any advice on how to teach medical students?

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rachmoninov3

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As I stumble through third year, and have just finished a rotation that was "complicated" at best, not knowing if it was me or the chief resident--probably was me--I am afraid to think that soon it'll be me who is responsible for teaching. Not the 5 minute mini lectures we do now, but teacihng and putting up with medical students. Medical students, who if karma has anything to say about it, will be just as bad as I am.

So I am opening up this thread to ideas on how to be a good sub-I, intern, resident, etc when it comes to teacihng and handling junior medical students. Any advice from former teachers, and or teachers you really liked would be much appreciated.

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So I am opening up this thread to ideas on how to be a good sub-I, intern, resident, etc when it comes to teacihng and handling junior medical students.

It's not your job to teach as a subI, so don't try to do it - you will be labelled a douchebag. As far as when you become an intern/resident, friendly pimping is always the easiest (and best) way to go. "Why is this patient on ________" or "what are we looking for on the SPEP in this patient" or even "what do you think we should do next" are all learning questions. If the student is motivated and wants to learn, he or she will then go home and read up on whatever they get pimped on, even if they answered correctly.
 
As I stumble through third year, and have just finished a rotation that was "complicated" at best, not knowing if it was me or the chief resident--probably was me--I am afraid to think that soon it'll be me who is responsible for teaching. Not the 5 minute mini lectures we do now, but teacihng and putting up with medical students. Medical students, who if karma has anything to say about it, will be just as bad as I am.

So I am opening up this thread to ideas on how to be a good sub-I, intern, resident, etc when it comes to teacihng and handling junior medical students. Any advice from former teachers, and or teachers you really liked would be much appreciated.

Agree with above - as a sub-I it is not your job to be teaching the 3rd years; you are too close to them in your education.

Now what I did do was help them get acclimated to the wards on their first couple of rotations - show them how to get vitals in the AM, where to look in the chart for I/O's, help them organize their presentations for rounds - that I think they appreciated. I'd say it was more "mentoring" than teaching.
 
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It's not your job to teach as a subI, so don't try to do it - you will be labelled a douchebag.

I would argue that it's not your job to PIMP as a sub-I. But guidance, mentoring (as SouthernIM said), and maybe even a little teaching is appropriate. (I think that showing the MS3s how to write prescriptions, how write a soap note, and how to write an H&P can be considered "teaching.")

As for the OP's question - I think the biggest favor you can do to MS3s is to tell them what the expectations can be. That can either be in an authority role (as a resident) or as a friendly "hint hint" role (as an MS4). I think that a lot of the reason why MS3s may come across as disinterested is that they simply don't know what the expectations are. Once they do, most are more than willing to get involved.
 
How to teach - you could write volumes on various methods -- I am going to try to remember a few points from my experiences as a 3rd year -

1) I'm going to try to remember that what most 3rd years want, especially if they have a shelf to pass at the end of the rotation (particularly if it's a barrier (no pass shelf, no pass rotation) exam), is TIME TO STUDY. Having said that, I'm going to try to waste as little of their time as possible and cut them loose as soon as I can if they want to leave.

2) I'm going to do what my upper level at Dallas Methodist IM did for me - if the case loses learning value, I'm going to pull them off and give them a different case to learn on.....no point in having them follow something that's mainly social work/placement work type of stuff.

3) If I choose to teach a topic, make sure it's high yield information and not just me listening to the sound of my voice and thinking it's a great lecture. Any PPTs will be bullet points of high-yield info that my lectures will (hopefully) add to so I won't just be reading the PPTs to them. I remember thinking during so many of my classes "I learned to read by age 6, I don't need you to read the information to me".

4) I will try my hardest NOT to pimp people. I hated that crap both in class and on wards. It always seemed to be denigrating. I can't recall one time where it actually made me WANT to go learn about a topic. Maybe it was just me and my own ego issues, but it always came across as the pimper wanting to embarass me by pimping me into submission in front of my peers. Learning occurs when people connect the dots, not when they are required to memorize random factoids, which is what most pimping I have been around tends to be asking...

5) I will try to give the med students structure to their learning and big picture connections that most of us now take for granted but most of us didn't know as 3rd years.

6) I will try not to restate the obvious. If they learned about CHF in 2nd year, why the hell should I reteach 2nd year?

