Attending/resident from hell horror stories

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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.

In Kaustikos' original rant, he was complaining about the attending taking over after he had tried intubating once. So it is part of the issue. He got his chance to intubate, didn't get it, and then the attending took over. But instead of accepting it, and just trying it on another patient, he is ranting as if he didn't get his fair shot at the procedure. But in this case, he did. Maybe the attending could have allowed him a second attempt, but that is at the discretion of the attending and how comfortable s/he feels with the student's skills.

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In Kaustikos' original rant, he was complaining about the attending taking over after he had tried intubating once. So it is part of the issue. He got his chance to intubate, didn't get it, and then the attending took over. But instead of accepting it, and just trying it on another patient, he is ranting as if he didn't get his fair shot at the procedure. But in this case, he did. Maybe the attending could have allowed him a second attempt, but that is at the discretion of the attending and how comfortable s/he feels with the student's skills.

Agreed
 
In Kaustikos' original rant, he was complaining about the attending taking over after he had tried intubating once. So it is part of the issue. He got his chance to intubate, didn't get it, and then the attending took over. But instead of accepting it, and just trying it on another patient, he is ranting as if he didn't get his fair shot at the procedure. But in this case, he did. Maybe the attending could have allowed him a second attempt, but that is at the discretion of the attending and how comfortable s/he feels with the student's skills.

Fair point. I don't agree with Kaustikos on that then. However, I think some of the 'attempts' I got at intubating/placing IVs while a MS3 weren't 'full' attempts. Giving a newbie MS3 10 seconds to do the entire process of intubating on a stable OR airway before huffing and puffing and taking over to me isn't a 'full' attempt.

Granted, I don't want to do Anes/EM/ENT, but still. Intubating is definitely one of the most interesting procedures we are allowed to do as MS3 at my hospital (since there is a nurse IV team that takes all IVs except those in pre-OP, and MS3s aren't allowed to place any central [including radial] lines).
 
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In Kaustikos' original rant, he was complaining about the attending taking over after he had tried intubating once. So it is part of the issue. He got his chance to intubate, didn't get it, and then the attending took over. But instead of accepting it, and just trying it on another patient, he is ranting as if he didn't get his fair shot at the procedure. But in this case, he did. Maybe the attending could have allowed him a second attempt, but that is at the discretion of the attending and how comfortable s/he feels with the student's skills.

Actually, his frustration was that he didn't get a second chance to get it right.

I don't see what's unreasonable about that. If I make a mistake, I'd like to have the opportunity to fix it myself (with guidance from you, the attending). During my surgery rotation, a significant portion of what the residents were learning seemed to be how to troubleshoot. And I'm a firm believer in the idea that you can learn a TON from mistakes. Look, I completely understand that you're the attending and that your name is the one that goes on all the paperwork and that you're the one liable in case something goes wrong - I really do! And if you deemed that only one attempt was tolerable and pushed me aside from the patient without any teaching or attempt to guide me through what I did wrong, I'm absolutely fine with it and will step aside without hesitation. Like you guys repeatedly keep saying, it's your patient after all. But don't expect me to not be internally frustrated for not having an opportunity to fix something I messed up on. That's a pretty natural human reaction, I think. That doesn't mean that I automatically have an ego/entitlement issue and will put patients at risk rather than call for help! I'm not expecting anyone to throw me a bone just because I'm a medical student. I honestly expect absolutely nothing. And I'm reminded on a daily basis how little I do know, before someone again points out "you don't know what you don't know" -- I never assume that I know everything (or even anything). I work hard on my H&Ps and on my presentations and on my A&Ps - my evals have been excellent so far, but I'll continue to keep working on improving every little bit I can. I just think it's ridiculous that showing eagerness for doing a procedure, on the rare opportunities that you get, and wanting to fix a mistake that I made (with guidance from you, the teaching attending, obviously) makes you think I'm acting like an entitled brat. I think that's just a natural human reaction.
 
