Attending hates me!

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I just started my surgery rotation, and on my first day of the rotation, the attending just gave out this vibe that he's not interested in me. There were 2 other students, and he would ask them questions, but he never once looked at me. When I would present one of his patients, he'd go in the room before I can even start the history. Even when he talks to us in group sessions, he never makes eye contact with me. It's been 2 weeks, and I figured by now he'd loosen up, but he still avoids me! He hasn't talked to me once, still ignores my questions, doesn't make eye contact with me, even though I've been going out of my way to try to talk to him. This rotation is absolutely hellish for me. I haven't done anything-- I just think he doesn't like me for whatever reason. I have a feeling his eval is going to suck for me! How is that going to affect my overall surgery grade?????
 
I have a feeling his eval is going to suck for me! How is that going to affect my overall surgery grade?????
I guess that just depends on how bad of an eval he writes you.


I would try to approach him alone and ask him for some type of feedback.
 
You definetly need to meet with him. Use your mid-rotation eval date as a chance to ask him how you are doing and what you need to do to improve. I would not let this fester any longer. Good luck
 
Its ok, everyone thinks their surgical attending hates them. My attending regularly told me (and others) that something was "basic information" that i should know, yelled at me for "having the inability to think", never smiled, etc etc. Another attending told another student on my time that he "doesnt see how she will ever make anything of herself", and regularly called people fat, stupid and ugly (but maybe with some different words, but you get the point. Surgeons are tired, stressed, mean, but they problably dont hate you and you will still pass. Show up on time, work hard, dont complain (to them), and you will do well
 
I'm just an intern, but I gossip with the attendings and residents about med students quite a bit. Just a little secrety: No, it's not always that we're tired and stressed, sometimes we really do hate you.

Let's talk about the common reasons why (yes, these all really happened):

1) On the first day of the block, you introduced yourself and told us that you don't really know much and aren't interested in surgery.

2) The attending asked you what you what you're interested in doing, and you said, "I don't know, but not surgery". Why is that? "Because I don't really like the personalities".

3) Instead of answering questions or saying "I don't know", you just stand there staring at the floor, pretending to think.

4) You need to leave early because you have childcare issues. Every day.

5) You never try to figure things out, you always come to one of us to ask how to do things.

6) We try to reward you for working hard by offering to let you suture or do parts of small cases, and you decline.

7) You claim to be interested in psychiatry, and tell us that you loved your psychiatry clerkship. But when we ask for input on psychiatric issues with our patients (what behaviors are common in bipolar disorder? what are some common atypical antipsychotics?), you don't seem to know even the simplest things.

8) You are late to rounds, and we are presenting your patient first.

9) We ask you what the xray or CT showed, and you say, "The radiologist didn't read it yet."

10) You are a slacker and obviously don't want to be here, but when we offer to let you go home early, you say, "I don't want you to think I'm a slacker."
 
3) Instead of answering questions or saying "I don't know", you just stand there staring at the floor, pretending to think.
...
8) You are late to rounds, and we are presenting your patient first.

9) We ask you what the xray or CT showed, and you say, "The radiologist didn't read it yet."

So true! Especially the last one. This happens in other fields as well. Sure we can't read a film like a radiologist, but at least look at the study yourself! You're going to feel dumb if you miss a huge mass on CT A/P or an obvious pneumothorax on CXR.

Waiting 1-2 days for the attending radiologist to dictate his/her read is unacceptable.
 
3) Instead of answering questions or saying "I don't know", you just stand there staring at the floor, pretending to think.

Is it worse to make an educated guess? Or is it worse to just admit right away that you don't know?



5) You never try to figure things out, you always come to one of us to ask how to do things.


Note to self: try more experimental surgeries before bothering an attending with a question.
 
1) On the first day of the block, you introduced yourself and told us that you don't really know much and aren't interested in surgery.

2) The attending asked you what you what you're interested in doing, and you said, "I don't know, but not surgery". Why is that? "Because I don't really like the personalities".

6) We try to reward you for working hard by offering to let you suture or do parts of small cases, and you decline.

Students actually do this stuff???
 
Students actually do this stuff???

Yeah. You might be suprised at the lack of social skills found amongst the medical population. They come in with preformed ideas, and don't understand that not only are they not being open-minded, but are sometimes being insulting.

You don't have to lie, but you don't need to denigrate a field to its practitioners, especially when you haven't done it, or are looking to get a good evaluation.😉
 
Yeah. You might be suprised at the lack of social skills found amongst the medical population. They come in with preformed ideas, and don't understand that not only are they not being open-minded, but are sometimes being insulting.

You don't have to lie, but you don't need to denigrate a field to its practitioners, especially when you haven't done it, or are looking to get a good evaluation.😉

It's hard being disingenuous about something you're not necessarily interested in, but clearly the evaluation repercussions are worth considering. Usually I take some form of the following approach:

Resident/attending: So you're interested in X?
Me: That's what I'm here to find out!
 
Is it worse to make an educated guess? Or is it worse to just admit right away that you don't know?

I don't think either one is necessarily wrong. Personally, if I think my guess may have a good shot at being correct, I'll toss it out there (confidently, like I know the answer). If I know I'll never get it, I just say, "I don't know sir, but I'll look it up."

Note to self: try more experimental surgeries before bothering an attending with a question.

I didn't mean surgical procedures. I meant things like pulling xrays, pulling lab results, or getting bandage supplies. If you don't know how to do that in a particular hospital, ask a nurse or tech, or a fellow student. Don't hassle the team with those kinds of questions unless absolutely necessary.
 
