Anyone else feel pressure to NOT work hard from residents?

[ChordaEpiphany]

I'm halfway through MS3 and until now had sort of "figured out" how to do well with attendings and residents. On most rotations I didn't really get excited about the medicine at all and just wanted to help patients in whatever small ways I could and survive the rotation. I was more sharp and composed around attendings and just sort of matched their intensity. With residents I just avoided any try-hard behavior and left as early as possible to go study for the shelf. The result has been great evals and shelf scores.

Now I'm on IM and genuinely loving the material. I get really excited about patients with cool pathology and often want to dive deep. I have absolutely no problem going a bit out of my way to help a patient understand their condition, learn to do a procedure, or see an interesting finding. This stuff will actually be useful to me in residency. Attendings love the enthusiasm, but residents seem ambivalent or even put off. I feel like I'm getting pressure from the chief resident to just leave immediately after rounds. I think it's coming from a good place (i.e., "I just wanted to leave as a med student, so I'm going to make sure my med students leave early"). As far as I can tell, my presence isn't a burden. I'm picking up scut appropriately to ease burden on the interns (e.g., calling family, writing notes, writing d/c instructions, etc...). And to be clear, if a resident tells me to go, I go. I'm not buzzing around. Seems like the vibes are overall pretty good. By no means am I clashing with anyone. It just sucks to get actively encouraged to stop trying when I'm simply excited and engaged.

I know what I have to do. I have another week with this team, and I'm going to mellow, care less, and make whatever personal connections I can. The irony is that to get good evals I have to stop trying hard, which is coming from a place of genuine interest, and be insincere so that I can avoid looking like I'm being insincere just to get good evals. This is absolutely exhausting.

---

Members don't see this ad.

 

[wysdoc]

I'm halfway through MS3 and until now had sort of "figured out" how to do well with attendings and residents. On most rotations I didn't really get excited about the medicine at all and just wanted to help patients in whatever small ways I could and survive the rotation. I was more sharp and composed around attendings and just sort of matched their intensity. With residents I just avoided any try-hard behavior and left as early as possible to go study for the shelf. The result has been great evals and shelf scores.

Now I'm on IM and genuinely loving the material. I get really excited about patients with cool pathology and often want to dive deep. I have absolutely no problem going a bit out of my way to help a patient understand their condition, learn to do a procedure, or see an interesting finding. This stuff will actually be useful to me in residency. Attendings love the enthusiasm, but residents seem ambivalent or even put off. I feel like I'm getting pressure from the chief resident to just leave immediately after rounds. I think it's coming from a good place (i.e., "I just wanted to leave as a med student, so I'm going to make sure my med students leave early"). As far as I can tell, my presence isn't a burden. I'm picking up scut appropriately to ease burden on the interns (e.g., calling family, writing notes, writing d/c instructions, etc...). And to be clear, if a resident tells me to go, I go. I'm not buzzing around. Seems like the vibes are overall pretty good. By no means am I clashing with anyone. It just sucks to get actively encouraged to stop trying when I'm simply excited and engaged.

I know what I have to do. I have another week with this team, and I'm going to mellow, care less, and make whatever personal connections I can. The irony is that to get good evals I have to stop trying hard, which is coming from a place of genuine interest, and be insincere so that I can avoid looking like I'm being insincere just to get good evals. This is absolutely exhausting.

You stay as long as you want & learn what's going on with your patients.
It's very odd to me that the residents are asking you to scram.
When I was chief resident I put my med students to work!

 

[odyssey2]

When they were medical students they were probably annoyed when their seniors didn't tell them to leave or only gave vague indications when it was time to go, so they probably think they're doing you a favor.

 

[lymphocyte]

I have absolutely no problem going a bit out of my way to help a patient understand their condition, learn to do a procedure, or see an interesting finding. This stuff will actually be useful to me in residency.

It just sucks to get actively encouraged to stop trying when I'm simply excited and engaged.

Might be a generational thing. Might be a personality thing. Might be a lazy thing, because teaching is a lot of extra work. In fact, most of what you describe as "trying" is actually more work for the team.

It's also possible you have a total lack of insight, which I've seen before in several "enthusiastic" medical students. The terrible thing is that you can't really know.

Just be honest. And grateful. "Thank you so much. I really appreciate that. I love this rotation. Here's my number in case the team needs any help. I'm going to use the extra time to do XYZ" or "go spend time with the attending." You're not going to learn too much more in one week.

It's swings and roundabouts with rotations, and nobody gets a perfect experience. Embrace it and move on.

 

[SurfingDoctor]

I'm halfway through MS3 and until now had sort of "figured out" how to do well with attendings and residents. On most rotations I didn't really get excited about the medicine at all and just wanted to help patients in whatever small ways I could and survive the rotation. I was more sharp and composed around attendings and just sort of matched their intensity. With residents I just avoided any try-hard behavior and left as early as possible to go study for the shelf. The result has been great evals and shelf scores.

Now I'm on IM and genuinely loving the material. I get really excited about patients with cool pathology and often want to dive deep. I have absolutely no problem going a bit out of my way to help a patient understand their condition, learn to do a procedure, or see an interesting finding. This stuff will actually be useful to me in residency. Attendings love the enthusiasm, but residents seem ambivalent or even put off. I feel like I'm getting pressure from the chief resident to just leave immediately after rounds. I think it's coming from a good place (i.e., "I just wanted to leave as a med student, so I'm going to make sure my med students leave early"). As far as I can tell, my presence isn't a burden. I'm picking up scut appropriately to ease burden on the interns (e.g., calling family, writing notes, writing d/c instructions, etc...). And to be clear, if a resident tells me to go, I go. I'm not buzzing around. Seems like the vibes are overall pretty good. By no means am I clashing with anyone. It just sucks to get actively encouraged to stop trying when I'm simply excited and engaged.

