Attending/resident from hell horror stories

[Top Gun]

To the attendings on this thread:

How much exposure to procedures/patient management did you have as a medical student? Do you feel the way you are treating them is the way you were treated at the same stage in training?

We had plenty of exposure to procedures as long as we worked hard and showed interest. How much we let med students do has nothing to do with our past experiences as students. I never even said med students shouldn't be allowed to attempt procedures. See my response above. What I said was that after the med student has attempted a procedure on a patient once or twice, and failed, its time to let someone more experienced take over so that time is not wasted. There will be plenty of opportunities for the student to practice, whether on other patients during the rotation, or even during residency.

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[neutropeniaboy]

To the attendings on this thread:

How much exposure to procedures/patient management did you have as a medical student? Do you feel the way you are treating them is the way you were treated at the same stage in training?

I got exposure to the usual amount of surgery, but really only retracted and closed skin. Once on my OB rotation I got to make an incision for the camera insertion during a laparoscopy. Delivered one baby; watched many. No lines. No intubations. Quite a few LPs. No I&Ds.

Even during my ENT rotation I mostly watched.

Did a lot of prerounding, note writing, film retrieval, and presenting on rounds. But, mostly watching and assisting the interns. Never once did I get any negative feedback from a resident. I made their lives easier and learned a lot in the process.

Picked up TONS of procedures during my intern year...

I tend to let students do a bit more. I'm pleased with my outcome, so I treat students the way I was treated.

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[MerickManual]

We had plenty of exposure to procedures as long as we worked hard and showed interest. How much we let med students do has nothing to do with our past experiences as students. I never even said med students shouldn't be allowed to attempt procedures. See my response above. What I said was that after the med student has attempted a procedure on a patient once or twice, and failed, its time to let someone more experienced take over so that time is not wasted. There will be plenty of opportunities for the student to practice, whether on other patients during the rotation, or even during residency.

Hey @Top Gun, no worries, my question was genuine and not accusatory. I was trying to see if there was a disconnect between attendings vs students in how they were treated, what they are/were able to do regarding procedures and if treatment was based on how the attendings themselves were treated as students.

 

[Top Gun]

Hey @Top Gun, no worries, my question was genuine and not accusatory. I was trying to see if there was a disconnect between attendings vs students in how they were treated, what they are/were able to do regarding procedures and if treatment was based on how the attendings themselves were treated as students.

Nope, no worries on my end either. Just didn't want you to think we all shared the same attitude as JustPlainBill.

 

[styphon]

To the attendings on this thread:

How much exposure to procedures/patient management did you have as a medical student? Do you feel the way you are treating them is the way you were treated at the same stage in training?

I feel had lots of "exposure" to procedures, but most if it was hanging around watching. For example: I had great interest in OB and wanted to be more involved with deliveries, but spent lots of time watching. What did help was doing another rotation at the same L&D and some of the residents were more responsive to letting me have a hands on experience.

I hope that I treat medical students differently than I was treated. A key piece of advice, you can't just say "I love family med(or whatever)" and then disappear when work is to be done, then come back expecting to do procedures. If this happens, I will let the guy who really loves Derm but has shown interest in other activities do it.

 

[evilbooyaa]

No, I did not know it going in -- the program was very good at providing plausible deviations from the truth to candidates -- and the boom got lowered after one month -- it sucked from there on out -- and to make it worse, I had people from my med school recommend the program and once there, tell me how much it sucked -- to the point that I thought of Stockholm Syndrome....

I'm out now and recovering but I do not have fond memories of that place....

I believe that your mistreatment at your residency program may have changed you closer to what you disliked so much, to the point where you have a off-color view on anyone below you in medical training.

 

[JustPlainBill]

To the attendings on this thread:

How much exposure to procedures/patient management did you have as a medical student? Do you feel the way you are treating them is the way you were treated at the same stage in training?

The med school I went to had just lost the associated teaching hospital and we were farmed out wherever slots could be found for us -- No, I am not treating medical students the way I was treated -- in my IM rotation, we had to be there for mornin rounds at 7 and then wait in the cafeteria tryin to study until the atteding got there at between 3-5PM (he was a Geriatrician who rounded on NH patients firs) and then do rounds while he lectured us on art history, economics, wine, food, etc - often we would round on 6-10 patients until 9 or 10 and then go home to wash/rinse/repeat -- there were a few half-ass lectures on CHF thrown in....for IM 2nd month, we were allowed to examine the patient, had to present one at morning rounds, could take it up to physical exam but assessment/plans were for interns and we didn't do any of that.....

For OB - we delivered placentas on occasion, mainly just watched; for Ortho,surgery,ent - held a retractor,

I do make it a point to actually try to teach the students who aren't self-impressed bozos how to go from patient presentation to a cohesive A/P and review their notes for clarity.....

Oh, did I mention that there was a psych attending who regularly made students from our school do pushups when they got an H&P presentation wrong....and he would stop you when you screwed up, drop you for 20 and then you got up and continued --- until the next screwup -- it could be a long night.....and then there was the one who slammed a resident against the wall in the tunnel that connected the psych ER to the inpatient psych unit -- yeah, grabbed 2 fistfuls of white coat and slammed him against a concrete wall -- and this was in the early 2000s......

So, no, I don't treat med students the way I was treated....I try to actually teach at an appropriate level.

 

[e30ftw]

To the attendings on this thread:

How much exposure to procedures/patient management did you have as a medical student? Do you feel the way you are treating them is the way you were treated at the same stage in training?

not an attending but I finished med school recently and can answer some of this..

during med school I did ~20 intubations, first assisted some really cool surgeries (using the bovie for an hour on a radical neck dissection while the attending blunt dissected? awesome), did a TON of suturing including a few complex lacs, got to reduce a few fractures, delivered 8 babies IIRC (actual deliveries where you caught the baby..) a few LPs, lots of I+Ds, lots of joint injections, etc among others.

I was happy with how i was treated and try to treat med students similarly.