2) The attending asked you what you what you're interested in doing, and you said, "I don't know, but not surgery". Why is that? "Because I don't really like the personalities".

4) You need to leave early because you have childcare issues. Every day.

5) You never try to figure things out, you always come to one of us to ask how to do things.

8) You are late to rounds, and we are presenting your patient first.

9) We ask you what the xray or CT showed, and you say, "The radiologist didn't read it yet."

10) You are a slacker and obviously don't want to be here, but when we offer to let you go home early, you say, "I don't want you to think I'm a slacker."

Tired, this is not meant to discredit what you are saying or the question the validity of your statements. However, I've come to find out that most of these problems are minor and can easily be avoided.

2) The student is being honest with you. I think you took this the wrong way (what happened to open, honest communication?). If I were you I would take this as an opportunity to change that persons mind or at the very least show him the good personalities in surgery. I hate to say it, but he is true...I know more surgeons with crappy personalities than any other field. Obviously anecdotal but my experience nonetheless.

4) This may well be true. Did you forget how expensive med school is? Not everybody's solution is to loan more $$ for expenses. If they have to pick up a child from daycare then why isn't this a valid reason to leave? Certainly more impt than an attending leaving to go home for an hr or two to mow the lawn or take care of their horses (which I've witnessed).

5) As an intern or resident, it is your responsibility to teach the students how to function on the wards. This info doesn't magically pop into their heads. This is not a problem unless you always have to tell them how to do the same thing.

8) There are multiple reasons why people are late. If it happens, I would hope that you ask them why. You know, we all oversleep at some pt in our lives, we all have been in unexpected traffic delays due to construction or accidents, and we all have had other misc reasons (spilling coffee on your clothes while driving). I would never hold this against a student, nor anyone else. I hope you wouldn't either (unless it happens frequently).

9) This goes back to #5. You need to teach them how to read films and to always look at the film even if the radiologist has read it. This is more of your fault than the students. Now, it would not be your fault if you had told them in the past to look at the films.

10) If this is happening, then there is a HUGE communication barrier bw you and the student. You need to provide honest and regular feedback. Obviously in this case the student does not know that you think they are slacking. You need to let them know you think they are slacking and give them pointed feedback about how they can improve.

Overall, I've noticed that most of this rambling about how bad students can be would be much reduced if all sides communicated to each other. I'm amazed at how little feedback students can get and then get grilled by a resident or attending. How are they supposed to know, particularly when they have a different set of expectations each month? It's your job to sit them down at the beginning and let them know whats expected and to provide feedback regularly. Don't let a small problem be the reason you give them a bad eval, particularly if you never communicated that problem to them.

And, be flexible when things come up. It happens to everybody. It's called life.
 
4) This may well be true. Did you forget how expensive med school is? Not everybody's solution is to loan more $$ for expenses. If they have to pick up a child from daycare then why isn't this a valid reason to leave?
...
8) There are multiple reasons why people are late. If it happens, I would hope that you ask them why. You know, we all oversleep at some pt in our lives, we all have been in unexpected traffic delays due to construction or accidents, and we all have had other misc reasons (spilling coffee on your clothes while driving). I would never hold this against a student, nor anyone else. I hope you wouldn't either (unless it happens frequently).

9) This goes back to #5. You need to teach them how to read films and to always look at the film even if the radiologist has read it. This is more of your fault than the students. Now, it would not be your fault if you had told them in the past to look at the films.

(4) While this may be true, and I sympathize with those who are fathers/mothers during med school, it doesn't seem fair to everyone else when you can just leave early every day to pick up your kid from daycare/babysitter's/school/etc. I mean, you wouldn't be leaving your job early everyday to do this, right? You have to make arrangements for this - as would be the case in any other school/occupation.

(8) Agreed that this shouldn't be a problem unless it occurs often enough to demonstrate a pattern. Sure everyone oversleeps now and then, but those students who will regularly come late to rounds - as in, once or twice a week - will get docked on their evals, that's for sure.

(9) Also agree that we residents need to teach the med students first. But the MS-IIIs who tend to not follow up on their patients' studies are the same ones who don't show interest/enthusiasm, want to leave early, occasionally come late for rounds, etc.
 
(9) Also agree that we residents need to teach the med students first. But the MS-IIIs who tend to not follow up on their patients' studies are the same ones who don't show interest/enthusiasm, want to leave early, occasionally come late for rounds, etc.

I agree with that 100%. Just be sure to let them know you sense their lack of interest, wanting to leave early, etc early on so they can try to improve. Sometimes, they may not know you sense a lack of interest even though they are indeed engaged but may show it differently or have an overtly introverted personality, in which case you can try to help them shine in front of the attending.

The wanting to leave early is tough. I can certainly empathize with them, as I have had my time literally wasted for hours as I was gaining no educational value at the expense of study or family time. We've all had this happen. We should remember that the MSIII role is very much of a learning one and residents/interns should be cognizant of this and release their students when the students time might be better utilized studying at home versus watching you write your notes in the PM or waiting around in case you have mindless work for them. If the student's work is done and it is a reasonable time, let them go home.
 
I agree with that 100%. Just be sure to let them know you sense their lack of interest, wanting to leave early, etc early on so they can try to improve. Sometimes, they may not know you sense a lack of interest even though they are indeed engaged but may show it differently or have an overtly introverted personality, in which case you can try to help them shine in front of the attending.

The wanting to leave early is tough. I can certainly empathize with them, as I have had my time literally wasted for hours as I was gaining no educational value at the expense of study or family time. We've all had this happen. We should remember that the MSIII role is very much of a learning one and residents/interns should be cognizant of this and release their students when the students time might be better utilized studying at home versus watching you write your notes in the PM or waiting around in case you have mindless work for them. If the student's work is done and it is a reasonable time, let them go home.