I know what I have to do. I have another week with this team, and I'm going to mellow, care less, and make whatever personal connections I can. The irony is that to get good evals I have to stop trying hard, which is coming from a place of genuine interest, and be insincere so that I can avoid looking like I'm being insincere just to get good evals. This is absolutely exhausting.

I don’t know, I’m too old and mostly find interacting with residents to be insufferable, slowing down rounds, presenting inaccurate data and coming up with pointless plans. If I could actually be efficient and putting in my own orders at my old age and cut out the rest, I’d get done with rounds in half the time.

You sound you belong in critical care though 😏. The place where the wheels really come off… also a great place to do science.

 

[lymphocyte]

I don’t know, I’m too old and mostly find interacting with residents to be insufferable, slowing down rounds, presenting inaccurate data and coming up with pointless plans. If I could actually be efficient and putting in my own orders at my old age and cut out the rest, I’d get done with rounds in half the time.

You sound you belong in critical care though 😏. The place where the wheels really come off… also a great place to do science.

Show me a medical student who only triples my workload, and I will kiss their feet.

 

[PathNeuroIMorFM]

I feel like the replies in this thread is a perfect representation of why SDN is on the decline and r/medicalschool is more popular than ever. All of these replies just do not reflect the views of most med students, residents, or young attendings.

It's more than fine to not be worked to death right now. 3rd year is to explore your interests, prepare for shelf/step, build your general clinical skills/acumen, and maybe do some minor scutwork on the side. Younger med folks get this. The Old Guard are still hung up on this idea that Step 2 requires 2 weeks of flipping through First Aid 2003 to ace the exam, while the rest of our time should be "working hard to prepare for the brutality of residency! Back in my day, we didn't have work-hour limits and we had rounds that was uphill both ways...in the snow!"

Don't worry about it right now. You'll get to indulge a lot more of this work during 4th year Sub-Is and enough of it to make you hate it during intern year.

The fact that you found what you really love and are scoring well means you officially beat the game. Now go home and play some Baldurs Gate 3 or something.

 

[WhereMyLiberalsAt]

why SDN is on the decline and r/medicalschool is more popular than ever.

r/medicalschool is 100% infinitely better than SDN! There is no place that confirms your bias and reaffirms maladaptive behaviors like Reddit!

Q: Should I rank a program with known VHCOL and I’m fully aware beforehand that I will not be able to afford my current lifestyle of eating out every night and using Uber everywhere I go?!?

Top reply: F&$@ boomers! You aren’t responsible for the consequences of your actions!!!


Q: I perceived a possible micro aggression… what should I do?!?

Top reply: I only see one possible recourse for this, report the bigot to HR and get them fired!


Back in the day their meme game was at least fresh, now it’s trash. No memes, no diversity of thought… Painfully banal.

 

[operaman]

yeah SDN has traditionally been where you go for truth and tough love. Lots of people at all career stages here too; I’m guessing not many attendings hanging around the Reddit threads.

OP, this is always a tough call and varies so much with the quality of your residents. When I was struggling as a resident I was a lousy teacher; when I got good, I was better.

They surely think they’re doing you a favor by letting you go early and maybe they are! If all the work is done and you’re not getting any admits, there’s probably little educational value and they’re just going to kill time until signout anyhow.

The best way I found to stay involved was to take notes on my list just like the interns and make all my own checkboxes. That way I’d know what needed to be done, and which things I could do. Then if there was something left I’d offer to do that specific thing. Eventually the work and learning does kinda wrap up and it’s nice to let people go at that point.

These days I always try to set clear expectations with students in terms of what their learning goals are for the day. Once those have been accomplished then I let them go. I’m pretty intentional with how I teach and I think students learn a lot and enjoy it. Many actually come back to work with me on their breaks from other rotations so must be doing something right!

 

[eyeeye_captain]

I feel like the replies in this thread is a perfect representation of why SDN is on the decline and r/medicalschool is more popular than ever. All of these replies just do not reflect the views of most med students, residents, or young attendings.

For the OP, you just got unlucky. I went to a "top" medical school with "top" residency programs, and depending on the luck of the draw, I got some "crap" rotations. You can't pick and choose everyone who trains you, but you can take advantage of short days to do whatever when you get them. There may have been a minimal amount of learning available at the end of the day, so they were potentially doing you a favor.

For this hit-piece post, c'mon man. I'm a young attending in a lifestyle field. You're still in med school. You know how I got a pretty sweet gig? I busted my rear end on rotations, research, and networking. I did the same in residency and fellowship. You do realize some of the top IM programs 30 years ago advertised Q2 24 hour call for the experience as a good thing, right? Have you ever worked a 36 hour shift? I have in a lifestyle specialty with "home call", and they suck, and you suck it up.

 

[SurfingDoctor]

The Old Guard are still hung up on this idea that Step 2 requires 2 weeks of flipping through First Aid 2003 to ace the exam, while the rest of our time should be "working hard to prepare for the brutality of residency! Back in my day, we didn't have work-hour limits and we had rounds that was uphill both ways...in the snow!"