In Kaustikos' original rant, he was complaining about the attending taking over after he had tried intubating once. So it is part of the issue. He got his chance to intubate, didn't get it, and then the attending took over. But instead of accepting it, and just trying it on another patient, he is ranting as if he didn't get his fair shot at the procedure. But in this case, he did. Maybe the attending could have allowed him a second attempt, but that is at the discretion of the attending and how comfortable s/he feels with the student's skills.

Fair enough.
 
Actually, his frustration was that he didn't get a second chance to get it right.

I don't see what's unreasonable about that. If I make a mistake, I'd like to have the opportunity to fix it myself (with guidance from you, the attending). During my surgery rotation, a significant portion of what the residents were learning seemed to be how to troubleshoot. And I'm a firm believer in the idea that you can learn a TON from mistakes. Look, I completely understand that you're the attending and that your name is the one that goes on all the paperwork and that you're the one liable in case something goes wrong - I really do! And if you deemed that only one attempt was tolerable and pushed me aside from the patient without any teaching or attempt to guide me through what I did wrong, I'm absolutely fine with it and will step aside without hesitation. Like you guys repeatedly keep saying, it's your patient after all. But don't expect me to not be internally frustrated for not having an opportunity to fix something I messed up on. That's a pretty natural human reaction, I think. That doesn't mean that I automatically have an ego/entitlement issue and will put patients at risk rather than call for help! I'm not expecting anyone to throw me a bone just because I'm a medical student. I honestly expect absolutely nothing. And I'm reminded on a daily basis how little I do know, before someone again points out "you don't know what you don't know" -- I never assume that I know everything (or even anything). I work hard on my H&Ps and on my presentations and on my A&Ps - my evals have been excellent so far, but I'll continue to keep working on improving every little bit I can. I just think it's ridiculous that showing eagerness for doing a procedure, on the rare opportunities that you get, and wanting to fix a mistake that I made (with guidance from you, the teaching attending, obviously) makes you think I'm acting like an entitled brat. I think that's just a natural human reaction.

Touche. If it were me, I'd probably let you have two attempts at a procedure. And while you were doing it, I'd try to guide you through it and show you what you were doing wrong. But that's me. Every attending uses their own discretion. And there comes a point where the procedure has to get done. I would say after two attempts, its time to let someone more experienced take over.
 
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Touche. If it were me, I'd probably let you have two attempts at a procedure. And while you were doing it, I'd try to guide you through it and show you what you were doing wrong. But that's me. Every attending uses their own discretion. And there comes a point where the procedure has to get done. I would say after two attempts, its time to let someone more experienced take over.

I am in complete agreement with you. And I completely understand that, as the attending, you're the one who deems when to step in. I don't think any med student in this thread would argue against that. Even if it's after just one attempt, I will absolutely step aside if asked to.

The thing that irked me really was that when Kaustikos mentioned that he would have liked a second attempt when he didn't get it in the first one, instead of thinking "he has a sense of responsibility to fix his mistake", the initial responses were along the lines of "this guy is an entitled brat who expects to be gifted everything regardless of patient safety, let's berate him publicly!" And Kaustikos can feel free to correct me if I'm misinterpreting his posts but, to me, he just came off like he wanted the opportunity to fix his own mistake and learn from it. Having that sense of responsibility to fix your mistakes is not a bad attribute to have, in my humble opinion, especially in medicine. Every rotation, we are told to "take ownership of your patients." This situation fits into that concept for me.

Apart from that, I think it's completely reasonable for attendings to step in whenever they deem necessary and take over a procedure. I just don't think that initial accusatory attitude in this thread was warranted. :shrug:
 
Touche. If it were me, I'd probably let you have two attempts at a procedure. And while you were doing it, I'd try to guide you through it and show you what you were doing wrong. But that's me. Every attending uses their own discretion. And there comes a point where the procedure has to get done. I would say after two attempts, its time to let someone more experienced take over.