 

[Kaustikos]

Jesus F'n Christ. Did you guys forget how to read? I told you; it's not narcissism or entitlement. I'm not overstepping my boundaries. Like I said - I'm confident in what I can do/can't do. I don't know everything but it's not entitlement for me to want to try again after one failed attempt. There's a different word for that and it's called determination. It's hilarious how you guys blow an intubation of a patient sedated out of proportion like "OMG IF HE GETS TO TRY AGAIN THE PATIENTS LUNGS ARE GOING TO EXPLODE AND HIS APPENDIX WILL **** ALL OVER!" You're telling me if I don't tie that knot right on the first try I'm doomed? That's hilarious because I've seen residents do that before and I don't harbor your kind of attitude. Judging me because of my rank is just ludicrous.

But seriously - you guys are blowing things beyond out of proportion with this attitude. I agree completely if the guy screws up then he should give up. I already clarified that I do that myself with IV's. I don't tread into unfamiliar territory nor do I stubbornly refuse to let someone else do something. That's not how medicine works.

But I'll be damned if I have someone not let me do something BECAUSE I'm a medical student. That kind of attitude is the reason why students don't learn anything or just end up not liking anything. You may call it a clerkship - but I'm beyond that. I'm done with this clerkship bull**** that some upper levels believe only involves scut work and the obedience of a dog without any opportunity for the student to learn/TRY to do medicine. You treat me like ****; then you've lost my respect and I won't scrub in your cases. I don't give a damn if your evals are bad. You're wasting my ****ing time. I don't have time to watch something I could do on youtube. I'm here - make it worthwhile. To those that disagree - get out of academics. Your attitude is just backwards. The funny thing is how satellite locations here let students do just what you guys don't want and it's always been handled great and no complications. Practice makes perfect. It takes a lot of intubations to get it down right. Who the hell are you to deny me the opportunity to hone that skill now if I want to/am interested in doing it?

The amount of arrogance and condescension from some of you guys is just ridiculous. And get out of here with that nonsense with "Oh, you'll learn in intern year". Bull****. I know what intern year involves and I know for a damn fact that being more competent in skills/etc will give you a MUCH larger leg up in the OR. The intern that has trouble knot tying or intubating won't hold **** next to one who's comfortable doing it. I've seen interns denied the chance to scrub because of it so you'll have to excuse me if I call your logic ridiculous.

 

[KnuxNole]

I'm the biggest hater of academics, but I would let a student try to suture or do a procedure if they wanted to. Sure, I would be horrid at teaching, but I'd give them a chance to learn

I think what people mean in the blowing out of proportion is thinking "Oh crap, this kid failed once, he won't get it again so let's just save him the misery!". Although you are confident you can be determined, other people don't have that confidence in you and auto-assume you'll keep failing and thus wasting their time. That is why it's tough to do procedures in a teaching setting, especially in emergent situation. Sure, intubating in an OR room is a bit easier vs. tubing in an ER code situation. Even in an OR case, the surgery attending or gas attending might get frustrated and wanting to get in and get out.

Also, apparently for some schools, you need to deliver actual babies to pass the OB/GYN rotation. That act was unheard of for a 3rd year during my OB week :/

 

[Evil_Abed]

Jesus F'n Christ. Did you guys forget how to read? I told you; it's not narcissism or entitlement. I'm not overstepping my boundaries. Like I said - I'm confident in what I can do/can't do. I don't know everything but it's not entitlement for me to want to try again after one failed attempt. There's a different word for that and it's called determination. It's hilarious how you guys blow an intubation of a patient sedated out of proportion like "OMG IF HE GETS TO TRY AGAIN THE PATIENTS LUNGS ARE GOING TO EXPLODE AND HIS APPENDIX WILL **** ALL OVER!" You're telling me if I don't tie that knot right on the first try I'm doomed? That's hilarious because I've seen residents do that before and I don't harbor your kind of attitude. Judging me because of my rank is just ludicrous.

But seriously - you guys are blowing things beyond out of proportion with this attitude. I agree completely if the guy screws up then he should give up. I already clarified that I do that myself with IV's. I don't tread into unfamiliar territory nor do I stubbornly refuse to let someone else do something. That's not how medicine works.

But I'll be damned if I have someone not let me do something BECAUSE I'm a medical student. That kind of attitude is the reason why students don't learn anything or just end up not liking anything. You may call it a clerkship - but I'm beyond that. I'm done with this clerkship bullcrap that some upper levels believe only involves scut work and the obedience of a dog without any opportunity for the student to learn/TRY to do medicine. You treat me like ****; then you've lost my respect and I won't scrub in your cases. I don't give a damn if your evals are bad. You're wasting my ******* time. I don't have time to watch something I could do on youtube. I'm here - make it worthwhile. To those that disagree - get out of academics. Your attitude is just backwards. The funny thing is how satellite locations here let students do just what you guys don't want and it's always been handled great and no complications. Practice makes perfect. It takes a lot of intubations to get it down right. Who the hell are you to deny me the opportunity to hone that skill now if I want to/am interested in doing it?

The amount of arrogance and condescension from some of you guys is just ridiculous. And get out of here with that nonsense with "Oh, you'll learn in intern year". bullcrap. I know what intern year involves and I know for a damn fact that being more competent in skills/etc will give you a MUCH larger leg up in the OR. The intern that has trouble knot tying or intubating won't hold **** next to one who's comfortable doing it. I've seen interns denied the chance to scrub because of it so you'll have to excuse me if I call your logic ridiculous.

I completely agree with you dude. I think it's insane that some of the residents and attendings here won't tolerate more than one attempt at something. I don't know if they forgot how many tries it took them to become good at something or what. I'm just thankful that I've had residents and attendings who, for the most part, have been good teachers and let me try my hand at stuff.

Even SDN is not a safe haven anymore for venting without being harassed.

 

[neutropeniaboy]

Even SDN is not a safe haven anymore for venting without being harassed.

I joined SDN about 12 years ago (maybe longer) - - that's when some of you were in junior high.

Since that time I've been through medical school, internship, residency, fellowship, being an attending, finishing business school, and over those years I've seen a lot of medical students come and go.

If there's one thing I've come to realize, it's that medical students think they know what it takes, but in fact they all don't know what they don't know and that they don't know **** when it comes to practicing medicine. Me? I'm but a learner still, and I am humbled many a day by the seemingly disastrous outcomes of otherwise straight forward problems. But I have some things that you students only think you have: experience, hindsight and introspection. And I learned this by doing a lot of silent watching.