 

[Kierkegaard's Bud]

I'm halfway through MS3 and until now had sort of "figured out" how to do well with attendings and residents. On most rotations I didn't really get excited about the medicine at all and just wanted to help patients in whatever small ways I could and survive the rotation. I was more sharp and composed around attendings and just sort of matched their intensity. With residents I just avoided any try-hard behavior and left as early as possible to go study for the shelf. The result has been great evals and shelf scores.

Now I'm on IM and genuinely loving the material. I get really excited about patients with cool pathology and often want to dive deep. I have absolutely no problem going a bit out of my way to help a patient understand their condition, learn to do a procedure, or see an interesting finding. This stuff will actually be useful to me in residency. Attendings love the enthusiasm, but residents seem ambivalent or even put off. I feel like I'm getting pressure from the chief resident to just leave immediately after rounds. I think it's coming from a good place (i.e., "I just wanted to leave as a med student, so I'm going to make sure my med students leave early"). As far as I can tell, my presence isn't a burden. I'm picking up scut appropriately to ease burden on the interns (e.g., calling family, writing notes, writing d/c instructions, etc...). And to be clear, if a resident tells me to go, I go. I'm not buzzing around. Seems like the vibes are overall pretty good. By no means am I clashing with anyone. It just sucks to get actively encouraged to stop trying when I'm simply excited and engaged.

I know what I have to do. I have another week with this team, and I'm going to mellow, care less, and make whatever personal connections I can. The irony is that to get good evals I have to stop trying hard, which is coming from a place of genuine interest, and be insincere so that I can avoid looking like I'm being insincere just to get good evals. This is absolutely exhausting.

The way I showed interest is through interesting patients, not necessarily through grunt work. I remember seeing a patient with a rare diagnosis, and the residents didn't know the therapy options recommended by subspecialties but did not have time to look into it either. I made an effort to make a handout of the top things to look out for, therapy mechanisms and next steps. I presented it in 3-4 min, and they appreciated it greatly and their evals reflected it.

 

[PathNeuroIMorFM]

r/medicalschool is 100% infinitely better than SDN! There is no place that confirms your bias and reaffirms maladaptive behaviors like Reddit!

Q: Should I rank a program with known VHCOL and I’m fully aware beforehand that I will not be able to afford my current lifestyle of eating out every night and using Uber everywhere I go?!?

Top reply: F&$@ boomers! You aren’t responsible for the consequences of your actions!!!


Q: I perceived a possible micro aggression… what should I do?!?

Top reply: I only see one possible recourse for this, report the bigot to HR and get them fired!


Back in the day their meme game was at least fresh, now it’s trash. No memes, no diversity of thought… Painfully banal.

You've proven my point right there. That's the most 2012 take on SDN vs Reddit. No one says that anymore. Not to mention that Obama era cringe Sargon of Akkad ass "haha-SJW **** and pissed their pants" "Ben Shapiro destroys lobruls ass jokes you just made. Real peak 2012 humor right there, bub. The hacker known as 4chan would be proud.

You can say what you want, but at the end of the day, r/medicalschool, r/residency, r/medicine each have literally 100x-1000x more people and that means a greater diversity of thought. You'll have some sensitive folks, but you also get some hard *sses in there, too. People who advocate for lifestyle and people who advocate for the grind. People there for the memes and people there for advice. People there are actively in the trenches of medical education and the information flows and evolves super quickly because of that.

Meanwhile on here, you get like the same 5-10 goobers who live here replying to every post. No hate to the goobers, but we all see the same names on here every day. At some point they're just too disconnected from how things are now.

Don't get me wrong, I love SDN and want to see it thrive. That's why I'm here and a pretty active user, but how many users on here you think are even students or residents anymore? How many attendings are sub-PGY-9? Older doesn't mean wiser. Harsher advice doesn't mean better advice.

It's just hard to take a lot of advice on here seriously when the vast majority of users probably don't know the modern frustrations of Zoom interview structures, how to operate Anking, or whether OME is currently part of the studying meta.

 

[WhereMyLiberalsAt]

It's just hard to take a lot of advice on here seriously when the vast majority of users probably don't know the modern frustrations of Zoom interview structures,

I think you’d benefit from an emotional support animal… think you’d get a lot of mileage out of a chinchilla.

how to operate Anking, or whether OME is currently part of the studying meta.

I don’t even know what those are….

r/medicalschool, r/residency, r/medicine each have literally 100x-1000x more people and that means a greater diversity of thought.

I like this type of thinking! It’s good! It’s critical! It’s challenging dialogue! If there were only more people in Jonestown, it wouldn’t have been considered a death cult. On the contrary! It would’ve had greater diversity of thought! Like maybe Hi-C instead of Kool-Aid? Gatoraid? I mean who knows with more people in the mix!

 

[Dantes]

You might come across as sucking up from the resident's perspective, but more likely they remember what it's like to have to stay past the point of educational value on their rotations. Probably just cutting you loose to have more time to study for the shelf.

 

[lymphocyte]

You've proven my point right there. That's the most 2012 take on SDN vs Reddit. No one says that anymore. Not to mention that Obama era cringe Sargon of Akkad ass "haha-SJW **** and pissed their pants" "Ben Shapiro destroys lobruls ass jokes you just made. Real peak 2012 humor right there, bub. The hacker known as 4chan would be proud.

You can say what you want, but at the end of the day, r/medicalschool, r/residency, r/medicine each have literally 100x-1000x more people and that means a greater diversity of thought. You'll have some sensitive folks, but you also get some hard *sses in there, too. People who advocate for lifestyle and people who advocate for the grind. People there for the memes and people there for advice. People there are actively in the trenches of medical education and the information flows and evolves super quickly because of that.