I think it would be great if every resident and intern could read your last two posts in this thread. 👍


Tired-I was just kidding about the surgery comment. But, you should know that at my hospital, medical students don't get access to radiology images-we just the reports when they show up in the patient's charts. I had to bring this issue up to the clerkship director and fight to get a password to look up radiological images and now I have one. But I didn't have one for medicine and peds and I only know of one other student who has a password. It's not that hard to take a second to be friendly and tell someone where something is one time. People aren't born knowing things, and neither were you.
 
2) The student is being honest with you. I think you took this the wrong way (what happened to open, honest communication?). If I were you I would take this as an opportunity to change that persons mind or at the very least show him the good personalities in surgery. I hate to say it, but he is true...I know more surgeons with crappy personalities than any other field. Obviously anecdotal but my experience nonetheless.

It may be true in your own personal experience (not with everyone's experience), but it's still a very rude thing to say.

It would be like someone saying "I don't want to do OB/gyn because pregnant women are all moody." Or saying "I don't want to do path because, you know, I have good social skills." Or saying, "I don't want to do family med because I actually managed to get > 185 on Step 1." Is there some truth to these stereotypes? Debateable (depending on your personal experience with pregnant women/pathologists/family practitioners). Is it extremely rude to make a statement that is based on these stereotypes? YES!!

5) As an intern or resident, it is your responsibility to teach the students how to function on the wards. This info doesn't magically pop into their heads. This is not a problem unless you always have to tell them how to do the same thing.

This is true, although I think that there are some things that you should pick up on your own just by being on the wards for 2 or 3 days. Some things, but not everything.

And I would argue that your responsibility as a 3rd year med student is to learn how to function on the wards on your own. Isn't that how they distinguish between an "Honors" student and a "Passing" student? Isn't it based on whether or not you can think independently, without having your hand held every step of the way? Interns and residents rarely get instruction on "how to function as a resident," so I guess they don't think that med students should get instructions on "how to function as a good med student."

9) This goes back to #5. You need to teach them how to read films and to always look at the film even if the radiologist has read it. This is more of your fault than the students. Now, it would not be your fault if you had told them in the past to look at the films.

If your school didn't teach you how to read a film during 2nd year, then you went to a crappy school. I mean, they have X-rays and CTs on Step 1 now. You don't need to read it expertly, but making a stab at it would probably be huge.

And if you need someone to tell you, "Hey, maybe you should look at the X-ray by yourself, without waiting for the radiologist," then you haven't prepared for 3rd year. EVERY SINGLE book/website/pamphlet that tells you how to "Get Honors on the Wards!" says, "Look up labs and X-rays without being told to." Every single one - how many 3rd year med students have really NOT read those books/websites?

[This is, of course, provided that your school provides access to the films. Ypo. - It sucks that your school doesn't provide access - I can definitely sympathize. I couldn't get into the OR by myself for a while on Gyn. 🙁 I hate it when they tell us to "BE TEAM PLAYERS!" but then don't give us the basic tools - like OR access - to do just that.]
 
Tired-I was just kidding about the surgery comment. But, you should know that at my hospital, medical students don't get access to radiology images-we just the reports when they show up in the patient's charts. I had to bring this issue up to the clerkship director and fight to get a password to look up radiological images and now I have one.

This is why I always make it a point to give my students my radiology login/password. Or we'll have a generic one listed on our patient list.
 
It's hard being disingenuous about something you're not necessarily interested in, but clearly the evaluation repercussions are worth considering. Usually I take some form of the following approach:

Resident/attending: So you're interested in X?
Me: That's what I'm here to find out!

Yours is a great answer.

I don't think many of us want students to be disingenuous and lie about their interests. The problem with the earlier comment was not that a student didn't like surgery but rather the way it was phrased which shows a lack of understanding about how one's comments are received.

Believe me, I KNOW a lot of surgeons have "difficult" personalities but I still think it rather rude to point that out, especially if the person with whom you are interacting might not be one of those personalities.
 
Overall, I've noticed that most of this rambling about how bad students can be would be much reduced if all sides communicated to each other. I'm amazed at how little feedback students can get and then get grilled by a resident or attending. How are they supposed to know, particularly when they have a different set of expectations each month? It's your job to sit them down at the beginning and let them know whats expected and to provide feedback regularly. Don't let a small problem be the reason you give them a bad eval, particularly if you never communicated that problem to them.

You portray the student vs resident/attending relationship as though it is one of equals. It is not. There is really no impetus on the team to have this great open and honest communication with the students. Med students who are active in helping out and making themselves valuable get rewarded with procedures, extra teaching, lunch, etc. Students who are apathetic, make more work for the team, and bail out early get a bad eval with no feedback.

Here's the truth: No resident has to do any teaching at all to students. They don't have to give them any responsibility, let them do any procedures, or even talk to them. We could force med students to follow us around silently and never let them see a patient indepently, and there would be zero consequences for us.

So if you want a good eval, why wouldn't you try to make yourself as useful as possible? And if you just don't care, or other things are more important to you (sleep, child care, reading) why would you complain about a less-than-awesome eval?
 
Here's the truth: No resident has to do any teaching at all to students. They don't have to give them any responsibility, let them do any procedures, or even talk to them. We could force med students to follow us around silently and never let them see a patient indepently, and there would be zero consequences for us.

This is categorically not true on the services I've been on. The senior resident made it very clear that each student was supposed to be allowed to admit two patients per night while on night float. I never heard her say that they had to teach us, but most of the residents I worked with made an effort to do so at the end of the shift.