So when I see an increasing number of jokers like the OP who cop attitudes and run to the Dean when their Generation Me feathers get all ruffled, I just gotta shake my head and move along...

 

[Substance]

I think a lot of the dissatisfaction in the current medical education environment stems from the fact that clerkship is not really about learning medicine but about kissing butt and navigating personalities. The status quo is for the student to do what they're told and learn whatever they're allowed to.

From my experience, students really aren't there to learn as much as they are there to grease the wheels to get good evals so that come match time they don't have to SOAP into some horrific pathology program in Albany. When avoiding that kind of outcome is the prime directive of medical school, you can be damn sure that the name of the game is pleasing your superiors, not learning medicine. Heck, coffee fetching and laundry delivery seems to be de rigeur at some malignant programs, all for the ever-so-important evaluation.

With that, I've seen plenty of these absolutely rockstar medical students absolutely fail hard during intern year because they didn't really learn how to be a doctor in medical school - they just sucked up and looked the part and got good marks because of it. You can't blame them, really.

 

[VisionaryTics]

If there's one thing I've come to realize, it's that medical students think they know what it takes, but in fact they all don't know what they don't know.

This strikes absolutely true with me. I've been lucky enough to be pretty hands on during my clerkships. The hardest lesson I've ever had to learn was that I don't know what I don't know. I learned it after causing a (minor) complication on a patient. Definitely changed my attitude.

 

[JustPlainBill]

I joined SDN about 12 years ago (maybe longer) - - that's when some of you were in junior high.

Since that time I've been through medical school, internship, residency, fellowship, being an attending, finishing business school, and over those years I've seen a lot of medical students come and go.

If there's one thing I've come to realize, it's that medical students think they know what it takes, but in fact they all don't know what they don't know and that they don't know **** when it comes to practicing medicine. Me? I'm but a learner still, and I am humbled many a day by the seemingly disastrous outcomes of otherwise straight forward problems. But I have some things that you students only think you have: experience, hindsight and introspection. And I learned this by doing a lot of silent watching.

So when I see an increasing number of jokers like the OP who cop attitudes and run to the Dean when their Generation Me feathers get all ruffled, I just gotta shake my head and move along...

Thank you for making my point quite eloquently and succinctly -- I actually had the unfortunate experience of winding up in a malignant University based FM program with quite a few students with a chip on their shoulder who rotated through. Actually had a student who asked the attending in charge of med student education to speak with me to have me reconsider a grade I gave them on an eval -- said it was not congruent with comments that I made on their MPSE input form --- I had a frank discussion with the attending stating that I knew how much flowery prose would be necessary to get them an interview in the increasingly competitive world of residency match and had written my comments to actually try to help them....but my eval was more realistic and an attempt to give feedback congruent with verbal feedback I had given during the rotation --- I also mentioned that the student should be counseled that if they really wanted me to give completely frank feedback on both of those forms, perhaps they should consider multiple conversations that took place during the rotation (read - "you're not as good as you think you are and try to take the hint when someone tells you that perhaps you should practice your presentations and management of common problems in FM")......they declined for a re-review

But I digress --- OP - I appreciate your desire to learn and get the most out of every learning experience -- that's a good thing -- just realize that most programs are interested in training their residents who only have a set amount of time to get required training and will likely go first in the queue; Any chances you get are a gift and the best way to maximize your training is to be helpful and read up on your cases/patients/guidelines and volunteer for scutwork -- being a team player can get you a lot --- I was actually given a nod for an experience because the PGY2 driving the team had overhead 2 other students whining about the long hours and having to wait to get lunch until after the residents had eaten (students were cutting out from rounds early and then getting multiple plates of food from noon conference and leaving nothing for the residents). When they asked me how long I was staying, I responded that I was part of the Green Team and I stayed until Green Team went home, period.

That got me some personal teaching from the PGY2 on how to really do a quick, efficient Neuro exam in the ED, what to look for, how to establish a differential and which tests to order and why -- along with an offer to speak with the PD to get me into the program if I wanted to do IM....AND a good word with the team attending --- all from that....

But hey, I've rambled -- seriously, good luck to you....

 

[Bacchus]

If there's one thing I've come to realize, it's that medical students think they know what it takes, but in fact they all don't know what they don't know and that they don't know **** when it comes to practicing medicine.

It's not procedures or management you need to know Day 1 of intern year, but the above. Some know this, but most do not.

 

[evilbooyaa]

The amount of arrogance and condescension from some of you guys is just ridiculous. And get out of here with that nonsense with "Oh, you'll learn in intern year". bullcrap. I know what intern year involves and I know for a damn fact that being more competent in skills/etc will give you a MUCH larger leg up in the OR. The intern that has trouble knot tying or intubating won't hold **** next to one who's comfortable doing it. I've seen interns denied the chance to scrub because of it so you'll have to excuse me if I call your logic ridiculous.

I'm not going to really respond to the rest of your rage-filled post, but I will say that before you start talking about what will help you and what will hurt you in the future, you should probably listen to the people above you on the totem pole (even the first-year residents) that have already gone through this process in the past (or at least the present).

I think the part about 'any procedure that a resident/attending lets you do as a 3rd year is a gift' is a decent statement. Yeah, I complained about not getting to suture/intubate as much as I wanted, but I still appreciated the opportunity, without getting butthurt anytime I was told 'no'.

 

[KnuxNole]

Agreed, especially since the student who gets the chance to intubate is a RARITY, not the norm. I know OP mentioned he is grateful for the gift, which is a good thing. He'll also know that half or more than hald of his co-interns will not have done any intubations or even sutured on 7/1/2014.

Of course, its ok if you haven't done those things, since it's expected. After all, 3rd/4th year teach you the basics of clinical medicine, everything else is extra sprinkles on the cake. I remember feeling worried since I had no idea how to deliver babies or intubate(or that there were two different types of blades to use :O), but you won't be far behind.

 

[neusu]

Dear medical students,

Welcome to modern medicine. In the past, you may have been able to write real notes, place orders, do procedures, actually learn things you will need to know during internship. Unfortunately, as you are not licensed and we live in a litigiousness society, any complication you have in your learning experience is magnified by lawyers. While seemingly innocuous procedures such as intubation, central line placement, thoracocentesis, etc. should be medical student territory, they can all go terribly wrong. I truly feel you guys should learn to do most of the things interns learn during medical school, but society feels otherwise. My apologies.