7) I will try to teach protocols for treatment that are clinically relevant. By that I mean: working diagnosis, labs/studies to rule in/out, first treatment step down to dosage of medications, next treatment step down to dosage of medications, etc. for the major clinical entities.....at least as much as I can.

I am so tired of the hodgepodge BS that passes as 'education' in medical school. I have a friend that's a professional educator and I have regaled them with tales of the crap that passes as 'teaching' that we were exposed to....and have been told that most of our 'teachers' wouldn't qualify to teach high school. Just because you're good at something doesn't mean you can accurately communicate the information to others such that others develop a modicum of skill in the topic or that you are able to write test questions in such a way as to test mastery of said topic......

Can you tell I'm a wee bit jaded about this whole deal?
 
Agree with above - as a sub-I it is not your job to be teaching the 3rd years; you are too close to them in your education.

Now what I did do was help them get acclimated to the wards on their first couple of rotations - show them how to get vitals in the AM, where to look in the chart for I/O's, help them organize their presentations for rounds - that I think they appreciated. I'd say it was more "mentoring" than teaching.

It's both. OP is right to want to teach properly. If I were a third year, and he knew a good clinical pearl (or where to find one) that would help keep me from looking like an idiot, I certainly wouldn't call him a douche for passing it on.

From my previous experience teaching (tutoring and TAing physics), teaching well mostly hangs on understanding your students. What do they know, what don't they know, and what pressures (both the immediate ones waiting to kick them in the butt and the future ones that they aren't yet preoccupied with) are they under?

As an MS-4 you'll be ideally placed to remember what you did and did not know as an MS-3, which will be invaluable. I'd say with your current attitude (genuinely interested in helping) you almost can't go too far wrong. If you do realize you've taken the wrong tack, which you will sometimes, that's okay -- just note it down for self and come up with something better for next time.
 
As a resident it is really important to seem available and be open to questions. Sometimes a resident that seems disinterested in teaching or involving medical students can ruin the time on that service and potentially lower the chances that the student will be interested in that specialty. Give the students direction and give them things to do. For example, have them look something up for later that day or for the next day. Have them research topics that you don't necessarily know how to handle. For example, if the resident sees a lot of hyponatremia after surgery and doesn't know how to handle it they would ask the student to look up the topic and do a 5-10 minute presentation.
 
Just thought I'd weigh in as, during my AI, which really was treated as an acting internship, we were expected to teach the MS3s. I completely agree with smq123 about pimping but then I try to avoid it now that I'm an intern, too. One other thing: while I have no problem with having a student look up a topic they should know and I already am familiar with, if I don't know enough about a topic I should be familiar with, it seems to me to be unfair to ask a student to do my work for me.
 
I actually do pimp 3rd years sometime, but I do it when they're not in a position to be embarassed in front of peers, and mostly as a method to show them where their knowledge lies in a topic. (so might not actually be pimping). This let's me fill in the gaps and connect the bridges so they have a better idea of how to handle it when they see it htemselves. I also try to pick cases out for them to go into that I think would be good learning experiences for them. If they've already seen a million of those types of cases, I tell them not to bother usually.
 
All of my "pimping" is done based on what patients they are currently seeing & trying to anticipate what the attending will ask them the next day about them. This gives them an opportunity to look good & in turn I solidify the info in my head.
 
As I stumble through third year, and have just finished a rotation that was "complicated" at best, not knowing if it was me or the chief resident--probably was me--I am afraid to think that soon it'll be me who is responsible for teaching. Not the 5 minute mini lectures we do now, but teacihng and putting up with medical students. Medical students, who if karma has anything to say about it, will be just as bad as I am.

So I am opening up this thread to ideas on how to be a good sub-I, intern, resident, etc when it comes to teacihng and handling junior medical students. Any advice from former teachers, and or teachers you really liked would be much appreciated.

So I'm currently an M4 but I do sometimes use my experiences to teach my fellow M3s when I see them. I usually try to give them brief advice on things that I saw/did on my 3rd yr rotations that I felt were either useful or utterly worthless (this is more relevant to studying for shelf exams and the such). I will try to help answer any questions they may have but I most certainly don't 'pimp' them, they are after all only a year behind us.

just my 0.02
 
^ i agree with that.
i pimp some of my fellow ms3s, only because i am studying for ck, and quiz them on stuff when we have free time...however, i NEVER bring them down and keep it constructive and we take turns in asking each other qns.

you have to make sure to keep this balance, otherwise its a very douche-bag kinda thing to do.

its amazing how big of a knowledge gap there is between ms3s and ms4s. i have certainly noticed it.

however, medicine is a hierarchy, and i owe a lot of my success to the experiences of those ahead of me - and i just try to give it back. give them tips, hints on what to do, etc.
i struggled a LOT in the first couple of months as an MS3...pimping was an everyday occurence and i got so many *******s ripped that its looked like disseminated meningococcemia...but i think it made me stronger and i try to prevent people from doing stupid ****.
like taking 1 hour on H&P and doing a physical exam taught out of BATES.
 