Attendings who work in a teaching hospital do have an obligation to help teach the residents and students.

You are right that there is a big power differential between the residents, attendings and students, which essentially means that we can't do much about it if the attending decides to ignore us. But...just as a student has a duty to try to learn and be proactive, the attending also has a responsibility to try and teach and make sure that the team (which includes learning as well as patient care) is running smoothly.

I just don't think your portrayal of how things work at a teaching hospital has been quite balanced.
 
I just don't think your portrayal of how things work at a teaching hospital has been quite balanced.

I'm not saying that the teams routinely treat med students in the way I described, I'm saying that there's really nothing to prevent it from occurring. I know that the teams I'm on function on a "the more you give, the more you get" principle. And that applies to everyone from the senior residents down to the medical students.

I think you should get away from this idea that the team has any responsibility to the students. They don't. Any teaching or patient care activities are at the discretion of the resident in charge, despite what your school tells you.

I have seen more than one student get iced out of most activities due to their attitude, personality, or work ethic. They invariably complain and write crappy evals of the residents. It makes no difference.
 
You portray the student vs resident/attending relationship as though it is one of equals. It is not. There is really no impetus on the team to have this great open and honest communication with the students. Med students who are active in helping out and making themselves valuable get rewarded with procedures, extra teaching, lunch, etc. Students who are apathetic, make more work for the team, and bail out early get a bad eval with no feedback.

Here's the truth: No resident has to do any teaching at all to students. They don't have to give them any responsibility, let them do any procedures, or even talk to them. We could force med students to follow us around silently and never let them see a patient indepently, and there would be zero consequences for us.

So if you want a good eval, why wouldn't you try to make yourself as useful as possible? And if you just don't care, or other things are more important to you (sleep, child care, reading) why would you complain about a less-than-awesome eval?

I would have to admit that there is alot of truth to what Tired said. I.e. there is a huge power differential between attendings and medical students, and residents and medical students, . . . I have seen several surgery residents verbally taken down a spot by attendings and higher up residents.

However, there are some excellent surgery residents who like students,

I was with a great group of surgery residents, one of whom even got take-out for the new students on the rotation😱 and was super nice to us, needless to say we were extra-motivated to help this resident. I have heard of surgery attendings talk about residents in the attendings lounge, just as residents gossip about students, and if a surgery resident has a bad attitude it usually is well known by every student and attending at the hospital. It is hard learning the first couple of days how to help out the team, . . . I sort of helped out in lots of unoffical ways as I used to work as a hospital volunteer and it was a reflex, while other students read/slept/talked on cell phones, I wasn't going into surgery, but I loved the rotation and helping in surgeries and postop care, and was surprised by the excellent eval I got (actually surprised that the surgery residents/attendings knew/cared that I was a good little worker, unsure how this relates to real clinical practice, but will take the eval😀).
 
Maybe I've just had a really bad day, which I have, but reading this cr@p makes me abhor the profession I have chosen.

Don't worry Tired, someday you'll get over how much the big bad residents hurt you when you were a med student. But throughout the healing process I am sure you will continue to propagate this backwards culture.

Run along back to the internship forum now to complain about nurses...maybe get off SDN and work on yourself a little bit.
 
Well, I think that while alot of what Tired said is true, some is obviously towards the end of the spectrum that residents have zero responsibility to teach and have complete authority of patient care. The surgery department clerkship director is responsible and when I took surgery made efforts to know about any mistreatment during the clerkship, (the amount of difference it makes is variable, but obviously if they are asking for input about mean residents then there will be perhaps repercusions for the mean residents), the repercusions for mean residents are silent, . . . sure they may go on to general surgery practice or a fellowship, but the BIG players in trauma surgery who have mega-grants, head chairman are the people who learned to get along with everyone and generally who everybody likes and trusts despite being "a surgeon", frankly the meanest surgeons/residents are the arrogant ones who believe that they have nothing to prove anymore and just need to see patients and treat staff, students, freshman residents like they are above them. Well, obviously these are the residents who don't become chairman of surgery, but basically live by their surgical skills alone and make alot of enemies in the hospital and have a harder time getting work done . . . learning to "appease the beast" i.e. the mean residents by helping out alot is something I discovered by accident, but something all medical students should know, now, . . . nothing is free in this world i.e. residents slacking off in terms of teaching and abrasive/mean attitude may eventually come back to haunt them. . . one mean resident P.O.'d a mean medical student who spread rumors about the resident which were ah . . . pretty personal to all of the students which circulated for years, so again nothing is free.
 
Yours is a great answer.

I don't think many of us want students to be disingenuous and lie about their interests. The problem with the earlier comment was not that a student didn't like surgery but rather the way it was phrased which shows a lack of understanding about how one's comments are received.

Believe me, I KNOW a lot of surgeons have "difficult" personalities but I still think it rather rude to point that out, especially if the person with whom you are interacting might not be one of those personalities.