Meanwhile on here, you get like the same 5-10 goobers who live here replying to every post. No hate to the goobers, but we all see the same names on here every day. At some point they're just too disconnected from how things are now.

Don't get me wrong, I love SDN and want to see it thrive. That's why I'm here and a pretty active user, but how many users on here you think are even students or residents anymore? How many attendings are sub-PGY-9? Older doesn't mean wiser. Harsher advice doesn't mean better advice.

It's just hard to take a lot of advice on here seriously when the vast majority of users probably don't know the modern frustrations of Zoom interview structures, how to operate Anking, or whether OME is currently part of the studying meta.

This is helpful feedback, thank you.

I'm sub PGY-9 so being a resident or even a medical student doesn't feel that distant to me. Plus I do a fair bit of teaching, so I see a lot on the other side.

I've definitely been that resident who's been so desperate for a quiet moment that I've told medical students to just go home. I was usually upfront with why, but some people still confuse vulnerability with weakness and come up with excuses or treat it like some kind of benevolence. Perhaps that's what's going on here.

Yes, there are modern frustrations but difficult interactions with residents is not one of them. I've been seeing posts about that since before I was in medical school.

 

[esob]

To keep this on track with the OP, the answer is likely that their reasoning varies.

Sometimes, I send my med students out early, but I do it for different reasons, most of which have already been mentioned. I usually keep my AI's most of the day because they are typically able to contribute more and because they are "auditioning" for the program, so I let them carry more than I would normally expect of an MS3.

 

[GoSpursGo]

Meanwhile on here, you get like the same 5-10 goobers who live here replying to every post. No hate to the goobers, but we all see the same names on here every day. At some point they're just too disconnected from how things are now.

Heyyyyyy... I resemble this comment 😡

Your fundamental point about not staying past when you're needed as an M3 is valid. I don't think anyone was disputing that--seriously, go back to the posts above your first post and show me where someone said otherwise.

As a young attending myself who has gone through training where work/life balance has begun to be emphasized, there is a problem with the balance swinging too far in the "life" direction recently. I'm being made to do things now that I had to do in residency and fellowship as part of my training because it's apparently "too much" for current trainees to handle. I suspect they don't realize that by not doing these things for 3-5 years in training, they're just ensuring they'll get to do it for 30+ years as an attending. But I would not be so foolish as to say that an MS3 should be sticking around until 8 every day just in case some learning opportunity might show up.

 

[DrZoidbergDO]

lmao sdn is so dead compared to reddit. is there even an eras thread this year?

 

[DrZoidbergDO]

I think you’d benefit from an emotional support animal… think you’d get a lot of mileage out of a chinchilla.


I don’t even know what those are….


I like this type of thinking! It’s good! It’s critical! It’s challenging dialogue! If there were only more people in Jonestown, it wouldn’t have been considered a death cult. On the contrary! It would’ve had greater diversity of thought! Like maybe Hi-C instead of Kool-Aid? Gatoraid? I mean who knows with more people in the mix!

no disrespect but if you don't know what anking is you're so far out of touch with med school that anything you say is basically ignorable.

 

[WhereMyLiberalsAt]

no disrespect but if you don't know what anking is you're so far out of touch with med school that anything you say is basically ignorable.

Bro I’m meme’ing and now you’re the butt of my joke. I’m going through the cycle as we speak and did Zanki/Anking from the start. I use Reddit everyday and when I need true advice I’ll rely of SDN a million times over. You can go discuss how your dating life is trash, how you need to unionize, and complain whatever the flavor of the week is on Reddit. It’s the blind leading the blind.

 

[DrZoidbergDO]

Bro I’m meme’ing and now you’re the butt of my joke. I’m going through the cycle as we speak and did Zanki/Anking from the start. I use Reddit everyday and when I need true advice I’ll rely of SDN a million times over. You can go discuss how your dating life is trash, how you need to unionize, and complain whatever the flavor of the week is on Reddit. It’s the blind leading the blind.

this place is filled with attendings who don't know what's going on, it's not inaccurate to say that this place largely is out of touch with the current reality.

 

[WhereMyLiberalsAt]

View attachment 379701

this place is filled with attendings who don't know what's going on, it's not inaccurate to say that this place largely is out of touch with the current reality.

No, it is inaccurate to say… SDN never was the forefront of Anki or STEP prep… you’re pretending like it was. It makes you out of touch. From premed, to medical student, it was never about any of those topics. If I need a direct answer on a serious topic that directly impacts my education or career, I can reach out on SDN and get responses from PDs, attendings, or residents.

*additionally I’ll quit posting on this topic (which if you’ve been around long enough knows that this has been rehashed multiple times.)

 

[GoSpursGo]

As noted above, the general discussion about SDN isn’t really relevant to the OP’s question. Let’s please try to stay on topic to help the OP.

 

[lymphocyte]

I'm halfway through MS3 and until now had sort of "figured out" how to do well with attendings and residents. On most rotations I didn't really get excited about the medicine at all and just wanted to help patients in whatever small ways I could and survive the rotation. I was more sharp and composed around attendings and just sort of matched their intensity. With residents I just avoided any try-hard behavior and left as early as possible to go study for the shelf. The result has been great evals and shelf scores.