I think a lot of the argument was whether medical students and residents should be treated differently when it comes to common procedures, or anything else really. There's nothing wrong with an attending only allowing learners one mistake on a procedure if he thinks its important to the patient, but I think a lot of people were arguing that Kat only merited one attempt (and should be grateful to get it) specifically because he was a medical student rather than a resident. That to me was the problem. I think it is an extremely toxic trend in medical education to treat medical student education as an option while resident education is considered a necessity. I think we need to approach medical student education with the same urgency as resident education.
 
I wish I could draw my decision flowchart for procedural attempts but I can't so I'll try to explain my thought process as an attending in the ED... I'll probably do a poor job at it.

Sick crashing patient, unstable and needing an optimized first pass success attempt -> senior resident
Sick crashing patient, but with a degree of stability or otherwise young and healthy who might tolerate a slower try -> junior resident
Rare procedure or an unusual presentation -> highest level resident available
Stable patient with elective indications -> medical student with junior resident backup
Stable patient with emergent indications -> medical student with senior resident backup
Failed first attempt by medical student/resident -> if competence demonstrated despite failure, second attempt warranted
Failed second attempt by MS/resident -> if no clinical decompensation and competence is still demonstrated, third attempt warranted
Failed third attempt by MS/resident -> backup tries
Failed attempt by backup -> it's my turn

Right of first refusal:
Lacerations: med student
I&D: med student
LP: junior resident
Intubation: junior resident unless patient is relatively stable and med student has been taking ownership of patient
Central line: junior resident unless as above
Art line: medical student while JR is doing central line
Cric/Thoracotomy: senior resident
Reductions: everyone gets to play
And so on and so forth

At the end of the day I have to weigh a) the medical liability, b) the patient's wellbeing, c) the scarcity of resources (procedures are a limited resource), d) the need to meet ACGME benchmarks. Should medical students be grateful to get to do any procedures? Yes... but so should the residents, and so should I.
 
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I think a lot of the argument was whether medical students and residents should be treated differently when it comes to common procedures, or anything else really. There's nothing wrong with an attending only allowing learners one mistake on a procedure if he thinks its important to the patient, but I think a lot of people were arguing that Kat only merited one attempt (and should be grateful to get it) specifically because he was a medical student rather than a resident. That to me was the problem. I think it is an extremely toxic trend in medical education to treat medical student education as an option while resident education is considered a necessity. I think we need to approach medical student education with the same urgency as resident education.

There are still many situations in which even resident education (let alone medical student education) is passed over for fellow education. There are places were entire skillsets are no barely taught in certain fields where they used to be routine. There are previously commonplace skills that many physicians are not comfortable with. On the plus side, if you weren't going to do them in daily practice it probably doesn't really matter. We are specialized. But on the downside, it's super lame. And we need the residents to be competent when they finish and for workflow. If having a medical student do a procedure means an intern won't be signed off and able to perform them with indirect supervision when things get busy, that's a problem for the system.

Depending on what time of year you do a rotation and if the residents have been "signed off" on their procedures, a medical student might do LPs, thoracenteses, paracenteses several times on a clerkship. Or none of them. You could deliver a baby. Or a placenta. Such is the state of things. If certain experiences matter to you as student, then the best you can do is time your third year clerkships accordingly and pick your fourth year electives how you want them.
 
I am in complete agreement with you. And I completely understand that, as the attending, you're the one who deems when to step in. I don't think any med student in this thread would argue against that. Even if it's after just one attempt, I will absolutely step aside if asked to.

The thing that irked me really was that when Kaustikos mentioned that he would have liked a second attempt when he didn't get it in the first one, instead of thinking "he has a sense of responsibility to fix his mistake", the initial responses were along the lines of "this guy is an entitled brat who expects to be gifted everything regardless of patient safety, let's berate him publicly!" And Kaustikos can feel free to correct me if I'm misinterpreting his posts but, to me, he just came off like he wanted the opportunity to fix his own mistake and learn from it. Having that sense of responsibility to fix your mistakes is not a bad attribute to have, in my humble opinion, especially in medicine. Every rotation, we are told to "take ownership of your patients." This situation fits into that concept for me.