How to teach - you could write volumes on various methods -- I am going to try to remember a few points from my experiences as a 3rd year -

As residents, a lot of what we teach is how to function as a doctor. It is a disservice to the medical students to allow them to disappear whenever possible, give them only the most interesting cases, never chastise them for poor work, etc. All it does is create a coddled, entitled student who will go on to be a weak resident.

I think it's important to prepare the student for residency and a career as a practicing physician. Obviously, some residents are better at this than others, and there is literature that shows we need to teach better. I will gloss over a few points.

Pimping is usually ineffective, and if utilized, should be as positive as possible, and followed by the actual answer, instead of an empty "look it up and tell me later" comment.

Always explain what you are doing with your patients and why you are doing it. It's very hard for students to "know more than anyone" about their patients when they don't understand why the care is taking a certain direction, why this antibiotic or this x-ray, etc.
--------Also, always walk them through your orders (post-op or admission) and notes, teaching the ADCVANDISMAL etc. You'd be surprised how many MS4's come through that can't do simple tasks like admit orders.

Be available and approachable. We don't realize as residents how intimidating we can be sometimes. I'm finding that out even more as a senior surgical resident.

While it's nice when people like you, it's more important that they learn from you. Your job as a resident is not to be their friend, so you have to be able to make the student do things they don't want to, or reprimand them for poor work.

If you are a specialist, most students won't choose your specialty as a career, so this may be their only chance to see this pathology. It is important to teach them the common clinical manifestations of these diseases. E.g. as a surgery resident, I can teach the student to know what a surgical abdomen feels like, etc, and avoid problems later on when that student goes into medicine, be it saving an unnecessary consult, or allowing them to recognize the need for an urgent/immediate consult that can't wait.

When teaching about actual topics, make sure you are keeping it on a "med student level." Often we unintentionally teach over their heads because we naturally regurgitate whatever it is that we are studying.


Sit down with them in the beginning and list out your expectations. Let them know what you want them to see and do, in the mornings, on call, etc. That way, they can't use the "I didn't know, you never told me I was supposed to...." excuse down the line, and you don't get mad for unfair reasons.


Provide feedback, early and often. Let them know what they are doing right and wrong. Don't be afraid to tell them where they need to improve. Approaching everyone with kid gloves leads to a bunch of weak residents down the line who never even knew they had a deficiency.
 
I dont' see what is so wrong with teaching medical students as a sub-I....some people enjoy teaching even if its the littlest things. I help 3rd years along, but let them know that I am a peer and not a resident.
 
Just thought I'd weigh in as, during my AI, which really was treated as an acting internship, we were expected to teach the MS3s. I completely agree with smq123 about pimping but then I try to avoid it now that I'm an intern, too. One other thing: while I have no problem with having a student look up a topic they should know and I already am familiar with, if I don't know enough about a topic I should be familiar with, it seems to me to be unfair to ask a student to do my work for me.

Agree with this. Not only is this lazy, it is irresponsible. If you ask someone to give a presentation, you better know enough about that topic to make sure that the material the med student presents is accurate.

As an MS3 I have had good and bad experiences with "acting interns". The good ones show you how to write an order, give you tips on navigating hospital bureaucracy, or give a heads up about a particular attending's favorite pimp questions. The bad ones act like they are somehow your superior, which they are not. A med student is a med student. As a 4th year you should NEVER pimp other students, especially not in front of a resident or attending. Believe, me you will come off poorly to everyone involved. In fact, you really shouldn't be teaching any medicine to younger students, unless they ask you for help with something. You don't know enough, and it's not your job.
 
as part of my job I teach pa, np, md, do students as well as family medicine and internal medicine residents.
first I try to get a good hold on their knowledge base and procedural skills then direct teaching at areas they are weak in and teach less to their strong points.
for example when a pt has a new ekg I ask the student/resident to show me how they approach reading an ekg. if they hit all the high points all well and good. if they don't I teach them a method for approaching every ekg every time so as not to miss anything.
ditto procedures. I ask them how they do it then have them watch me do a few, then watch/critique them from the bedside until they are proficient.
I really like to teach and have done it for a long time. I was an emt and medic instructor before pa school and also taught acls and phtls(prehospital trauma life support) .
if teaching paid more than 1/2 of what I currently make I would even consider doing it full time if I could still work 1 shift/week.
 