Now I'm on IM and genuinely loving the material. I get really excited about patients with cool pathology and often want to dive deep. I have absolutely no problem going a bit out of my way to help a patient understand their condition, learn to do a procedure, or see an interesting finding. This stuff will actually be useful to me in residency. Attendings love the enthusiasm, but residents seem ambivalent or even put off. I feel like I'm getting pressure from the chief resident to just leave immediately after rounds. I think it's coming from a good place (i.e., "I just wanted to leave as a med student, so I'm going to make sure my med students leave early"). As far as I can tell, my presence isn't a burden. I'm picking up scut appropriately to ease burden on the interns (e.g., calling family, writing notes, writing d/c instructions, etc...). And to be clear, if a resident tells me to go, I go. I'm not buzzing around. Seems like the vibes are overall pretty good. By no means am I clashing with anyone. It just sucks to get actively encouraged to stop trying when I'm simply excited and engaged.

I know what I have to do. I have another week with this team, and I'm going to mellow, care less, and make whatever personal connections I can. The irony is that to get good evals I have to stop trying hard, which is coming from a place of genuine interest, and be insincere so that I can avoid looking like I'm being insincere just to get good evals. This is absolutely exhausting.

I'm curious how this turned out OP. Did your evaluations go okay? Are you still interested in IM? Seems like you've done great so far and had a rough rotation.

 

[VA Hopeful Dr]

Compared to most of the attendings who have posted in this thread (except @SurfingDoctor , he might as well be the crypt keeper at this point), I'm ancient (I've been out of residency for 11 years now). So, take this with a grain of salt:

When I was a med student there was little I hated more than literally sitting around waiting for something to happen. I can read at home. If I'm not needed and there's nothing planned, let me go home. I still feel that way but since I'm the attending now I can just leave.

So I send students home early if there's nothing to do. Most commonly this happens if I am also leaving early. Sure, I could have them go hang out with one of my partners for the afternoon/morning but a few extra hours on a month-long rotation isn't going to impact much and I know when I was in their shoes I'd have loved the chance to just leave.

Occasionally I'll have patients at 1:30 and 1:45 and then nothing until 3:30. I'll usually let them leave after the 1:45 patient rather than have them stay an extra 2 hours to see at most 2 more patients.

 

[ChordaEpiphany]

I'm curious how this turned out OP. Did your evaluations go okay? Are you still interested in IM? Seems like you've done great so far and had a rough rotation.

Still waiting on evals... Idk why, but everyone waits super long to fill them out. I got back one from an intern who gave me straight 3s with no comments. Another from an attending who gave mostly 5s and a few 4s. I need a >90 average for Honors between clinical evals and shelf which means a > 4.5/5 clinical eval average and/or 90%+ on the shelf (which is 97-99th percentile).

Honestly I've given up. Assuming you aren't in the 20% of students who have visible deficits in social skills, MS3 is about 95% luck. You can't really stand out as "excellent" on the wards, especially in IM. No one teaches you how to do IM. The shelf/UWorld material is ambulatory + EM/first steps in management. It's never like, "A patient came in 2 days ago with chest pain and already got a full workup from the ED with a full plan started by the night float resident last night. Now they have mild/moderate abdominal pain. What do you think your attending's threshold for additional imaging is in this case?" Or a classic, "A patient came in with ADHF and is now on day 4 of IV lasix. Creatinine bumped from 0.98 to 1.36 this morning. They are still slightly volume overloaded w/ improving bibasilar crackles and +1 pitting edema from 2+ yesterday, but down 3.5 kilos since admission. No known dry weight. How aggressive is your attending in continuing IV lasix vs. transitioning to oral in this scenario?"

I'm trying to maintain my interest in IM, but I've been struggling recently. The second half of my rotation was worse than the first (was assigned to a private hospital in the burbs instead of the university medical center in the city). It just wasn't a teaching environment and it showed. Honestly I'm super bummed and feel extremely demoralized and let down. I did a PhD and spent years anticipating this rotation thinking I was dead set on IM to Heme/Onc. Feels like everyone in IM was just extremely tough on me and picked me apart. I've gotten a clinical H in every other rotation, but this was just a real punch in the face, especially after clearly performing better on this rotation compared to others. Got rocked by a shelf yesterday that had an absurd amount of step 1 material (from which I'm now 5.5 years removed). I'm definitely at a low point in my med school years after this rotation.

 

[Drrrrrr. Celty]

As long as you're not being daft, then it's not you. It's just that at a certain point a lot of people are either mildly burnt out, or have better things to do than teach, talk, etc.

I can say that as a final year fellow right now it can honestly be hard to work with residents because it makes rounds last longer. And I just want to go home and go to the gym or eat something that's not bar form.

 

[psyspy]

“Reddit is more popular than SDN”
Argumentum ad populum.

“Reddit has more diversity of thought”
lol not a chance. It’s literally mob democracy. Most popular opinions are brought to the forefront via voting. Many people have been banned from the medicine subs and even Reddit in general via a ban threshold that has lowered substantially in the past few years.

Here you see everyone’s opinion. That said, if SDN really doesn’t have that many posters nowadays, maybe SDN is no better, because you get perspectives of few

 

[ChordaEpiphany]

I'm curious how this turned out OP. Did your evaluations go okay? Are you still interested in IM? Seems like you've done great so far and had a rough rotation.

Just because this thread has been bumped I'll give the final update. A lot of what I was feeling was in my head, some of it wasn't. Ultimately, I think a few interns regarded me as a tryhard, but most could see that the interest was genuine (and it truly was). Got 2-3 lackluster evals to start that rotation, but in the end I wound up with fantastic (Honors level) evals from attendings, one additional lackluster eval from an intern I already knew didn't love me, and great evals from the senior residents. I got almost no evals from the second half of my rotation...