Call me when you're an intern.

Sincerely,
neusu

 

[Kaustikos]

I'm not going to really respond to the rest of your rage-filled post, but I will say that before you start talking about what will help you and what will hurt you in the future, you should probably listen to the people above you on the totem pole (even the first-year residents) that have already gone through this process in the past (or at least the present).

I think the part about 'any procedure that a resident/attending lets you do as a 3rd year is a gift' is a decent statement. Yeah, I complained about not getting to suture/intubate as much as I wanted, but I still appreciated the opportunity, without getting butthurt anytime I was told 'no'.

No,
I shouldn't. Because these are all biased opinions that are completely different from person to person. If the idea that I should be allowed to do these things in an academic setting and controlled environment strikes as ridiculous or entitled, then I see no reason to listen to your advice. If you're saying that I'm being stubborn/whatever because I'd like a couple tries at doing this, then I have nothing more to say about that because that's just the kind of attitude that leads to unprepared interns/residents. I've seen what happens to these guys who weren't prepared well or don't have these technical skills - getting kicked out/not allowed into future procedures. Being told to do scut work because of it. So you're telling me I should just be okay with being at the same level of skill as my classmates? Get out of here. I'll take every opportunity to become better than that. This is about becoming competent/prepared for the next level - which is somehow being misinterpreted for 3 pages.

I understand the totem pole and hierarchy so it's not that I'm asking to outrank residents or the attending. I'm also not saying (and I don't know why you guys are even getting that from my posts) I know everything and can do everything. I try to follow a whipple procedure and I don't even know how I'd ever become competent enough to do all of that but I also know that my school expects people in internship/residency to know how to do the basics of surgical skills and it doesn't entail practicing on pigs feet. Thankfully, I've had interns/residents let me practice a lot on things and I've become comfortable enough with these things that I can do what's expected of me. Closing/tying is no issue to me anymore. But you ask me to get involved in the deeper workings; I shut up and listen/watch. I've had people remark about how well prepared/trained I am in the OR as a medical student. This took a while but I'm glad I am at that level. And it's paid off; like today when the residents/fellows weren't able to scrub in on a procedure so I was there next to the attending doing a cranial vault remodeling. Probably one of the best experiences I've had and I'm thankful for it; but the stuff expected of me was something I'd learned/become comfortable with. So when she wanted me to close - I did that with no problem. Is that arrogance? No, it's confidence.

So I'll listen to you if you stop misconstruing/misinterpreting my posts. You guys get the impression that irrigating/suctioning in a procedure is a gift that I should be extremely thankful for like it's the best thing ever. No, it's not. I'll do it with no problem but I'll be damned if you somehow have the idea that I can't do this or shouldn't feel confident enough to be able to do it. Considering I'm extremely interested in doing surgery, it's downright ridiculous to think I'm being entitled in wanting to do more. I'm done with this med school nonsense. I'm ready to move on to 4th year and start my surgical electives/Sub-I and get into the respectable area of residency. Because apparently it's entitlement to want for me to do these things when I'm not a resident/intern. I'm trying to become a good physician, so you'll have to excuse me if I want to learn/be able to do some of these things.

 

[Kaustikos]

Agreed, especially since the student who gets the chance to intubate is a RARITY, not the norm. I know OP mentioned he is grateful for the gift, which is a good thing. He'll also know that half or more than hald of his co-interns will not have done any intubations or even sutured on 7/1/2014.

Of course, its ok if you haven't done those things, since it's expected. After all, 3rd/4th year teach you the basics of clinical medicine, everything else is extra sprinkles on the cake. I remember feeling worried since I had no idea how to deliver babies or intubate(or that there were two different types of blades to use :O), but you won't be far behind.

That's hilarious because my anesthesia rotation requires me to be able to intubate by the end of the rotation and intubate 10 patients in 1.5 weeks. So, tell me, what do I do in that situation?

"Oh, THANK YOU for allowing me to do ONE intubation in this past week. I should be so thankful!"

And to add salt to the wound - I was required to be directly assisting in vaginal deliveries. Only 3. THREE. I had to scramble because residents/interns didn't feel comfortable with me doing it. Or that I should be thankful to just be in the room watching. Bitch, I'm not a ****ing volunteer. My school expects me to do 3 so stop it.

 

[VisionaryTics]

I'm done with this med school nonsense. I'm ready to move on to 4th year and start my surgical electives/Sub-I and get into the respectable area of residency.

Heh, be prepared to be disappointed as an M4.

 

[Wordead]

I'm not going to really respond to the rest of your rage-filled post, but I will say that before you start talking about what will help you and what will hurt you in the future, you should probably listen to the people above you on the totem pole (even the first-year residents) that have already gone through this process in the past (or at least the present).

I think the part about 'any procedure that a resident/attending lets you do as a 3rd year is a gift' is a decent statement. Yeah, I complained about not getting to suture/intubate as much as I wanted, but I still appreciated the opportunity, without getting butthurt anytime I was told 'no'.

I don't understand what you think the purpose of 3rd year is for then. Are we just supposed to shadow all day and do 500 H+Ps? We cant even write orders anymore. I can't believe how little exposure some other medical students are getting. Attendings, if you're on this thread saying that it can wait until internship, you sure as hell better not be the ones complaining how poorly trained graduating residents are these days. Or about the 80 hour work week.

 

[KnuxNole]

That's hilarious because my anesthesia rotation requires me to be able to intubate by the end of the rotation and intubate 10 patients in 1.5 weeks. So, tell me, what do I do in that situation?

"Oh, THANK YOU for allowing me to do ONE intubation in this past week. I should be so thankful!"

And to add salt to the wound - I was required to be directly assisting in vaginal deliveries. Only 3. THREE. I had to scramble because residents/interns didn't feel comfortable with me doing it. Or that I should be thankful to just be in the room watching. Bitch, I'm not a ******* volunteer. My school expects me to do 3 so stop it.