There is a whole unwritten protocol that involves asking medical students what they want to be when they grow up on a particular rotation. It used to be in the past (maybe still is the case) is that if you wanted surgery you had to say you wanted it to the attendings and they would grade you on a different curve: i.e. a surgical attending meets a perfectly academically qualified medical student whom is technically qualified, takes good h & p's, knows their stuff in the OR and is interested, but for some reason rubs the attending wrong they would torpedo the student in the evaluation because for some undefined reason they didn't think they were "cut-out" to be a surgeon, i.e. maybe they had to much of outside life that would thought to interfere with being a surgeon or weren't as extroverted etc . . . supposedly this is frowned on today because obviously there are many who don't fit the mold of a typical surgeon, i.e. quiet, introverted but passionately all-about-surgery and known to colleagues as an excellent surgeon i.e. one of america's best doctors . . . so I think the idea came along to judge people by their talents and more objectively, admit more women and minorities to medical school and just try to get the best people. However, from what I hear peripherally about orthopedic surgery residency is that according to myth or canon at one medical school you had to blow away the top orthopaedic surgeon i.e. department chairperson who if they think you are up to snuff will give you the "two thumbs up" and basically fast-track you to ortho i.e. you "fit" their mould of what a surgeon should be although this obviously just perpetuates a cadre of surgeons who think and act alike. However, the culture still persists in each specialty, even though today there are no/few pyramid residencies and in ways it is easier to become a surgeon once in medical school, . . . still the question of if you want to do specialty x while on rotation x is like a loaded gun in the medical student's face, personally I have known medical students who didn't do surgery because of the "personalities" in surgery (subjective at any rate) so if I was a surgeon and a medical student said that they didn't want to go into surgery because of personalities, well, that is straightforward and truthfull so I wouldn't hold it against the student, I personally know someone who thought they would hate surgery and loved it and then decided it was their calling. I think today that medical students are stereotyped on the wards as being uninterested in something if it wasn't what they were going into, personally I found all my rotations interesting, I'm not doing cartwheels in halls after a CSection, but yes I find the physiology of pregnancy extremely fascinating although I do not plan to be an ob/gyn. . . I was asked on rotation x if I wanted to do it, and rotation x was what I wanted to do and I truthfully told the attending so, but they didn't believe me initially! So, basically, I don't think that attendings should be asking nervous third years if they want to be what they are, and perhaps medical schools should ask attendings not to do this or give all the medical students instructions to answer saying that they fully hope to enjoy third year and that their dean asked them all to keep their minds open! As you can see from Dr. Cox's comments, if a student says that she doesn't want to do surgery because of the "personalities" (fair enough even the general public has a strong preconceived notion of surgeons and so do med students) what would happen is she discovers that she loves surgery?! if she stuck her foot in her mouth and offended Dr. Cox? What if they would have become a leading heart surgeon? Personally I find it offensive when an attending asks me in a low voice if I want to do x (or a resident) it serves no real educational purpose as I would ask/do more if I loved the rotation regardless of what I wanted to do but only pigeon-holes students. I try to be polite and tell people I am looking at something else but find specialty x interesting which is true! i really do find it all interesting, no harm telling that, obviously they are more tactful ways to say things, and I would never tell a surgical attendings that I didn't like the personalities of surgeons, but surgeons do expect an almost different form of english when spoken to, i.e. excessive differential cowing and a certain culture that is foreign to a third year medical student, so at times the "game" looks a little silly to outsiders

so at times the "game" looks a little silly to outsiders, here is the naive third year:

Attending: "Where is the patient for the lap chole? Where is the resident? Turns to med student, why aren't you following this patient?"
Naive 3rd:"I was just told to go to the OR for the fifth case, I haven't gotten to see the chart yet"
Attending: "Didn't we TELL you during orientation to know your patient, did you read up on the case?"
Naive 3rd: "I know that obviously, . . . I would if I knew what . . . "
Attending: "The OR list has the names of the patients AND cases if is unacceptable for you not to have read up."
Naive 3rd: Shruggs shoulders, "I don't know . . . I didn't know that . . ."
Attending walks away angry, the anger of the tardy patient/resident is displaced on student, the student in their mind just met a jerk of an attending, and during the operation berrates medical student for now knowing charcot's triangle on second day of rotation, but when you know the game:

Attending: "Where is the patient for the lap chole? Where is the resident? Turn to med student, why aren't you following this patient?"
Seasoned 4th: "Right, I had expected the patient to be down in the OR by now, the residents to me to meet him/her down here now, let me go phone the 7th floor and ask his nurse (looks very concerned)" . . . returns 10 minutes later, "I paged the resident, they are still doing the central line on the floor and the patient just left their room, . . . do you mind if I scrub in?"
Attending: "Sure, just go talk to the scrub, ah nurse . . . Where are all of the residents?!? This is no way to run a hospital, ridiculous!!"

Final Touch: Go up to 7th floor or wherever patient is and "help" get the patient down faster or push nurse to get patient down to OR faster, and then push in OR and tell attending that "We've found the patient!" grinning, attending will say "About time" but happy that you are responsive, I personally don't mind acting like the most compassionate concierge at the most expensive hotel which caters to the most obnoxious guests when i found that this what attendings respond to (surprise) normally you would be paid to act this way. I think it is helpful to look at hospital work as hotel hospitality work (close spelling eh?), if you basically cater to the guests (patients) and to the hotel managers (attendings) who fret about every little thing, the residents are just the senior bellhops, but it helps if you treat them like management too as they feel like they are close to "running the place" themselves. Here is the seasoned fourth year scenario rewritten in hotel language:

Attending (Hotel Manager): Where is the limo for Mr. X who is waiting in the lobby? Didn't I tell you to be more attentive with your guests?
Fourth year (Bell Hop): Right, let me go call for them again, they told they would be here in a minute . . . come back 10 minutes later: "I'll again for the limo, and they were delayed so they will be right over, I asked them for discount and told them they shouldn't treat our guests this way."
Attending (Hotel Manager): Oh, ok, demand the discount, this is no way to run a hotel limo service!
Fourth year (Bell Hop): I'll go tell Mr. X myself and apologize and offer him a complimentary massage downstairs.
Attending (Hotel Manger): Oh, ok good, . . .