I toned things down, learned to simply enjoy the company of the people around me, and ended up with an H. The second half of the rotation really did sour me on IM, and I tried to look past it, but immediately after I fell in love with the OR and it all became moot. Currently on my 2nd surgical sub-I. Of note, I definitely did not have my original problem on my surgical rotations. Worked my a** off and got my best evaluations of 3rd year. No one judged if I wanted to stay late for an emergent case. Interns were more than happy to let me actually be useful.

Maybe this is survivorship bias or plain old ego, but now having finished 3rd year, the grades are absolutely not 95% luck. There's a luck component (like everything else in life), but ultimately this rotation taught me how to honor the rest. After this, I literally never wondered if I'd get Honors. It's as simple as asking, "what can I do to make this person like me?" It's different for every person, and you may swing and miss occasionally (I have), but it's pretty easy to suss out if you actually take the time to observe and think about it.

 

[psyspy]

May have been your experience but most of the clinical grades at most schools are rotating with the right people and asking the right people for evals

In general interns give worse evals because of self serving bias. They think they were just very recently a far better med student than you. That + interns have a mindset in current day that they “have something to prove”. More senior residents on their way out don’t give two ****s about feeding the system

“What can I do to get this person to like me”. For some seniors you rotate with this is more trouble and more ignoble than it’s worth, and you’re best off folding your hand and just doing the bear minimum in a no win situation

 

[dgdg]

Clinical rotations in med school and residency are often an intense training environment where your superiors generally lack management training and feel that they are also in an intense environment. Frankly, I found the 'teaching' environment downright dysfunctional at times.
Get good grades/evals, get along with challenging personalities, and do your best to learn from your patients. Stand by your principles.
It sounds like you have worked out a good system for the current team.

 

[Hollow Knight]

After this, I literally never wondered if I'd get Honors. It's as simple as asking, "what can I do to make this person like me?"

Honestly though, this is horrible for medical education.

On your IM rotation for example- the fact that you were incentivized (from a career perspective) not to stay late/go do those procedures is insanity. Not your fault obviously, I'm not ridiculing you.

I'm just grateful that, as someone who is interested in FM, I just don't really have to care about this stuff. But I honestly think we'd be better off at just leaving grades purely as shelf scores and then having mandatory hours students had to be in the hospital.

 

[SurfingDoctor]

Honestly though, this is horrible for medical education.

On your IM rotation for example- the fact that you were incentivized (from a career perspective) not to stay late/go do those procedures is insanity. Not your fault obviously, I'm not ridiculing you.

I'm just grateful that, as someone who is interested in FM, I just don't really have to care about this stuff. But I honestly think we'd be better off at just leaving grades purely as shelf scores and then having mandatory hours students had to be in the hospital.

Most feedback and “grades” based on rotations are ultimately a sham and function only as a general disservice to trainees. On the other hand, dealing with disgruntled trainees and having to hear about it from the governing bodies is much worse…

Therefore, you get the rubber stamp of education.

 

[chssoccer7]

Honestly though, this is horrible for medical education.

FWIW, this is not limited to medical education. This is true in the vast majority of professional fields, networking, the military, etc. Skill/knowledge can only take you so far and then it's "how can I get the correct person/people to say yes to X Y Z or that I deserve this job/promotion/raise more than the next person" or whatever which usually results in a healthy amount of "how do I get this person to like me". Pretty much any profession with upward mobility and people ends up like this. It's not really productive or beneficial for anyone, but it's just what comes with dealing with people.

 

[voxveritatisetlucis]

Yes, residents here definitely get annoyed if they dismiss you and you don’t leave.

 

[voxveritatisetlucis]

happy to let me actually be useful.

How did you make yourself useful

 

[Tangerine123]

I tell my students to leave whenever they want to, specially when I notice that they have no interest in the specialty (Psych). At the end of the rotation, I always just sign everything with the highest grades and rate them as top students because I know how competitive the world has become.

I encourage them to visit other wards and get involved in courses (the last medical student did a 2 day EEG workshop) or study for their tests if they wish.

The students that are actually interested in psych stay voluntarily until late and get really involved. It's nice to work with them. The ones that don't, it's fine too. I've been in their shoes and wish I were dismissed earlier when I rotated through stuff that I had 0 interest in (basically any surgical field). I could have used that time to do more productive things and it would have helped my physical and mental health.

 

[slowthai]

I tell my students to leave whenever they want to, specially when I notice that they have no interest in the specialty (Psych). At the end of the rotation, I always just sign everything with the highest grades and rate them as top students because I know how competitive the world has become.

I encourage them to visit other wards and get involved in courses (the last medical student did a 2 day EEG workshop) or study for their tests if they wish.

The students that are actually interested in psych stay voluntarily until late and get really involved. It's nice to work with them. The ones that don't, it's fine too. I've been in their shoes and wish I were dismissed earlier when I rotated through stuff that I had 0 interest in (basically any surgical field). I could have used that time to do more productive things and it would have helped my physical and mental health.

Strong work. Gonna copy this. "Leave when you want. No seriously, it's not a trick."

 

[ChordaEpiphany]

May have been your experience but most of the clinical grades at most schools are rotating with the right people and asking the right people for evals

In general interns give worse evals because of self serving bias. They think they were just very recently a far better med student than you. That + interns have a mindset in current day that they “have something to prove”. More senior residents on their way out don’t give two ****s about feeding the system

“What can I do to get this person to like me”. For some seniors you rotate with this is more trouble and more ignoble than it’s worth, and you’re best off folding your hand and just doing the bear minimum in a no win situation

Many interns and even junior residents are classic cases of rosy retrospection and selective memory. I got the benefit seeing my friends/classmates go off to M3, hearing about their experience in real time, and then knowing/meeting them again as interns or residents. They are a 50/50 split of reasonable and downright delusional when it comes to recalling their M3 experience.