Apart from that, I think it's completely reasonable for attendings to step in whenever they deem necessary and take over a procedure. I just don't think that initial accusatory attitude in this thread was warranted. :shrug:

That's exactly what I was getting at. And what I've been trying to reiterate. I don't understand how I can better say that or explain that... People just jumped to entitlement when that wasn't the case at all. I know I'm the bitch at the bottom of the totem pole.

Honestly, my frustration at the moment is how differently people feel about this (as demonstrated here). You read this thread and different attendings/residents have varying viewpoints on how to approach things. Some attendings stop you if you stop for a millisecond to examine your intubation/see the airway and finish it. Some let you try and fail. Some let you try and let you try again if you know what you did wrong. Some just make you sit down and never do it. I've had no issues acclimating to these different people for the most part. My issue is how frustrating it can be when people say "You're a medical student, so this is just supposed to be a volunteer thing and not for you to learn how to be competent. That's what internship is for". I hate hearing that because it almost makes me not want to give a **** about anything and just study for my shelf exams and nothing else. Why put any effort into becoming better at something if someone's gonna cockblock me because they assume something because of my "status"? It's this biased viewpoint that frustrates me at times. Unfortunately to some of the people on here; I'm not going to stop trying. Call me arrogant/entitled/annoying, but that's not what I'm trying to do. In the end - I'm trying to become a competent doctor. Maybe I'm naive in thinking "Hey, I want to learn more/do more during clinicals so I'm better prepared". But my experiences (as I've illustrated) shows to me what could happen to me if I'm not like I am.

I apologize for my rant earlier - it had a lot to do with my current neurosurgery rotation I'm in. I've never felt like a bigger idiot in my life until these past few weeks with these guys. Every little thing I studied was never enough for what they pimped me on/asked me. And its no fault of their own. I just got beat down mentally by these impressive peds neurosurgeons. So, yeah, I did need a drink after that :lol:

I want to take back my respect/rant comment (even though it's the internet so I can't run for politics - EVER) but I can't. I've just had the most annoying of circumstances/issues during 3rd year that's made way more of an dingus/cynic. I've loved my surgery team/residents for the most part. But I've hated hated HATED the bull**** that comes with it. The attending that tells me I need to be more confident in my answer and to defend it properly and then gives me a failed evaluation because I "argued" with him on a point. The director who wanted to talk to me about that situation but I couldn't do anything about it (What? Argue my point that I'm too argumentative?). The times people have given be bad evaluations because I didn't wear scrubs on rounds on the hospital floor when university dress code says that it's preferred to wear dress shirt/tie/suit. The constant annoyances of "mandatory classes" that serve no benefit - only because they were at times when we rounded and not during grand rounds. Or saying that being in the OR is the lowest of priorities during surgery... and classes were more important. Which caused me to get a bad eval. I'm learning how right I was in thinking how med school is like:

watchmen-20090223034854066.jpg
 
I apologize for my rant earlier - it had a lot to do with my current neurosurgery rotation I'm in. I've never felt like a bigger idiot in my life until these past few weeks with these guys. Every little thing I studied was never enough for what they pimped me on/asked me. And its no fault of their own. I just got beat down mentally by these impressive peds neurosurgeons. So, yeah, I did need a drink after that :lol:

