude towards residents. First of all, I despise rounding. In fact, medicine rounds are like torture to me. I would rather just stroll along listening to the attending then ever be bothered to present a patient and I certainly don't mind having a couple of "lightning rod" gunners in my group. The more the better. I look forward to the day when I am in private practice and can round without the huge entourage in a private, non-teaching hospital.

One of the reasons why I like surgery and Ob-Gyn is because rounds are kept to a minimum, we adress a specific problem, and don't spend a lot of time debating the finer points of obscure diseases.

It's not that I don't care, because I do. It's just that I don't want to spend third year stressed out. With the exception of the first three weeks of surgery which was my first rotation and freaked me out until I got the hang of it, I have spent a rather relaxing third year. I do everything I am asked cheerfully and willingly, I report where I'm supposed to report, study what I'm supposed to study, but I just don't get intimidated by the residents or lose sleep if I can't answer a pimp question.

Just try to relax and be pleasant to everyone you meet, including your gunner teammates.

 

[kcrd]

Thank you, everyone, for the good advice! I spoke to my classmate this morning, and he completely backed off today. Rounds today were nice and relaxing because I didn't feel like I had to compete - I could just discuss my plans, and answer or ask questions without having him interject things before I get the chance to.

I'm not concerned with what my resident and intern think of me, per se, I am mainly upset that I have been working very hard, but they think that he has been doing the work because he is more vocal than I.

 

[jldavis]

I doubt this will be the only time that you have a gunner med student on your team. And talking to them doesn't always work. I have found that these people try to speak up first so that they will not be asked questions. If you get in a pinch, you need to fight back. Once usually does the trick and then you can back down. It's not a fun game, but if you don't want to end up on protonix, you have to figure out how to tell these gunners to back off.

 

[irlandesa]

be careful about some of the advice given on here.. while what the resident thinks of you shouldn't be important in your personal life, your evaluations from residents can make up a majority, if not ALL of your grade at bigger teaching hospitals. In pediatrics at my school, we are evaluated entirely on our inpatient experience of 3 weeks by residents, while the outpatient portion, which involves attending supervision, does not count in the grade. I still don't know my grade, but I have a feeling from the way the course director spoke to me that it will be determined greatly by one specific unflattering comment made by a resident, even though she had a number of other good things to say. Not to sound like a whiner, but sometimes no matter how perfect, on top of things, or goody-goody you try to be you can really get screwed by residents on the wards. Even though my resident's criticism of me was fair, I think it should be really taken into context in terms of grading, and it just wasn't.

 

[kcrd]

Originally posted by irlandesa
be careful about some of the advice given on here.. while what the resident thinks of you shouldn't be important in your personal life, your evaluations from residents can make up a majority, if not ALL of your grade at bigger teaching hospitals.

At this point, I think my grade is already shot, because my team basically loves this classmate of mine, and they pretty much ignore me. I don't know how to recover from a week of my team thinking that this guy is such a superstar that he can handle his patients AND mine, while (in their eyes), I've been slacking.

 

[huktonfonix]

A week's nothing. You have probably 4-6 weeks to make up for it. Just keep doing your thing. work hard, don't sink to his level by kissing everyones ass. It'll turn out all right.

 

[Skip Intro]

Originally posted by kcrd
Thank you, everyone, for the good advice! I spoke to my classmate this morning, and he completely backed off today. Rounds today were nice and relaxing because I didn't feel like I had to compete - I could just discuss my plans, and answer or ask questions without having him interject things before I get the chance to.

I'm glad it worked out for you. I've seen similar situations too (and have been guilty myself - the "show what you know" phenomenon), but this is the best way, should it happen again with someone else in the future or this guy's traits begin to rear their ugly head, to put the kabosh on it:

When you present your patient, cover everything. If the person interupts, you say politely yet strongly "well, if you would allow me to finish." This sends a dual message: (1) you've already thought about it, and (2) the interupter is being an a-hole for cutting you off. A gunner never wants to look like an a-hole... a "go to" know-it-all, maybe, but not an a-hole.