Well, damn, I didn't know they expected you to do that. Calm down, take a deep breath, it's only med school, chillax with some nice vodka for a sec. If they have documented requirements, that's fine. Noone said anything about that. For MOST people though, they have ZERO requirements, and what you're doing is extra. In other words, most medical students watch deliveries and catch the placenta, and the minority, you, get to directly assist. For a week or two, doing 3 deliveries is quite a lot so that's a plus . If it was two weeks of OB, 3 deliveries is very standard anyway, considering they have to let you watch first, before they feel comfy. Obviously, noone will let you jump in Day 1, and yes, being thankful for observing the first few is amazing. I can't name one thing wrong with that at all. However, after 2 weeks, with being proactive, you can get those number no problem, which I'm sure you did.

Besides, one intubation is more than most of your co-interns will get! You won't like that fact, but it's very true.

Also keep in mind that most of your classmates are fine with being at the same skillset, and you might feel singled out for being the only one that wants to go above and beyond. Don't change that mindset though, but don't kill yourself too much, get through the requirements. Hell, your classmates who hate surgery or don't want to learn would pass all those things up and give them to you .

So perhaps, in hindsight, if you paired up with someone who didn't want to do anything, it might make your life slightly easier.

 

[neutropeniaboy]

I don't understand what you think the purpose of 3rd year is for then. Are we just supposed to shadow all day and do 500 H+Ps? We cant even write orders anymore. I can't believe how little exposure some other medical students are getting. Attendings, if you're on this thread saying that it can wait until internship, you sure as hell better not be the ones complaining how poorly trained graduating residents are these days. Or about the 80 hour work week.

The quality of graduating residents has nothing to do with the small numbers of clinically relevant procedures medical students get.

You see: that's what you don't understand. You students seem to think this somehow has a significant impact on the knowledge or procedural competency you will have as a resident.

It doesn't. There's no correlation. In fact, one of the most consistently identified factors that makes a medical student a good resident is previous participation in a team sport.

(Maybe some of you students should join a beer league - you'd have more fun and increase your chances at a better residency.)

The third year of medical school is about learning how to take that vast fund of knowledge and being able to apply it: to learn how to listen to patients, examine the data and come up with a differential diagnosis and treatment plan. It's about seeing. It's about listening. It's about exploring. If you get some procedural exposure as a third year, great.

4th year is a more intense version of the 3rd year with some expectation that one gets more involved (not competent).

So, yes, I expect you to be patient and wait.



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[neutropeniaboy]

Bitch, I'm not a ******* volunteer. My school expects me to do 3 so stop it.

Hmm. "Bitch"? An avatar of a woman with large breasts flying out?

I hear you loud and clear.

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[e30ftw]

I had to scramble because residents/interns didn't feel comfortable with me doing it. Or that I should be thankful to just be in the room watching. Bitch, I'm not a ******* volunteer. My school expects me to do 3 so stop it.

impressive..

 

[KnuxNole]

The quality of graduating residents has nothing to do with the small numbers of clinically relevant procedures medical students get.

You see: that's what you don't understand. You students seem to think this somehow has a significant impact on the knowledge or procedural competency you will have as a resident.

It doesn't. There's no correlation. In fact, one of the most consistently identified factors that makes a medical student a good resident is previous participation in a team sport.

(Maybe some of you students should join a beer league - you'd have more fun and increase your chances at a better residency.)

The third year of medical school is about learning how to take that vast fund of knowledge and being able to apply it: to learn how to listen to patients, examine the data and come up with a differential diagnosis and treatment plan. It's about seeing. It's about listening. It's about exploring. If you get some procedural exposure as a third year, great.

4th year is a more intense version of the 3rd year with some expectation that one gets more involved (not competent).

So, yes, I expect you to be patient and wait.



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This is key. Remember, 3rd year is about learning the basics of clinical medicine!

 

[Nasrudin]

Never before has a thread topic promised so much yet delivered so little from so few....(surgeons and their offspring)

 

[neutropeniaboy]

Never before has a thread topic promised so much yet delivered so little from so few....(surgeons and their offspring)

I'm all ears.

 

[VisionaryTics]

I'm all ears.

http://instantrimshot.com/classic/?sound=rimshot

 

[neusu]

I don't understand what you think the purpose of 3rd year is for then. Are we just supposed to shadow all day and do 500 H+Ps? We cant even write orders anymore. I can't believe how little exposure some other medical students are getting. Attendings, if you're on this thread saying that it can wait until internship, you sure as hell better not be the ones complaining how poorly trained graduating residents are these days. Or about the 80 hour work week.

Third year has become a year long shadowing experience with additional pimping. It is in no way an educational experience except for the fact that you are required to be involved with the spectrum of medicine. You are in no way expected to be prepped to become a "doctor" by finishing medical school. While I agree with this in some ways, in others, I am disappointed. Historically, you could finish medical school, do an internship, and hang a shingle. Anymore, it requires a residency (or more likely, a fellowship) before you can, in some way, become an independent practitioner. Pair this with our friends in the mid-level field, e.g. NP or PA, who go to school and get on the job training in the field in which they are interested. They are fully licensed out of school, and for the NP people in particular who do not have a scope of practice. It is quite an interesting box we have painted ourselves in to.

The quality of graduating residents has nothing to do with the small numbers of clinically relevant procedures medical students get.

You see: that's what you don't understand. You students seem to think this somehow has a significant impact on the knowledge or procedural competency you will have as a resident.

It doesn't. There's no correlation. In fact, one of the most consistently identified factors that makes a medical student a good resident is previous participation in a team sport.

(Maybe some of you students should join a beer league - you'd have more fun and increase your chances at a better residency.)

The third year of medical school is about learning how to take that vast fund of knowledge and being able to apply it: to learn how to listen to patients, examine the data and come up with a differential diagnosis and treatment plan. It's about seeing. It's about listening. It's about exploring. If you get some procedural exposure as a third year, great.

4th year is a more intense version of the 3rd year with some expectation that one gets more involved (not competent).

So, yes, I expect you to be patient and wait.



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Totally agree. Graduating residents experience have nothing to do with their experience coming in to residency.

4th year is the most expensive vacation most people will take, aside from the months they spend on away or home sub-internships.

 

[Wordead]

The quality of graduating residents has nothing to do with the small numbers of clinically relevant procedures medical students get.