I want to take back my respect/rant comment (even though it's the internet so I can't run for politics - EVER) but I can't. I've just had the most annoying of circumstances/issues during 3rd year that's made way more of an dingus/cynic. I've loved my surgery team/residents for the most part. But I've hated hated HATED the bullcrap that comes with it. The attending that tells me I need to be more confident in my answer and to defend it properly and then gives me a failed evaluation because I "argued" with him on a point. The director who wanted to talk to me about that situation but I couldn't do anything about it (What? Argue my point that I'm too argumentative?). The times people have given be bad evaluations because I didn't wear scrubs on rounds on the hospital floor when university dress code says that it's preferred to wear dress shirt/tie/suit. The constant annoyances of "mandatory classes" that serve no benefit - only because they were at times when we rounded and not during grand rounds. Or saying that being in the OR is the lowest of priorities during surgery... and classes were more important. Which caused me to get a bad eval. I'm learning how right I was in thinking how med school is like:

watchmen-20090223034854066.jpg


I feel your pain -- MS3, 2nd IM month, asked to give a 5 minute talk on a learning point for the team by the attending -- picked a relevant topic -- reading what the article said during the pre-lunch brief with the entire team doing something else (I find those 5 minute talks on a "clinically relevant topic" uber useless since most everyone wants to get done with ward work and get the hell home) mentally --- when the attending corrected something I had said -- without thinking, I commented, politely I thought, that while I didn't doubt what he was saying, I was quoting information from the article -- after I was done, he asked me to stay behind and cut the team loose for lunch -- and proceeded to rip me a new anal orifice, saying that I was being disrespectful and it was a good thing he wasn't attending So-and-So or I would have been humiliated in front of the team for my disrespectful attitude!!! I just kept my mouth shut during the rant, took my whupping like a man, apologized and promised that it would never happen again, Sir!.....he later wound up writing one of my best letters and according to the chief resident of the team, could not stop talking about what a great student I was and how he really thought the residency should go after me for their program......

But between the ass chewing and letter, he tried to pimp me into submission and I answered the questions promptly and with as much gusto as I could generate and pulled one factoid (tree bark appearance on the aorta for syphillis) out of my posterior and worked really hard -- and turned it around.....

Turns out, he was a great guy, a damn good doc and I learned a lot from him, I just rubbed him the wrong way that day......
 
I'm learning how right I was in thinking how med school is like:

watchmen-20090223034854066.jpg

And to a large degree, you're right -- it certainly was not what I expected, and residency surely was not what I expected -- virtually no teaching, just thrown into the deep end of the pond and blamed for every mistake made with no help from upper levels or attendings -- figure it out on your own and hope to hell you get it right.....
 
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This is what I'm talking about:

33aw3yb.jpg


I'm not an MS1/MS2. God ****ing damn it - let me do what I need to do and stop it with this ****.
 
Wait so your mad that you get an email after you forgot about a commitment after previously saying "it won't happen again"?

Nothing your going to see (or do) during some random surgery as an MS3 is worth ticking off the course director over.

If they really needed you there as an extra hand helping to retract or something and the attending asked you to stay then just tell the course director that and would be no problem
 
Wait so your mad that you get an email after you forgot about a commitment after previously saying "it won't happen again"?

Nothing your going to see (or do) during some random surgery as an MS3 is worth ticking off the course director over.

If they really needed you there as an extra hand helping to retract or something and the attending asked you to stay then just tell the course director that and would be no problem

No, I hate class/lectures. The mandatory attendance and that being in the OR is not an excuse because lecture has precedence when it's just a waste of time. A complete waste of time. Being in cases/rounding/with patients is way more useful/helpful than lecture.

Also - "Nothing your going to see (or do) during some random surgery as an MS3 is worth ticking off the course director over."
Not a director. But keep in mind what I said earlier - going to class affects your evaluations like it did for me. When the time comes that the director tells me "Yes class is mandatory and everyone in the hospital knows this and shouldn't hold it against you" and it actually happens, then I'll stop hating lectures.
Lectures/Assignments/etc are all bull****.
 
I'm not an MS1/MS2. God ******* damn it - let me do what I need to do and stop it with this ****.

No, you're not a first or second year student. You sound more like a third grader rather than a third year medical student.
 
This is what I'm talking about:

33aw3yb.jpg


I'm not an MS1/MS2. God ******* damn it - let me do what I need to do and stop it with this ****.