If that doesn't work, then you approach them as you've done. The result was good this time. If it turns out bad, like he/she says "well, you should do a better job working up your patient next time" (etc.), then the next rounds you tell your resident that your colleague is going to present the patient. Inevitably, he or she will say, "no I'm not, it's not my patient" and then let you have at it. (Or, if they are really egotistical and/or stupid, they actually will likely feebly try to present your patient, and you can then interupt and correct them - point made.) If the former (which is more likely) happens, then when they start to interupt again, you say "didn't you just say that this wasn't your patient? Or, are you ready to present him now?" At worst, you'll make a real enemy of this supposed colleague. At best, you'll get a laugh from your resident, you'll look like you have balls, and you'll get your point across once and for good. The only way this could possibly backfire is if indeed your colleague knows better what's going on with your patient, in which case you DO need to do work harder (but, sounds like this is not the case).

Originally posted by kcrd
I'm not concerned with what my resident and intern think of me, per se, I am mainly upset that I have been working very hard, but they think that he has been doing the work because he is more vocal than I.

I slightly disagree. I think you should try to look your best at all times in front of everyone - your residents, your colleagues, your attendings, your patients... you get the idea. And, I think that standing up for yourself and speaking out is an important lesson to learn, especially if you are female. It's been long studied and known, ever since early on in childhood, that boys blurt and girls quietly contemplate. Unfortunately, medicine is also a field that rewards the former. "Show what you know" is the motto. I know it's often seen as a negative trait by women, and I've heard enough war stories about how males should avoid blurting during their OB/Gyn rotations (a female dominated specialty). But, just remember that blurting is also a double-edged sword. The only way your foot will fit into your mouth is if it's open. Think quickly, and next time he steps on your toes fire something back at him so he trips and falls.

-Skip

(I'm assuming that you are a female. If I'm mistaken, my apologies.)

 

[rrreagan]

Just try to do best the you can in future.

I wouldn't recommend being overly aggresive or retaliating in kind.

Make a point of acing the NBME exams and the course directors will be more or less obliged to edit out unflattering commentary.

I've never understood why students have to go around sabotaging each other...

 

[Mirror Form]

Originally posted by kcrd
Anyway, I don't know what to do. I actually have to share an apartment with this student, because I'm at a satellite hospital, so I can't have things be tense at the hospital and at home.

Well, if all else fails, at least you have plenty of options for getting even! I'd recommend waiting until just before the rotation ends so he can't retaliate.

 

[JP2005]

YEA THAT HAS HAPPENED TO ME ALSO...ESP WITH THOSE "GUNNER PA STUDENTS"....DAMN THEY ARE ANNOYING AND THINK THEY KNOW SO MUCH........

THE BEST PART IS WHEN THE RESIDENT OR ATTENDING PULLS YOU TO THE SIDE AND SAYS HOW ANNOYING THAT PA STUDENT IS....THAT ALWAYS BRINGS A SMILE TO MY FACE.....IT GOT TO THE POINT WHERE THE OTHER DOCS COULDNT EVEN SIT IN THE SAME CONFERENCE ROOM BC OF THIS RAMBLING PA STUDENT THAT WENT ON AND ON ABOUT HER FUTURE JOB OFFERS WHEN SHE GRADUTED LATER THIS SPRING........

JUST IGNORE HIM/HER (THE JACK@SS STUDENT, THAT IS)....DO YOUR SH%T....AND YOU WILL BE RECOGNIZED FOR IT.......

 

[Winged Scapula]

Unfortunately, as others have noted, this does happen a fair bit in medicine. I did a 4th year visiting AI with another student who happened to be the "local boy" (ie, he was a student at that school). He rounded on my patients, would arrive at the OR before I did and start scrubbing, etc. I was lucky in that not only did the residents and attendings notice, but they actually talked to me about it, apologized, told me not to worry because they were "on to him" and told him not to scrub on my cases. It was so glaring that 4 months later when I interviewed for residency there, they were still talking about it!