You see: that's what you don't understand. You students seem to think this somehow has a significant impact on the knowledge or procedural competency you will have as a resident.

It doesn't. There's no correlation. In fact, one of the most consistently identified factors that makes a medical student a good resident is previous participation in a team sport.

(Maybe some of you students should join a beer league - you'd have more fun and increase your chances at a better residency.)

The third year of medical school is about learning how to take that vast fund of knowledge and being able to apply it: to learn how to listen to patients, examine the data and come up with a differential diagnosis and treatment plan. It's about seeing. It's about listening. It's about exploring. If you get some procedural exposure as a third year, great.

4th year is a more intense version of the 3rd year with some expectation that one gets more involved (not competent).

So, yes, I expect you to be patient and wait.



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The question, of course, is why. You seem to present the application of knowledge as something you have to learn before you can do procedures. Those are entirely different skillsets and both should be developed in medical school. You say there's no correlation between getting familiarity with procedures in medical school and being a good resident; are you sure we're talking about the same thing? You are saying that doing x procedure 10 times will NOT make a student better at the procedure than another student who does it once? Or just that it doesn't matter long term?

 

[neusu]

The question, of course, is why. You seem to present the application of knowledge as something you have to learn before you can do procedures. Those are entirely different skillsets and both should be developed in medical school. You say there's no correlation between getting familiarity with procedures in medical school and being a good resident; are you sure we're talking about the same thing? You are saying that doing x procedure 10 times will NOT make a student better at the procedure than another student who does it once? Or just that it doesn't matter long term?

Ugh.. So every medical student that rotates with us wants to place an EVD. Should I let them? No.

Do I let the kids that want to do neurosurgery place EVD's preferentially? Yes. Do I let the kids who want to do anesthesia preferentially intubate? No

Do I think either will be preferentially picked based on these decisions? Yes, I think the neurosurgery medical student that I teach to place an EVD will have a leg up..

 

[Wordead]

Ugh.. So every medical student that rotates with us wants to place an EVD. Should I let them? No.

Do I let the kids that want to do neurosurgery place EVD's preferentially? Yes. Do I let the kids who want to do anesthesia preferentially intubate? No

Do I think either will be preferentially picked based on these decisions? Yes, I think the neurosurgery medical student that I teach to place an EVD will have a leg up..

That's really all we're asking for. Not that it needs to be standardized so you let everyone do everything. The people looking to go into peds don't need to be doing that. But hey, if I'm with an ENT (I'll use ENT for neutropenia boys sake as I know nothing about neurosurg), why can't I use the laryngoscope on all the patients? Why can't I have a couple tries intubating? How about you let us close on the patients where the end aesthetic appearance doesn't matter that much? My HN oncology attending let me do so much - incisions, closures, scoped every patient. Give us a leg up - isn't that what attendings/mentors are supposed to be doing?

Obviously residents have priority. But to me, it's crazy for someone to say that it won't help us look better on aways, or to be more proficient as interns/residents.

 

[neusu]

That's really all we're asking for. Not that it needs to be standardized so you let everyone do everything. The people looking to go into peds don't need to be doing that. But hey, if I'm with an ENT (I'll use ENT for neutropenia boys sake as I know nothing about neurosurg), why can't I use the laryngoscope on all the patients? Why can't I have a couple tries intubating? How about you let us close on the patients where the end aesthetic appearance doesn't matter that much? My HN oncology attending let me do so much - incisions, closures, scoped every patient. Give us a leg up - isn't that what attendings/mentors are supposed to be doing?

Obviously residents have priority. But to me, it's crazy for someone to say that it won't help us look better on aways, or to be more proficient as interns/residents.

I cannot agree with you more..

Sorry neutropenia, we disagree on something..

1) Airway - elective airways are easy, everyone gets a try.. as long as you can bag the patient, you're not knocking teeth out, not scraping the **** out of the oropharynx, it's a controlled situation
2) Airway - You can't bag, there's blood, no one can visualize the cords.. This is where neutropenia shines.. he has his magical scope to find the cords.. if this doesn't happen (1) because he can't visualize the cords, 2) he's already in a case and can't come) you cric the patient. End of story. There really is no scenario wherein a surgical service should ever lose an airway. (BTW, if you mess up THAT bad intubating, medical students, you can probably count your PRS career gone).

 

[neutropeniaboy]

The question, of course, is why. You seem to present the application of knowledge as something you have to learn before you can do procedures. Those are entirely different skillsets and both should be developed in medical school. You say there's no correlation between getting familiarity with procedures in medical school and being a good resident; are you sure we're talking about the same thing? You are saying that doing x procedure 10 times will NOT make a student better at the procedure than another student who does it once? Or just that it doesn't matter long term?

Wordead, I don't think it matters long term. I've never said that medical students shouldn't do procedures. I've simply said that 1) it's not a right; 2) there are residents that need to be competent before you; 3) patient above all else; 4) it doesn't matter long term.

I'll give you a shot at things. And yes, I do preferentially give ENT sub-Is more chances at ENT things than 4th years just doing an ENT rotation. I'll admit to my bias. I rarely let 3rd years do much. It's not punitive.

I agree that book smarts don't lead to technical smarts. However, if you can't demonstrate book smarts and demonstrate that you are prepared for a particular case, I'm not going to assess your technical smarts, because you're not going to get a chance at the procedure. I treat all students and even my chief residents the same. I've given cases to PGY-2 residents on my service when a chief failed to read up about my patient or look at the scan.

To circle back, I just don't think it matters long term. But I will also say that I've seen students and residents do things "10 times" and still not be as good as others who have done them "1 time." (There are a lot of attendings like this as well; numerical experience doesn't always equate to technical proficiency, skill and quality outcomes.)

 

[neutropeniaboy]

Sorry neutropenia, we disagree on something..

tope.

 

[Wordead]

Wordead, I don't think it matters long term. I've never said that medical students shouldn't do procedures. I've simply said that 1) it's not a right; 2) there are residents that need to be competent before you; 3) patient above all else; 4) it doesn't matter long term.

I'll give you a shot at things. And yes, I do preferentially give ENT sub-Is more chances at ENT things than 4th years just doing an ENT rotation. I'll admit to my bias. I rarely let 3rd years do much. It's not punitive.