I remember several times that I was very grateful that M4s helped me out when I was an M3. If the M4s hadn't given the three of us M3s on trauma surgery an orientation to what we were expected to do, we wouldn't have had any orientation. When I did my surgery sub-I, the M3s were just starting their first rotation of third year, so they were always asking me questions (what's ARBF, TPN, APR, D5 1/2, c/d/i, where's the PACU, what's a post-op note). If I found some good review articles when I was studying, I'd make them some extra copies. I was just trying to be helpful, but it ended up as positive comments in my final grade.
 
As residents, a lot of what we teach is how to function as a doctor. It is a disservice to the medical students to allow them to disappear whenever possible, give them only the most interesting cases, never chastise them for poor work, etc. All it does is create a coddled, entitled student who will go on to be a weak resident.

I think it's important to prepare the student for residency and a career as a practicing physician. Obviously, some residents are better at this than others, and there is literature that shows we need to teach better. I will gloss over a few points.

Pimping is usually ineffective, and if utilized, should be as positive as possible, and followed by the actual answer, instead of an empty "look it up and tell me later" comment.

Always explain what you are doing with your patients and why you are doing it. It's very hard for students to "know more than anyone" about their patients when they don't understand why the care is taking a certain direction, why this antibiotic or this x-ray, etc.
--------Also, always walk them through your orders (post-op or admission) and notes, teaching the ADCVANDISMAL etc. You'd be surprised how many MS4's come through that can't do simple tasks like admit orders.

Be available and approachable. We don't realize as residents how intimidating we can be sometimes. I'm finding that out even more as a senior surgical resident.

While it's nice when people like you, it's more important that they learn from you. Your job as a resident is not to be their friend, so you have to be able to make the student do things they don't want to, or reprimand them for poor work.

If you are a specialist, most students won't choose your specialty as a career, so this may be their only chance to see this pathology. It is important to teach them the common clinical manifestations of these diseases. E.g. as a surgery resident, I can teach the student to know what a surgical abdomen feels like, etc, and avoid problems later on when that student goes into medicine, be it saving an unnecessary consult, or allowing them to recognize the need for an urgent/immediate consult that can't wait.

When teaching about actual topics, make sure you are keeping it on a "med student level." Often we unintentionally teach over their heads because we naturally regurgitate whatever it is that we are studying.


Sit down with them in the beginning and list out your expectations. Let them know what you want them to see and do, in the mornings, on call, etc. That way, they can't use the "I didn't know, you never told me I was supposed to...." excuse down the line, and you don't get mad for unfair reasons.


Provide feedback, early and often. Let them know what they are doing right and wrong. Don't be afraid to tell them where they need to improve. Approaching everyone with kid gloves leads to a bunch of weak residents down the line who never even knew they had a deficiency.


Is there any way I can send you a money order for the case of beer I want to buy you? I wish someone would have taken their teaching duties half as seriously as you seem to on any of the clerkships I've been on....

Granted, with the shelf exam hanging over my head as a 'make or break' exam, the thing I valued most was study time to prepare for that thing at the end of each rotation but I feel like I missed a lot of good learning experiences. Most of what passed for learning (with the significant exception of Dallas Methodist IM) was standing around watching the residents or attendings write notes or discuss patient care with no explanation of what the hell was going on......all it did was make me so tired that I didn't want to study when I got home and really question what the hell I was doing on the wards.....

I've talked to a few classmates and some of us are those MS4s that have never written a set of admit orders, have no clue about fluids and what to hang when and are pretty scared about starting intern year. I'm already planning out my 'vacation' month as a time when I'll be looking up the particulars about WTF to do for the most common clinical/hospital situations I'll incur -- down to admit orders.....

I'll succeed....but only because I refuse to be a weak resident and choose not to fail.....
 
Best way is to always refer back to basic sciences and tie it in to clinicals. That way their mind maintains a link and easily adapts to the new info.
 
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