The delusional ones have erased their memories of early M3 and only remember themselves on their best day near the end of the year. They think they were super chill and well-liked by all residents (almost universally these are the ones who aren't/weren't). They recall getting plans correct... on week 7 of a rotation. They remember charming the socks off of some little old ladies who would've been enamored by Hannibal Lecter if he told them he was a med student. Then they hold every M3 to that imaginary standard. They also tend to forget all of the anxiety and the pressure of M3, because it's hard to remember/replicate that anxious feeling. Odd talking to these people, who then go on tangents about how these younger med students are somehow worse than their cohort.

The reasonable ones remember the stress of being a perpetual outsider in a new environment that is constantly evaluated on an extremely unclear set of tasks. They acknowledge that residency is more work in the hospital, but med school is socially isolating and anxiety-inducing, and studying for high scores on rapid-fire shelf exams sucks.

FWIW, this is not limited to medical education. This is true in the vast majority of professional fields, networking, the military, etc. Skill/knowledge can only take you so far and then it's "how can I get the correct person/people to say yes to X Y Z or that I deserve this job/promotion/raise more than the next person" or whatever which usually results in a healthy amount of "how do I get this person to like me". Pretty much any profession with upward mobility and people ends up like this. It's not really productive or beneficial for anyone, but it's just what comes with dealing with people.

I think the big difference is that as a medical student you are explicitly barred from doing most of the useful tasks, and the team is expected to be able to run with or without you. So you have no defined useful responsibilities by design.

I used to setup my team in the lab so that rotating students would do lots of scut. They'd run ELISAs and PCRs. They'd maxiprep plasmids the whole lab used regularly. They'd take a spot on the autoclave schedule. They'd also take on a piece of my project that  could fail but would be nice if it worked. That way you could evaluate them by whether or not they were reliable, they'd be an actually useful member of the team and feel valued, and if the research worked out they'd get a pub out of it. Early on I tried to "be nice" and spare these students as much work as possible, but quickly realized that it only increased their anxiety because they had no means to prove themselves outside of the results of a (likely poorly thought out) research project, so most of my impression of them was just personality.

M3 is essentially the second setup. You have no tasks, so it comes down  entirely to personality. You can't piss people off by being bad or unreliable, because they aren't relying on you. What I learned during my PhD is that there are a lot of personable people out there who would be a nightmare to actually work with, especially in a clinical environment where things move fast and there is no room for error.

 

[dgdg]

It's a challenge for sure, as a 'reasonable' person remembers.
I focused on what simple tasks I could do, made my own assessments to compare with others', and read something about each patient case (book, uptodate, or review article). That daily patient focused reading is an enormous teaching tool for your future board exams.
Some residents/interns love teaching and engagement, others are just trying to make it through their experience.
Then as an intern you are expected to do everything, giving the resident an unreasonable break. When you can't, they get angry and bitter.
Then as a resident.... [change names/roles]
Then as an attending....[change names/roles]

 

[Redpancreas]

I'm halfway through MS3 and until now had sort of "figured out" how to do well with attendings and residents. On most rotations I didn't really get excited about the medicine at all and just wanted to help patients in whatever small ways I could and survive the rotation. I was more sharp and composed around attendings and just sort of matched their intensity. With residents I just avoided any try-hard behavior and left as early as possible to go study for the shelf. The result has been great evals and shelf scores.

Now I'm on IM and genuinely loving the material. I get really excited about patients with cool pathology and often want to dive deep. I have absolutely no problem going a bit out of my way to help a patient understand their condition, learn to do a procedure, or see an interesting finding. This stuff will actually be useful to me in residency. Attendings love the enthusiasm, but residents seem ambivalent or even put off. I feel like I'm getting pressure from the chief resident to just leave immediately after rounds. I think it's coming from a good place (i.e., "I just wanted to leave as a med student, so I'm going to make sure my med students leave early"). As far as I can tell, my presence isn't a burden. I'm picking up scut appropriately to ease burden on the interns (e.g., calling family, writing notes, writing d/c instructions, etc...). And to be clear, if a resident tells me to go, I go. I'm not buzzing around. Seems like the vibes are overall pretty good. By no means am I clashing with anyone. It just sucks to get actively encouraged to stop trying when I'm simply excited and engaged.

I know what I have to do. I have another week with this team, and I'm going to mellow, care less, and make whatever personal connections I can. The irony is that to get good evals I have to stop trying hard, which is coming from a place of genuine interest, and be insincere so that I can avoid looking like I'm being insincere just to get good evals. This is absolutely exhausting.

Not trying to rub salt in wounds. Coming from someone who’s received similar non-verbal and subtle cues in the past, the issue wasn’t who I was fundamentally, it was how I came across to others.

Also, you won’t get along with all people. There are some who don’t really see eye to eye with those who take a deep interests in pathophysiology, explaining things to patients, etc. and would rather just do their job and leave and invest more in personal relationships with others. You may not see eye to eye with people like this and you can definitely rub each other the wrong way so just try to be friendly/kind/mellow if needed as you say.

Best of luck!

