Ask a 4th year!

[yehhhboiii]

I can't remember anything now, but there's a great (and old) post by a then-MS4 that addresses this exact topic. I can't seem to find it but it's reposted often so hopefully someone can come by and share it.

This may be what you are looking for.
http://forums.studentdoctor.net/showthread.php?t=104541

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[NickNaylor]

This may be what you are looking for.
http://forums.studentdoctor.net/showthread.php?t=104541

Yup, that's the one - thanks.

 

[sinombre]

This may be what you are looking for.
http://forums.studentdoctor.net/showthread.php?t=104541

Pshhh... I already posted this earlier in the thread. But yeah, good read... haha

 

[LovelyBRass]

While I don't think you necessarily intended it this way, this comes off as a tiny bit condescending when you're talking to other M3/M4s. I understand what the point of rounds are, and I understand the getting out of it what you put in part. I'm sure MBD2013 does as well. I don't even completely hate rounds, I just can't stand it when they drag on for ages. For some people, this just isn't an efficient learning style, and it always a productive use of time. I don't dislike rounds because I don't understand them, I dislike them because many times they can devolve into an academic circle jerk with attendings ranting about some minutiae that isn't particularly relevant or interesting.

You could use your same argument against people who say they don't like standing in the OR holding a retractor. If they had only read up on the cases, they could be involved and asking relevant questions during the case. That doesn't mean that everyone is going to like standing in the OR for an 8-hour whipple.

And I'm trying to say that it isn't always an "academic circle jerk" and that spreading this attitude makes people appreciate rounds less and therefore not use them to their advantage. And then you get pre-clinical students who have never even been on the floors dreading the sound of rounds and long days when they can be the most educational time of third year.

Re: holding a retractor. If you stand there holding a retractor and show no interest because you actively do not care and/or didn't read about the case, then all you're going to do is hold a retractor. If you want someone to include you and you want to learn, it's so important to read about the case, ask questions, even just lean in... holding a retractor isn't passive if you actually know what's going on in the case. (ok I may be going into Medicine but I loved Surgery too)

I am just frustrated that these methods of learning get such a terrible rap before people even start rotations. You can argue that it's inefficient or whatever, but this is how you learn in residency - by doing, discussing, and watching, not by staring at a textbook.

 

[MDbound2013]

And I'm trying to say that it isn't always an "academic circle jerk" and that spreading this attitude makes people appreciate rounds less and therefore not use them to their advantage. And then you get pre-clinical students who have never even been on the floors dreading the sound of rounds and long days when they can be the most educational time of third year.

Re: holding a retractor. If you stand there holding a retractor and show no interest because you actively do not care and/or didn't read about the case, then all you're going to do is hold a retractor. If you want someone to include you and you want to learn, it's so important to read about the case, ask questions, even just lean in... holding a retractor isn't passive if you actually know what's going on in the case. (ok I may be going into Medicine but I loved Surgery too)

I am just frustrated that these methods of learning get such a terrible rap before people even start rotations. You can argue that it's inefficient or whatever, but this is how you learn in residency - by doing, discussing, and watching, not by staring at a textbook.

Yes, agreed, in residency you learn by doing and discussing. However I will disagree that rounds (at least the way most of my rounds went) had anything to do with doing or discussing. My best learning experiences on Medicine came after rounds when the residents and I would sit and run the list and go through the plan for each patient, or when I'd get to sit with an intern one-on-one, help him/her put in orders and discuss why those orders were being put in the first place. Not on rounds. Sorry. For me they were the definition of "hurry up and wait"- we were always theoretically in a rush to move on to the next patient, so asking too many questions was rude, but then we'd just stand there for hours discussing things that made me completely check out 3 minutes in. I'm glad that someone finds a 45 minute conversation about broad spectrum antibiotics interesting- someone has to- but I don't. Asking questions doesn't make it any better and just prolongs the torture for everyone. In fact, a lot of the time if we had a really long-winded attending the residents purposefully would take me aside and tell me to not ask questions on rounds because they had way too much work to do and couldnt spend 6 hours there, so I could ask them later. I couldn't blame them, I would have done that too. Besides, I get the same amount of learning looking up patient charts and asking residents about things or looking stuff up on uptodate.