Dude, just go to ****ing lecture. Give your resident a heads up at the start of a case and tell him "Dr. So-and-So really gets on us if we miss, and I'll be back at time XXX". And then excuse yourself politely during the case. If you get a bad eval from your attending for missing OR time for lectures, bring it up to your course director. There is no course director in the world who makes lectures mandatory and then doesn't somewhat protect the students.
 
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Dude, just go to ******* lecture. Give your resident a heads up at the start of a case and tell him "Dr. So-and-So really gets on us if we miss, and I'll be back at time XXX". And then excuse yourself politely during the case. If you get a bad eval from your attending for missing OR time for lectures, bring it up to your course director. There is no course director in the world who makes lectures mandatory and then doesn't somewhat protect the students.

Seriously bro if you gotta go you gotta go. We don't even do most of rounds with our teams in the morning because of lecture...they don't love it but the course director makes it clear that you gotta show up. Same thing happens to us (the "noticed you weren't there that morning" email) if we don't swipe in.
 
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Dude, just go to ******* lecture. Give your resident a heads up at the start of a case and tell him "Dr. So-and-So really gets on us if we miss, and I'll be back at time XXX". And then excuse yourself politely during the case. If you get a bad eval from your attending for missing OR time for lectures, bring it up to your course director. There is no course director in the world who makes lectures mandatory and then doesn't somewhat protect the students.

... Yeah, except there is. It happened to me which is why I'm not the biggest fan of lecture. I'd have no issue with these lectures if they were in the afternoon/weekend/whatever so I didn't miss clinicals/hospitals. My circumstances tell/show me a different side of the equation where attendings/residents applaud dedication/commitment to being there when they're there. At this point; I'm reliant on these evaluations because shelf exams aren't my forte. Lectures don't help me and administration doesn't write my letter/eval/etc.

Whatever, I'm done arguing this. I hope I'm wrong and I'll go to lecture. But it's downright insulting to infer that I need this when I've been able to study on my own without lectures. That I gain no benefit being in the hospital instead of a classroom. But the more and more they throw these things at me; the more I hate this. This is exactly why I just don't care anymore. I'm gonna do vascular surgery - PVD's for smokers, AV Fistulas for diabetics, Carotid Endarterectomies for people eating too many fried mayonnaise balls. I'm done caring. This attitude will only get worsened by these requirements that I spend less time with patients - which is what I used to love/get excited for. Now I'll just play this game and then get into what I want and not have to deal with it. This is the joke I refused to see for what it is and why people with the highest step 1 score go into specialties that's more about the lifestyle/money than the patients. Smart people. The idiots are the ones going into things that deal with patients...
 
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Seriously bro if you gotta go you gotta go. We don't even do most of rounds with our teams in the morning because of lecture...they don't love it but the course director makes it clear that you gotta show up. Same thing happens to us (the "noticed you weren't there that morning" email) if we don't swipe in.

Yeah,
But you don't receive a failed evaluation from it, do you?
 
The thing that irked me really was that when Kaustikos mentioned that he would have liked a second attempt when he didn't get it in the first one, instead of thinking "he has a sense of responsibility to fix his mistake", the initial responses were along the lines of "this guy is an entitled brat who expects to be gifted everything regardless of patient safety, let's berate him publicly!" And Kaustikos can feel free to correct me if I'm misinterpreting his posts but, to me, he just came off like he wanted the opportunity to fix his own mistake and learn from it.

To me, he came across as a jerk and that's why he got the response he got from others. This is my first post on this thread, but I read the whole thing and Kaustikos would get more sympathy if he would quit using language that reeks of an entitled toddler having a tantrum. Phrases like "but I'll be damned if I have someone not let me do something BECAUSE I'm a medical student" and "Who the hell are you to deny me the opportunity to hone that skill now if I want to/am interested in doing it?" are about as entitled as you can get. Being a medical student doesn't buy you a free pass to everything you want just because. Who are they to deny you the opportunity? They're your ATTENDINGS and RESIDENTS, the ones whose butts are on the line when you screw up because you're a know-it-all who doesn't know what he doesn't know. Frankly, that kind of attitude never would have passed at my med school.