 

[hopefulraddaddypls]

Interesting thread. This site is out of touch, medicine has become an increasingly poor ROI, and students are catching on to this. Why would you want to pay (and might I add tuition is insane right now) to stay late in a crappy hospital on IM/surgery when that time could be used to do uworld or anki to get a high shelf and step 2 score- which will get you into the specialty you want. Staying late for "educational purposes" is a poor ROI of your time, this isn't the early 2000s. Im a prelim intern and send med students home as soon as I can, as I understand they're stressed about scores and ECs to match, those who want to stay tend to be a bit interesting.... which is why they get subpar evals. Getting good evals is more about how personable you are, not about what you know.

 

[Splenda88]

Honestly though, this is horrible for medical education.

On your IM rotation for example- the fact that you were incentivized (from a career perspective) not to stay late/go do those procedures is insanity. Not your fault obviously, I'm not ridiculing you.

I'm just grateful that, as someone who is interested in FM, I just don't really have to care about this stuff. But I honestly think we'd be better off at just leaving grades purely as shelf scores and then having mandatory hours students had to be in the hospital.

3rd/4th year of med school is a personality contest to an extent. I literally had an attending in 3rd year that introduced me to his mistress, invited me to go to strip club, giving me the key to test drive his Ferrari etc...

On the other hand, I had an attending (general surgeon) despite giving me HP editorialized in my evaluation about me not being a team player because I only see medicine thru the lens of internal medicine. I had my school removed that BS comment.

Glad to be an attending now. Not dealing with the personality contest anymore.

 

[SurfingDoctor]

3rd/4th year of med school is a personality contest to an extent. I literally had an attending in 3rd year that introduced me to his mistress, invited me to go to strip club, giving me the key to test drive his Ferrari etc...

On the other hand, I had an attending (general surgeon) despite giving me HP editorialized in my evaluation about me not being a team player because I only see medicine thru the lens of internal medicine. I had my school removed that BS comment.

Glad to be an attending now. Not dealing with the personality contest anymore.

Yeah, but how cool was it to drive that Ferrari?

 

[Splenda88]

Yeah, but how cool was it to drive that Ferrari?

Lol. I did not drive it because I was afraid something might happen to a 400k+ car.

That guy was one of the coolest and most hard working attendings that I have worked with.

 

[psyspy]

Interesting thread. This site is out of touch, medicine has become an increasingly poor ROI, and students are catching on to this. Why would you want to pay (and might I add tuition is insane right now) to stay late in a crappy hospital on IM/surgery when that time could be used to do uworld or anki to get a high shelf and step 2 score- which will get you into the specialty you want. Staying late for "educational purposes" is a poor ROI of your time, this isn't the early 2000s. Im a prelim intern and send med students home as soon as I can, as I understand they're stressed about scores and ECs to match, those who want to stay tend to be a bit interesting.... which is why they get subpar evals. Getting good evals is more about how personable you are, not about what you know.

Agreed. Efforts must be made from seniors to minimize ass kissing and the impact thereof.

Also imo, if you’re truly assessing students for evals instead of giving good ones to all of them, you should try to make it fairer than “personability”. That still counts but there are better ways to separate who has better clinical ability for their level than their peers

Good evals should center on making one’s time in the hospital count rather than staying as late as possible in hopes of a better eval

 

[psyspy]

Now that it’s common knowledge that the rotations hardly do squat to prepare you for shelves/step2, that part of med ed is due for a serious rehaul. Needs to be a better way to balance specialty exposure with time to study for shelves

 

[guytakingboards]

Interesting thread. This site is out of touch, medicine has become an increasingly poor ROI, and students are catching on to this. Why would you want to pay (and might I add tuition is insane right now) to stay late in a crappy hospital on IM/surgery when that time could be used to do uworld or anki to get a high shelf and step 2 score- which will get you into the specialty you want. Staying late for "educational purposes" is a poor ROI of your time, this isn't the early 2000s. Im a prelim intern and send med students home as soon as I can, as I understand they're stressed about scores and ECs to match, those who want to stay tend to be a bit interesting.... which is why they get subpar evals. Getting good evals is more about how personable you are, not about what you know.

I'm going to come off sounding like a boomer (despite being ~5 years out of training) saying this, but a major part of the transition from the didactic world to the clinical/real world is understanding just how valued competence is relative to personality.

I agree that people need to get themselves in the door with baseline metrics. Med students do need to get time to study for their shelf exams. But once you get past that, personality is almost certainly going to take you further than competence.

Part of clinicals/residency and the job are pure "learning to play the game to get ahead"

Agreed. Efforts must be made from seniors to minimize ass kissing and the impact thereof.

Also imo, if you’re truly assessing students for evals instead of giving good ones to all of them, you should try to make it fairer than “personability”. That still counts but there are better ways to separate who has better clinical ability for their level than their peers

Good evals should center on making one’s time in the hospital count rather than staying as late as possible in hopes of a better eval

I think you grossly overestimate the ability of MedEd to fairly and appropriately distinguish 100's of medical students purely on their clinical skills.

Personality (just call it high EQ) is a pseudo-substitute for competence because it portends how the trainee will respond in different settings. Is the student an eager learner who can feel the room and know when to take advantage of learning opportunities and not triple the workload? At the end of the day, that's what MedEd is judging: someone's suitability for the next stage.

 

[Dr. Anonymouss]

I think it comes from a place of your resident wanting you to enjoy and value your time. I personally look at the interest each medical student has and that factors into how involved I want to be with them. If they show me and interest in learning and wanting to understand diagnoses and management then I will teach them, but I am not going to go out of my way to try to precept a student who shows no passion. I am far too busy and have other things I can be doing.