I agree that book smarts don't lead to technical smarts. However, if you can't demonstrate book smarts and demonstrate that you are prepared for a particular case, I'm not going to assess your technical smarts, because you're not going to get a chance at the procedure. I treat all students and even my chief residents the same. I've given cases to PGY-2 residents on my service when a chief failed to read up about my patient or look at the scan.

To circle back, I just don't think it matters long term. But I will also say that I've seen students and residents do things "10 times" and still not be as good as others who have done them "1 time." (There are a lot of attendings like this as well; numerical experience doesn't always equate to technical proficiency, skill and quality outcomes.)

How are you expecting your sub-Is to be competent if you don't let them do anything as 3rd years? This circles back to your "away rotations suck" thing, I suppose - a lot of us have to do away rotations (ie no strong home program), but how can we do well on these audition rotations if our home attendings aren't helping us become better? I agree with all your 4 points; I just think it's the line at which you'll let students do more is too high. When we're on your service as a sub-I, we're trying to show competence so you'll write us good letters and let us do intern-level tasks. It is way too late to be making beginners mistakes, not knowing how to sew, etc.

 

[KnuxNole]

Dumb question, but won't they teach you that in your sub-I? Only a freak would expect a sub-I on day 1 to know how to do everything and master basics. I'm sure there are TONS of sub-I's who have had zero procedure experience before stepping foot, which makes sense. That's why you are there. TO LEARN! If they expect you to know everything, well they are probably "those people" that expects you to be a genius or a prodigy haha.

 

[Wordead]

Dumb question, but won't they teach you that in your sub-I? Only a freak would expect a sub-I on day 1 to know how to do everything and master basics. I'm sure there are TONS of sub-I's who have had zero procedure experience before stepping foot, which makes sense. That's why you are there. TO LEARN! If they expect you to know everything, well they are probably "those people" that expects you to be a genius or a prodigy haha.

I mean, theoretically, but you're competing for one of the 2-5 spots at that program. Who are they going to take? The guy that works well with the team, obviously, and a good knowledge base, but procedural competence has got to come into it in some respect. What surgical program is really going to want that sub-I that can't do a simple stitch smoothly?

 

[evilbooyaa]

Ugh.. So every medical student that rotates with us wants to place an EVD. Should I let them? No.

Do I let the kids that want to do neurosurgery place EVD's preferentially? Yes. Do I let the kids who want to do anesthesia preferentially intubate? No

Do I think either will be preferentially picked based on these decisions? Yes, I think the neurosurgery medical student that I teach to place an EVD will have a leg up.

Okay, well that flies in the face of what neutropenia has been representing.

Neutropenia - If a stable OR airway is available to intubate, will you let a MS3 on your service have a shot at intubating (assuming residents do not require them and the patient is stable without co-morbidities)?

Also, I will agree with Wordead that if you expect stellar Sub-Is (especially in the OR on surgical sub-Is) then you really have to let them get some experience with basic procedures as a MS3. The first time a student closes shouldn't be while he's on his 4th year rotation, IMO. A student going into anesthesia should hopefully have at least one or two intubations under his belt before stepping into his 4th year Anes sub-I.

I'm all for MS3s getting to do procedures. However, I do understand that the residents take precedence, even at the minor things (incision/closing, catching a baby, etc.). Anytime I lost a procedure, it was because the resident was taking point.

 

[KnuxNole]

True, that is a tough situation. Then again, they can learn how to do it in 4 weeks

But, you are right. There are people that assume a 3rd year SHOULD know that in a gen surgery rotation, which sucks...since there are tons of students who don't come close to doing 1 suture attempt in 2 years of clinicals. As we know, there are surgery rotations where people do nothing and ones where people are heavily involved. I suppose if you are one of those few that like surgery, you have to find opportunities to try suturing before an away. How to do that...I dunno. Perhaps a suture workshop to prep surgery peeps so they'll look good when shipped to the vast faraway lands?

 

[neutropeniaboy]

How are you expecting your sub-Is to be competent if you don't let them do anything as 3rd years? This circles back to your "away rotations suck" thing, I suppose - a lot of us have to do away rotations (ie no strong home program), but how can we do well on these audition rotations if our home attendings aren't helping us become better? I agree with all your 4 points; I just think it's the line at which you'll let students do more is too high. When we're on your service as a sub-I, we're trying to show competence so you'll write us good letters and let us do intern-level tasks. It is way too late to be making beginners mistakes, not knowing how to sew, etc.

I think you're not seeing the big picture here.

I don't expect subis to be competent on day 1 or day 30 of their rotation.

I guarantee you that nearly every academic attending will write you a stronger letter of support if you are a team player, excellent historian, accurate on your exam, come up with a focused differential diagnosis and treatment plan than if you struggle at these but are great at doing procedures.

I guarantee you that we can train almost anyone to become a great technical surgeon. As my fellowship director said to me when I had concerns about my procedural competency when first starting: "I can train a monkey to drill."

I'll take med student who works up a patient in no time over the med student who can't organize but knows how to cric at the drop of a hat any day of the week.

Every letter I write and every letter I read focuses on the time management, people skills, organizational skills and H&P skills a med student has. I will occasionally mention how well a student sews or did a single PE tube with me.

No one cares about that stuff... They care about the nonprocedural skills.

As a Millennial, you guys generally see and want to see how you get from A to B to C to D with feedback along the way. I see things as never that linear and value the end point.

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[Wordead]

I think you're not seeing the big picture here.

I don't expect subis to be competent on day 1 or day 30 of their rotation.

I guarantee you that nearly every academic attending will write you a stronger letter of support if you are a team player, excellent historian, accurate on your exam, come up with a focused differential diagnosis and treatment plan than if you struggle at these but are great at doing procedures.

I guarantee you that we can train almost anyone to become a great technical surgeon. As my fellowship director said to me when I had concerns about my procedural competency when first starting: "I can train a monkey to drill."

I'll take med student who works up a patient in no time over the med student who can't organize but knows how to cric at the drop of a hat any day of the week.

Every letter I write and every letter I read focuses on the time management, people skills, organizational skills and H&P skills a med student has. I will occasionally mention how well a student sews or did a single PE tube with me.