When picking a specialty, I purposefully chose one with no rounding involved. Sorry, for me it's not efficient or useful and it was the worst hours of my day. Hell I'm very good friends with a bunch of medicine residents, and most of them agree with me. It's necessary, and sometimes it's not as bad, and there's the occasional awesome attending who involves the med student and who goes quickly and efficiently and doesn't retake the history and physical you just presented and doesn't spend 45 minutes chatting about the good ol' days of antibiotics. But then there are the other days, and you're stuck there, and you can't ask questions cause rounds have already been going on 3 hours and everyone is exhausted, and your attention span died 2 hours ago, and I'm sorry but you can't possibly know every patient every morning (our census, depending on the team, was between 12-36 -- not happening). So yes, that to me was useless. Sorry if that biases the kiddos coming in to third year, I hope it's better for other people, but for me it was a waste of time.

As for retracting: for me it wasn't nearly as bad. For one thing, it's an environment that I find much more conducive to asking question (as long as the attending allows talking in the OR) because you're not just trying to move along from one patient to the next. You're not slowing anything or anyone down by asking something that has a long, complicated answer. Also, you have something to look at. At the very least, even if you can't speak, you can review anatomy by looking at what you're retracting or where your camera is pointing during a laparoscopy, and that's great learning. Finally, there's just fewer patients. You can prepare for <10 surgeries and know those cases and know the anatomy and go in ready to learn. Part of my issue with rounds is that I couldn't possibly know all the patients in enough detail for the plan to make sense to me. I vaguely knew why everyone was there, what the primary diagnosis was, and what I could do to help- but that's about it. This made it a lot harder for me to learn.

Anyway, it's a moot point cause thankfully those days are over for me and other than on off-service rotations, I'll never have to round again in my career. I think it's clear that some people find rounds useful and educational, although I take offense to the implication that the reason that some don't is that we're not doing enough. Not everyone learns the same way, and thankfully there are plenty of specialties in medicine that have more and less rounds so you can choose whatever you want.

 

[a2014]

Yes, agreed, in residency you learn by doing and discussing. However I will disagree that rounds (at least the way most of my rounds went) had anything to do with doing or discussing. My best learning experiences on Medicine came after rounds when the residents and I would sit and run the list and go through the plan for each patient, or when I'd get to sit with an intern one-on-one, help him/her put in orders and discuss why those orders were being put in the first place. Not on rounds. Sorry. For me they were the definition of "hurry up and wait"- we were always theoretically in a rush to move on to the next patient, so asking too many questions was rude, but then we'd just stand there for hours discussing things that made me completely check out 3 minutes in. I'm glad that someone finds a 45 minute conversation about broad spectrum antibiotics interesting- someone has to- but I don't. Asking questions doesn't make it any better and just prolongs the torture for everyone. In fact, a lot of the time if we had a really long-winded attending the residents purposefully would take me aside and tell me to not ask questions on rounds because they had way too much work to do and couldnt spend 6 hours there, so I could ask them later. I couldn't blame them, I would have done that too. Besides, I get the same amount of learning looking up patient charts and asking residents about things or looking stuff up on uptodate.

When picking a specialty, I purposefully chose one with no rounding involved. Sorry, for me it's not efficient or useful and it was the worst hours of my day. Hell I'm very good friends with a bunch of medicine residents, and most of them agree with me. It's necessary, and sometimes it's not as bad, and there's the occasional awesome attending who involves the med student and who goes quickly and efficiently and doesn't retake the history and physical you just presented and doesn't spend 45 minutes chatting about the good ol' days of antibiotics. But then there are the other days, and you're stuck there, and you can't ask questions cause rounds have already been going on 3 hours and everyone is exhausted, and your attention span died 2 hours ago, and I'm sorry but you can't possibly know every patient every morning (our census, depending on the team, was between 12-36 -- not happening). So yes, that to me was useless. Sorry if that biases the kiddos coming in to third year, I hope it's better for other people, but for me it was a waste of time.