Basically accept responsibility for everything even if you don't know what is going on, and then run around like mad to fix it! Alot of times if you are nice to patients and treat them like guests they don't want to leave the "hotel", . . . I just tell them they are going for a "CAT scan" and wheel them down to radiology and keep going to the exit.
 
Although medicine is great because if you like science and helping people with their healthcare problems you won't be bored, . . . but I think that some hospitals are just as malignant as the worst corporate culture anywhere as there is alot of backstabbing, ridiculously egotistical bosses and jealousy . . . so I don't think you escape that, but if you find a good hospital/residency that is non-malignant then you don't have to worry about it as much. Watch the television show "the Office" or that comic Dilbert about the woes of the corporate world, alot of the same things happen in medicine, . . . only thing with medicine is that you are in prolonged contact with your superiors and they feel justified via medical culture to give you a daily dose of verbal dressing down, . . . for a normal job most people would quit over this.
 
I think you should get away from this idea that the team has any responsibility to the students. They don't. Any teaching or patient care activities are at the discretion of the resident in charge, despite what your school tells you.

I have seen more than one student get iced out of most activities due to their attitude, personality, or work ethic. They invariably complain and write crappy evals of the residents. It makes no difference.

I'm sorry but you are wrong. There is a responsibility to teach and provide feedback to the students, which is why residents get the opportunity to evaluate students and why students get the opportunity to evaluate them. If an attending or a resident decides to power trip because that is their thing, then nothing much will happen other than they will get a bad reputation among the students, but it doesn't change the fact that they are at a teaching hospital. If you are one of those who are buying into this power trip I really hope you snap out of it before you inadvertently spread some negative impressions of the surgery profession.
 
Here's the truth: No resident has to do any teaching at all to students. They don't have to give them any responsibility, let them do any procedures, or even talk to them. We could force med students to follow us around silently and never let them see a patient indepently, and there would be zero consequences for us.

This is so far from the truth, it probably isn't worth commenting on. But, in our hospital system we evaluate residents on two levels: a general eval and then a teaching eval form. If you think you have no teaching responsibility to students perhaps you should re-read your resident manual again. If it's absent, then I'm sorry for you because if you go around thinking this, then you will get a bad rap around the hospital because these actions are generally not specific to med students but to other people below you as well (nurses, etc).

And, your comment about not being equals is true from a hierarchical level, but I don't see it appropriate to act like it is true. There are indeed times when this needs to be the case, but for the most part we spend so much time with you guys it will only result in rising tensions if you actually act like this. Don't forget too that we are only a couple of years from being in your position and we may in fact work at your hospital. Guess what happens if you were totally bad to me and you all the sudden page me for a consult.

Life's too short to think you are better than people, esp if they are your colleagues or future colleagues. You will get a reputation for this and, most unfortunate, will propagate one of the biggest problems in medicine.
 
This is so far from the truth, it probably isn't worth commenting on. But, in our hospital system we evaluate residents on two levels: a general eval and then a teaching eval form. If you think you have no teaching responsibility to students perhaps you should re-read your resident manual again. If it's absent, then I'm sorry for you because if you go around thinking this, then you will get a bad rap around the hospital because these actions are generally not specific to med students but to other people below you as well (nurses, etc).

And, your comment about not being equals is true from a hierarchical level, but I don't see it appropriate to act like it is true. There are indeed times when this needs to be the case, but for the most part we spend so much time with you guys it will only result in rising tensions if you actually act like this. Don't forget too that we are only a couple of years from being in your position and we may in fact work at your hospital. Guess what happens if you were totally bad to me and you all the sudden page me for a consult.

Life's too short to think you are better than people, esp if they are your colleagues or future colleagues. You will get a reputation for this and, most unfortunate, will propagate one of the biggest problems in medicine.

I get why you think your description is true (because that's what your school tells you) but I think that the moment you cross that MD divide, you're going to realize that most of what the schools tells students is really a lot of lip service.

- I have seen students get no teaching and no responsibility, and there is no complaints from the department

- I have had evals by student done on me for every block, and I have never seen them or had anyone comment on them; medical student opinions appear nowhere on my evals by the services I rotate through

- Mistreatment of medical students has no impact on your reputation in the hospital, because students have no friends here, while we work with each other each and every day. That's why nurses can get away with it.

- When you are an intern or junior resident, if I call you for a consult, you will do it regardless of your feelings about me.

Look, this has turned unnecessarily adversarial, and I know at this point you think I'm the kind of guy who craps on students. I'm not. I am a big defender of my students, from both residents and nursing staff. I have gotten into several arguments with my residents and nurses over the way students are treated. I have willingly scrubbed out of cases to let the students come in and close. I routinely pull papers for my students prior to cases so they have a better concept of what we're doing (which is really something they should do on their own, but rarely do).

But the number one killer of med students is a sense of entitlement. Once you come in with the attitude that "It's your job to teach me!" you're done, and there's nothing I can do to save you. It happens all the time. The best way to get good teaching and the chance to do a lot of stuff is by having (or pretending to have) a strong sense of humility and gratitude.
 
I think there would be negative repercussions on the resident if he did what Tired suggests (at least at my school)-- mainly the hospital would find it unacceptable, unless the student had some serious problem, the resident would get a bad reputation at the hopsital for not fulfilling his teaching and would likely not receive endorsement for further training anywhere academic. I know I would *strongly* complain if I were treated like that and the attendings would not be pleased. I think it is only fair that if students can get bad evals for not being "proactive" and "helping the resident" when really we have zero responsibility for patients and are there entirely to learn (the dean never said, during your clerkship your goal is to be fakely enthusiastic and lighten the resident's workload, yet this is how one does well), that likewise residents get bad evals for not educating med students even if it is not in their primary job description.