I'd also take the advice about the resident's evaluation not counting for much with a grain of salt. IMHO, there are certain rotations where you spend most of your time with the residents and the attendings either have little direct interaction with the students, have little interest or simply just rely on the judgement of the residents when it comes to evaluation time. There has been more than one rotation for me where the attending's evaluation of a student was largely based on the resident's input.

 

[rrreagan]

So did you ultimately get the residency there, Kimberli?

 

[rrreagan]

I think maybe students have so little to do and such limited responsibilities that they feel the need to sabotage each other and increase their workload by stealing duties from their fellow students.

While I personally would let anyone scrub in on "my" case (since when can students dub cases as "theirs?"), I was more than a little irritiated when my classmates poached a few patients from me on morning rounds.

Once, our chief resident told us that we would be rounding relatively late in the morning (~7:00), so I naturally came in later, only to discover that my classmates had come in early anyway and rounded on all of my patients.

So, when you guys have bad experiences on rotations, keep that in mind---the role of the student is ill-defined at best.

A lot of the stuff that residents do could easily be done by students---but for the title.

 

[Winged Scapula]

Originally posted by rrreagan
So did you ultimately get the residency there, Kimberli?

Nope, I matched somewhere else (but neither did the "local boy").

 

[hosskp1]

I have dealt with this kind of behavior from both ends of the spectrum. Student and now resident. This obnoxious toolbox needs to be talked to. Very diplomatically, but forcefully from you the student so it never seems like you are talking behind someone's back. if that does not calm him daown and give you a chance then, talk to the residents and attendings. They probably already know and have written the guy off. what ever happens be true to yourself- do not escalate to trying to be like him. We do not need anymore obnoxious personalities in medicine (we already have our fair share).

 

[md03]

I had a situation similar to Kimberli's as a visiting student. The local boy was on the trauma service, I was on gen surg, and another visiting student was in the SICU. The local boy regularly made a point of telling us that HE was the SI on trauma so HE was going to scrub all the trauma cases. However, for overnight call the inhouse team covered both trauma and gen surg. There was one time that he had been on call on a Fri night, it hadn't been busy enough for him. So he STAYED most of Sat night as well, even though I was on call, not him. I almost couldn't get the trauma pager away from him. And he went to every trauma.

So every time a resident/attending saw both of us, they asked who was on call. When it was revealed that I was, this local boy was then informed that I would scrub any case that came in since I was on call. He always said "I know" but I also realized that he would do his damndest to steal any case from me. Fortuanley, no operative trauma came in that night. I probably would have had to physically fight him to scrub. And I heard a number of people making fun of him after he finally left. He had been marked as a looser with nothing better to do on a Sat night than stay when not on call.

I didn't wind up at that program, didn't rank it very high. Don' t know where he wound up.

 

[GeddyLee]

hmm...I tend to be pretty up front with people, so I'd ask this person why they are so certain they will match there. Just ask..."you seem pretty sure you'll match here, to be looking at houses and all...what gives?."

Hey...maybe you'll find out his dad is the PD or something...then you'll know that you may need to re-think your plan. Maybe you'll finally get him to shut up.

Either that, or stab him in the eye with a pair of EKG calibers next time he makes a comment.

 

[MD'05]

... what are these used for and how do I learn how to use them so that I can too look like I know how to read an EKG. I saw an attending pull them out and they looked so coooooolllll ...

 

[Azn Slacker]

A classmate of mine used to grub info from me before rounding or before scheduled meets with our attending ie) why is the team is doing this procedure, what disease does this patient have, etc. He'd do it smooth like "what did you do over the weekend, man?..... ..oh by the way, why are they ordering that lab?" While I certainly don't mind helping people out, on multiple occasions this guy then carjacks my info by presenting it as if he thought it up or interviewed the patient himself.. like "yeah, they did that test because...BLAH". then I sit there looking non-participant because that was the stuff I was planning on talking about...
Lesson: don't be naive; always keep a distance from keener classmates. Even if crap like that does happen, don't let it stress you out.

 

[po' boy]

I would pants the other person while they're scrubbed in the OR.
Just my suggestion.