As for retracting: for me it wasn't nearly as bad. For one thing, it's an environment that I find much more conducive to asking question (as long as the attending allows talking in the OR) because you're not just trying to move along from one patient to the next. You're not slowing anything or anyone down by asking something that has a long, complicated answer. Also, you have something to look at. At the very least, even if you can't speak, you can review anatomy by looking at what you're retracting or where your camera is pointing during a laparoscopy, and that's great learning. Finally, there's just fewer patients. You can prepare for <10 surgeries and know those cases and know the anatomy and go in ready to learn. Part of my issue with rounds is that I couldn't possibly know all the patients in enough detail for the plan to make sense to me. I vaguely knew why everyone was there, what the primary diagnosis was, and what I could do to help- but that's about it. This made it a lot harder for me to learn.

Anyway, it's a moot point cause thankfully those days are over for me and other than on off-service rotations, I'll never have to round again in my career. I think it's clear that some people find rounds useful and educational, although I take offense to the implication that the reason that some don't is that we're not doing enough. Not everyone learns the same way, and thankfully there are plenty of specialties in medicine that have more and less rounds so you can choose whatever you want.

I agree with everything you said. The bolded part is what I was trying to get at before. I know people that love rounds, but they just don't do it for me. I find they're usually composed of hours of boredom sprinkled with a few little nuggets of medical wisdom. I brought up the point about retracting in the OR because that's what most people complain about. Like you, the OR was a great learning experience for me, much more so than rounds. Everyone learns differently, and it's not productive to tell everyone who doesn't like rounds that they're just not doing it right.

What do you regret doing or not doing from the last 4 years?

I also don't regret very much. I've tried to fit in traveling and doing things I like whenever possible. In hindsight I would probably change what I did during my first summer. I did ~3 months of work on a research project here, when I probably would have enjoyed doing something international more. I also didn't study with other people very much until this last year. Our clinical year group had a few people who would get together and study fairly regularly, and I thought it was really helpful.

As a 4th year, would you say you are satisfied with your choice to pursue medicine? You always hear about the students who didn't do enough research and end up hating the field or the others who get burned out, etc. We all know you've been working hard the past 4 years, but do you feel like its been worth it? Are you excited to graduate and start "doctoring", though you know the road ahead is going to be even more difficult?

I'm more or less satisfied. There are certainly the days when I look at all of the other things I could be doing instead of studying or going to the hospital at 6am, but I still enjoy medicine and there's a certain satisfaction that comes with becoming competent in something as vast as medicine. I agree with MDB2013 in that I'm fairly jaded to certain aspects of medicine, and there really are parts of medicine that really suck. At the same time, there are parts of medicine that are really cool, and you have to focus on those aspects that excite you.

 

[LovelyBRass]

I agree with everything you said. The bolded part is what I was trying to get at before. I know people that love rounds, but they just don't do it for me. I find they're usually composed of hours of boredom sprinkled with a few little nuggets of medical wisdom. I brought up the point about retracting in the OR because that's what most people complain about. Like you, the OR was a great learning experience for me, much more so than rounds. Everyone learns differently, and it's not productive to tell everyone who doesn't like rounds that they're just not doing it right.

I think the overarching sentiment I hear from my classmates is that rounds or whatever suck and don't matter. I simply want to be the one person who says to the next gen that hey, it's not only not that terrible, it actually can be a really great experience. If someone had told me that, maybe I would have gone in with an open mind and taken better advantage of every educational opportunity I had.

 

[a2014]

I think the overarching sentiment I hear from my classmates is that rounds or whatever suck and don't matter. I simply want to be the one person who says to the next gen that hey, it's not only not that terrible, it actually can be a really great experience. If someone had told me that, maybe I would have gone in with an open mind and taken better advantage of every educational opportunity I had.

Honestly, I'm not sure how much your preconceptions matter in how you'll like various parts of clinical year. They might impact how you perceive your first few weeks on the floor, but after that I'm not so sure. You spend enough time in rounds, on the floor, in the OR, and doing pretty much everything else that each person quickly finds out what they do and don't like about med school. People who think they're going to love the OR hate surgery, people who think rounds sound horrible end up loving medicine, etc. You seem to be evidence of that yourself, stating that you thought your were going to hate rounds but apparently seem to love them now.

I don't think telling other med students that they're just not putting enough effort into rounds to get the most out of them is the right way to go about it.