No one cares about that stuff... They care about the nonprocedural skills.

As a Millennial, you guys generally see and want to see how you get from A to B to C to D with feedback along the way. I see things as never that linear and value the end point.

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My point is that we want to be the "whole package", not just good at being on the ward. We aren't saying that isn't important - we know that most of intern year is not even being in the OR, and is learning how to manage the floor. But we are already working on that - and on every other service. On peds/med/obgyn/FM, you do the same thing. Organize your thoughts, form a differential, be efficient in seeing patients, writing notes, people skills, pre/postop management, all that. We are working on that the entire year. We CANT work on procedural skills except in that time that we're with you and what you allow us to do.

And I understand that you don't consider technical skill very important in applicants. Would you say none of your colleagues do either when looking at potential residents? Because my ENT attending is telling me to work on palming and passing multiple instruments. He says he likes that in residents. So what are we med students supposed to do? What if we end up on a sub-I with an attending that DOES place importance on procedural skill?

 

[JustPlainBill]

True, that is a tough situation. Then again, they can learn how to do it in 4 weeks

But, you are right. There are people that assume a 3rd year SHOULD know that in a gen surgery rotation, which sucks...since there are tons of students who don't come close to doing 1 suture attempt in 2 years of clinicals. As we know, there are surgery rotations where people do nothing and ones where people are heavily involved. I suppose if you are one of those few that like surgery, you have to find opportunities to try suturing before an away. How to do that...I dunno. Perhaps a suture workshop to prep surgery peeps so they'll look good when shipped to the vast faraway lands?

Well,you could always walk your butt down to the local grocery store (Wal-mart has a great package of these) -- buy some skin-on chicken breasts, appropriate a suture kit and some spare sutures, and spend a Friday/Saturday night cutting up chicken breasts and sewing them back together -- you'll get good...or you can one hand tie the hell out of your TV tray legs...amusing to the dog and the kiddos (if you have any) think it's cool --- not as glamorous as demonstrating your skills in an OR on a live human being, but it does build muscle memory....

It's interesting looking over the student responses and in general they seem to fall into a pattern -- and it's common for all students -- they want to get on with the job of being a doctor -- you've just sat through 2 years of hell, excelled and are ready to jump into the fray -- good marks for enthusiasm, but recognize that there's a path to where you want to go and there's a fine line between being gungho and being an ass -- we had someone in class with prior experience in the medical field, hard charger, wanted surgery, involved in all the clubs/experiences possible during pre-clinical years --- but effed up seriously during a rotation --- went in on a medicine service during wards, rounded on everyone's patients, dropped notes on everyone's patients and then decided to really have a brain fart and challenged an attendings plan in front of the patient --- and when the attending kindly tried to let him off the hook gently and recover the situation, continued to challenge and began citing cases/studies --- the attending politely asked the students to leave the room, stayed behind and discussed the treatment plan with the patient --- and then stepped outside, took the students to a small conference room off of the nurses station and proceeded to rip that particular student a new anal orifice with great skill and artistry -- damn near failed them on the spot.......

Reason I shared that -- watch yourselves -- it's ok to be ready to go and want good experiences -- most people see that and depending on how it's presented, will enjoy working with you....but the thing that will get you smacked around is if you come off as feeling entitled by virtue of how hard you work or how much you're paying or how good you think you are -- it's a really common attitude in gunners (some of which are good) and NPs.....but that's another topic.

Back to the original topic -- as far as attendings from hell -- one guy in our class did an away surgery rotation at another site the school had set up -- there were several residencies at the site that had agreed to take our students and he was wanting a slot in one of those residencies since he was from that area -- no biggie.

Well, seems he was on a surgery rotation and went into a patient's room that he was following with the whole crowd on rounds that day -- He started his presentation, described the case, named the procedure and answered basic questions about the procedure -- the attending then begins to pimp him -- and after the first," I'm sorry, I'll have to look that up" starts getting more and more nitpicky -- 10 minutes, 15 minutes pass....and the pimping continues.....20 minutes -- residents are now pulling up chairs and sitting down -- and the pimping continues --- 30 minutes, 35 minutes and now the other students are leaning on walls --- finally after 45 minutes of being pimped, the attending stopped, turned and walked out of the room to the next patient.......my classmate was pimped for 45 minutes straight, never blinked, never broke down mentally and was courteous throughout.....

 

[neutropeniaboy]

My point is that we want to be the "whole package", not just good at being on the ward.

Well, good luck with that.

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[Wordead]

Well, good luck with that.

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That wasn't rhetorical. Is my attending an outlier in your experience? No attending cares about technical ability?

 

[Top Gun]

That wasn't rhetorical. Is my attending an outlier in your experience? No attending cares about technical ability?

To tell you the truth, as a med student, not really. Its far more important for you to learn how to do a good H&P, and from that, formulate an assessment and plan. That's what will really help you on July 1. Procedures are just the icing on the cake. And again, we're not even saying you shouldn't try to learn procedures. Of course you should! But how many times are you going to try a procedure on the same patient? Twice, five, maybe a billion times ? How would you feel if you were the patient, and you were getting poked 5 times in a row for a central line? How would you feel if your family member was? If you don't get it, and the attending/resident takes over, no big deal. Try the procedure again later on a different patient. That's how you practice. By trying the procedure on different patients. Not by repeatedly trying on the same patient!

 

[evilbooyaa]

To tell you the truth, as a med student, not really. Its far more important for you to learn how to do a good H&P, and from that, formulate an assessment and plan. That's what will really help you on July 1. Procedures are just the icing on the cake. And again, we're not even saying you shouldn't try to learn procedures. Of course you should! But how many times are you going to try a procedure on the same patient? Twice, five, maybe a billion times ? How would you feel if you were the patient, and you were getting poked 5 times in a row for a central line? How would you feel if your family member was? If you don't get it, and the attending/resident takes over, no big deal. Try the procedure again later on a different patient. That's how you practice. By trying the procedure on different patients. Not by repeatedly trying on the same patient!

I'm sure nearly every single medical student here is OK with an attending/resident taking over after 2 full attempts at anything per patient. Both of us know that is not the issue that we are really discussing here.