I think a lot of times students want to help but just don't know how, and are afraid of stepping on the resident's feet, but nobody shows us how to do anything. Today the resident took just 5 minutes to teach me how to write postpartum and discharge orders. It not only saved time but is much more pleasant than being berated for doing it wrong when you are forced to figure it out yourself. Teach, delegate, then correct. This is how students learn well and also help the team.
 
But the number one killer of med students is a sense of entitlement. Once you come in with the attitude that "It's your job to teach me!" you're done, and there's nothing I can do to save you. It happens all the time. The best way to get good teaching and the chance to do a lot of stuff is by having (or pretending to have) a strong sense of humility and gratitude.

I agree that the "It's your job to teach me" attitude is the fastest way to kill any chance of a good relationship between you and your resident.

But I would argue that it's the resident's job to give the student some clue of what's going on. Nothing big, just very basic stuff - like "the locker room is on the 4th floor," or "We're meeting on the 9th floor at 6:15 tomorrow." Just so I don't wander around like an idiot for 20 minutes.

I would also say that the best way to get good teaching and to get the chance to do cool stuff is by helping out as much as possible. I tried to do that on my ENT elective, and by the time the rotation was over, they were letting me suture, letting me use the flexible bronch, and one of the residents let me make a skin incision in the neck for the trach tube. 🙂
 
I think it is only fair that if students can get bad evals for not being "proactive" and "helping the resident" when really we have zero responsibility for patients and are there entirely to learn (the dean never said, during your clerkship your goal is to be fakely enthusiastic and lighten the resident's workload, yet this is how one does well), that likewise residents get bad evals for not educating med students even if it is not in their primary job description.

Lightening the workload isn't just how you do well. One of the attendings kind of explained it to me:

* By helping to lighten the workload, it shows that you know what's supposed to come next. That means that you prepared for the operation/procedure, and that you've been paying attention. It's not something that they expect from you from day 1, but by day 10, you should have an idea of how to help.

* By helping out, it also makes the residents more likely to let you do stuff, because it shows that you're trustworthy. It's also a reward for hard work. (I guess it is kind of twisted that they "let you" do stuff as a reward...but oh well.)

* By being enthusiastic, it reminds the residents of why they went into Surgery/OB/medicine in the first place, which makes them more likely to teach.

* I've never had a resident complain when I've offered to take some responsibility for the patient. Nothing major - but just doing a quick Post op check, or looking up their labs, or calling radiology. I get some responsibility for the patient, I learn how to take care of patients, and the resident gets some relief - everybody wins! 🙂
 
- I have had evals by student done on me for every block, and I have never seen them or had anyone comment on them; medical student opinions appear nowhere on my evals by the services I rotate through

- Mistreatment of medical students has no impact on your reputation in the hospital, because students have no friends here, while we work with each other each and every day. That's why nurses can get away with it.

But the number one killer of med students is a sense of entitlement. Once you come in with the attitude that "It's your job to teach me!" you're done, and there's nothing I can do to save you. It happens all the time. The best way to get good teaching and the chance to do a lot of stuff is by having (or pretending to have) a strong sense of humility and gratitude.

1) At my school residents and attendings do not see our evals of them for at least a year (depends on clerkship). So, if you are an intern it is likely you haven't seen them yet for confidentiality reasons.

2) I have heard stories (from attendings) of other attendings getting reprimanded by the school admins for their mistreatment of students. Generally, these are the kinds of people who look down not only on med students, but residents and nurses too. At my school, we have the teacher learner advocacy commission (TLAC) where we can go to report student abuse and they investigate.

3) The "it's your job to teach me" attitude is not wrong, at least at my school. We can easily be taken off a rotation and moved somewhere else if we bring the situation up early enough for these reasons alone (clerkship dependent of course). This attitude IS wrong if the student lives by this solely and does no independent thinking/learning. There exists a balance between the two.

The culture is changing. Student mistreatment is no longer tolerated at my school. I'm glad my school has made the right changes and you will see others follow suit.
 
I get why you think your description is true (because that's what your school tells you) but I think that the moment you cross that MD divide, you're going to realize that most of what the schools tells students is really a lot of lip service.

- I have seen students get no teaching and no responsibility, and there is no complaints from the department

- I have had evals by student done on me for every block, and I have never seen them or had anyone comment on them; medical student opinions appear nowhere on my evals by the services I rotate through

- Mistreatment of medical students has no impact on your reputation in the hospital, because students have no friends here, while we work with each other each and every day. That's why nurses can get away with it.

- When you are an intern or junior resident, if I call you for a consult, you will do it regardless of your feelings about me.

Look, this has turned unnecessarily adversarial, and I know at this point you think I'm the kind of guy who craps on students. I'm not. I am a big defender of my students, from both residents and nursing staff. I have gotten into several arguments with my residents and nurses over the way students are treated. I have willingly scrubbed out of cases to let the students come in and close. I routinely pull papers for my students prior to cases so they have a better concept of what we're doing (which is really something they should do on their own, but rarely do).

But the number one killer of med students is a sense of entitlement. Once you come in with the attitude that "It's your job to teach me!" you're done, and there's nothing I can do to save you. It happens all the time. The best way to get good teaching and the chance to do a lot of stuff is by having (or pretending to have) a strong sense of humility and gratitude.

I think that Tired offers excellent advice for medical students on how to do well on a clerkship, you don't want to be seen as entitled, . . . and I absolutely never had the attitude that anyone needed to teach me, I got 90% of my learning from reading up on patients and reading textbooks and journals, . . . some residents are excellent and love the opportunity that medicine gives to those who want to teach, . . . However, it has been shown that people with like >130 IQ can basically teach/train themselves to do any job i.e. you are smart enough to teach yourself how to be an engineer, a doctor etc. . . I am learning another foreign language in my down-time and brushing up on another . . . same thing with medicine the trick is that you ARE given credit for being smart enough to be a professional and train yourself, a medical student who asks silly questions is seen as not being able to inhale and process knowledge on their own, being in a hospital is an environment where you can be like a spounge if you are pro-active and make the effort to learn about your patients. I have seen medical students sit around and complain they "don't get to see anything" although they have five patients on the floors or saw three operations, I could ask them if they understood what the fem-pop bypass that they saw was and what are the indications and they would have NO IDEA, I could sit them down to a computer and show them how to read online about a fem-pop bypass but they rather complain, . . . two cheers for IUSM's med school for helping out students, I think that the problem arises not when residents don't teach (as I stated we should be able to train ourselves with minimal guidance period), but when residents/attending are jerks and do crappy things to medical students to slight them . . . rare but does happen
 
Lightening the workload isn't just how you do well. One of the attendings kind of explained it to me:

* By helping to lighten the workload, it shows that you know what's supposed to come next. That means that you prepared for the operation/procedure, and that you've been paying attention. It's not something that they expect from you from day 1, but by day 10, you should have an idea of how to help.

* By helping out, it also makes the residents more likely to let you do stuff, because it shows that you're trustworthy. It's also a reward for hard work. (I guess it is kind of twisted that they "let you" do stuff as a reward...but oh well.)

👍 👍
 
- Mistreatment of medical students has no impact on your reputation in the hospital, because students have no friends here, while we work with each other each and every day. That's why nurses can get away with it.

- When you are an intern or junior resident, if I call you for a consult, you will do it regardless of your feelings about me.

Look, this has turned unnecessarily adversarial, and I know at this point you think I'm the kind of guy who craps on students. I'm not. I am a big defender of my students, from both residents and nursing staff. I have gotten into several arguments with my residents and nurses over the way students are treated. I have willingly scrubbed out of cases to let the students come in and close. I routinely pull papers for my students prior to cases so they have a better concept of what we're doing (which is really something they should do on their own, but rarely do).

But the number one killer of med students is a sense of entitlement. Once you come in with the attitude that "It's your job to teach me!" you're done, and there's nothing I can do to save you. It happens all the time. The best way to get good teaching and the chance to do a lot of stuff is by having (or pretending to have) a strong sense of humility and gratitude.

I don't think that anyone is advocating a sense of entitlement here.

Put it this way; as a civilian you have a responsibility to stop at red lights. You may choose not to, and assuming there are no cops around, you'll get away with it. But that doesn't change the fact that you are responsible to follow traffic laws. Now, take a cop who decides to put on his lights and run a red light (assuming he's off the clock). He's much less likely to get in trouble for this, but he has an equal (and some might say stronger) responsibility to follow the law and set an example.

Think of students as the civilian and residents/attendings as the cops. The attendings have more power and can get away with shirking their responsibility to the students (to teach) much easier and with less consequence than the students can shirk their responsibilities (which are graded subjectively by the residents and attendings). But it does not take away the fact that there is a responsibility there; for the resident/attendings to try and facilitate the student's medical education, and for the student to be proactive and not expect everything to be spoonfed to them.

I get what you are saying and most of your advice I think is golden. But I bet if you do a little more research, you will find that somewhere near the beginning of your intern year, you were informed that you would be evaluated by students based on your teaching skills and that you were encouraged to try to do some teaching.

I have seen an attending reprimand residents for not talking with students about patients conditions. 95% of the attendings I have worked with have at some point, asked if I had any questions, or if there was anything I need to learn or work on. This says to me that most physicians in a teaching hospital are cognizant of the fact that they should be part of a team that not only cares for patients, but also ensures that the students and residents are learning.
 
I get what you are saying and most of your advice I think is golden. But I bet if you do a little more research, you will find that somewhere near the beginning of your intern year, you were informed that you would be evaluated by students based on your teaching skills and that you were encouraged to try to do some teaching.

Or he may not. Yes, residents and attendings are supposed to be evaluated on their ability to teach students. If that is done or what weight is put on it is another matter entirely and may vary based on department/hospital.

I know a subspecialty of one of the core rotations in our hospital (which all students are required to spend a week on during their third year rotation) does no teaching. None. Doesn't matter if you have interest or not, if you do extra work as part of the team. You don't get to show that you've read or prepared, because you're not even pimped. You show up, follow the attending and resident and nobody acknowledges you exist for a week. Numerous complaints from medical students and poor evaluations, and nothing changes. And this is at an institution where student feedback on attending and resident teaching is valued in almost every other department.

So why is this happening? The attendings are forced to take students because they work at a teaching hospital, but their department head values keeping his attendings happy versus student education. So he doesn't care how many students write poor evaluations. They go right into the shredder. The medical school has to choose between poor education versus no education and chooses just to send you along and hope you pick up something by just being there.
 
I just started my surgery rotation, and on my first day of the rotation, the attending just gave out this vibe that he's not interested in me. There were 2 other students, and he would ask them questions, but he never once looked at me. When I would present one of his patients, he'd go in the room before I can even start the history. Even when he talks to us in group sessions, he never makes eye contact with me. It's been 2 weeks, and I figured by now he'd loosen up, but he still avoids me!

...may we all be as lucky as you in having surgery attendings like this. 🙂
 
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