"I'm confident in what I can do"? So is a 16-year-old new driver who thinks he can handle the wheel, no matter what happens. Like it or not, we're med STUDENTS. That means that we still have a lot to learn. Every single time I ran across a post from Kaustikos in this thread, I cringed because he makes us all look bad.
 
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To me, he came across as a jerk and that's why he got the response he got from others. This is my first post on this thread, but I read the whole thing and Kaustikos would get more sympathy if he would quit using language that reeks of an entitled toddler having a tantrum. Phrases like "but I'll be damned if I have someone not let me do something BECAUSE I'm a medical student" and "Who the hell are you to deny me the opportunity to hone that skill now if I want to/am interested in doing it?" are about as entitled as you can get. Being a medical student doesn't buy you a free pass to everything you want just because. Who are they to deny you the opportunity? They're your ATTENDINGS and RESIDENTS, the ones whose butts are on the line when you screw up because you're a know-it-all who doesn't know what he doesn't know. Frankly, that kind of attitude never would have passed at my med school.

"I'm confident in what I can do"? So is a 16-year-old new driver who thinks he can handle the wheel, no matter what happens. Like it or not, we're med STUDENTS. That means that we still have a lot to learn. Every single time I ran across a post from Kaustikos in this thread, I cringed because he makes us all look bad.


You know, I don't usually come to anyone's defense on here...but since I actually KNOW Kaustikos, I know that he is far from an entitled bratty child.
No ****, you guys work under the license of the people around you and if something goes wrong its their fault. Like OMG, what a revelation.
People come on here and vent about things in a way that they would never actually do IRL.... If he actually acted this way, he probably wouldn't be too successful thus far in his academic career. Right? Just like Anastomoses' thread where everyone jumped all over her, it doesn't seem like you read most of what he said for what it was: an.Internet.rant.
 
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Dude, just go to ******* lecture. Give your resident a heads up at the start of a case and tell him "Dr. So-and-So really gets on us if we miss, and I'll be back at time XXX". And then excuse yourself politely during the case. If you get a bad eval from your attending for missing OR time for lectures, bring it up to your course director. There is no course director in the world who makes lectures mandatory and then doesn't somewhat protect the students.

This. If you have an attending that gave you a bad eval for missing cases due to lectures, take it to the course director and have it thrown out. If they won't listen, take it to the dean of students. If lectures are mandatory, you cannot and should not be dinged for going to them.
 
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Lol thank god my girlfriend isn't dumb enough to post in this thread. You're just making your man look even more like a bitch
 
To me, he came across as a jerk and that's why he got the response he got from others. This is my first post on this thread, but I read the whole thing and Kaustikos would get more sympathy if he would quit using language that reeks of an entitled toddler having a tantrum. Phrases like "but I'll be damned if I have someone not let me do something BECAUSE I'm a medical student" and "Who the hell are you to deny me the opportunity to hone that skill now if I want to/am interested in doing it?" are about as entitled as you can get. Being a medical student doesn't buy you a free pass to everything you want just because. Who are they to deny you the opportunity? They're your ATTENDINGS and RESIDENTS, the ones whose butts are on the line when you screw up because you're a know-it-all who doesn't know what he doesn't know. Frankly, that kind of attitude never would have passed at my med school.

"I'm confident in what I can do"? So is a 16-year-old new driver who thinks he can handle the wheel, no matter what happens. Like it or not, we're med STUDENTS. That means that we still have a lot to learn. Every single time I ran across a post from Kaustikos in this thread, I cringed because he makes us all look bad.

See, this is so funny. I almost believed the idea you guys had until today. I had to (yeah, no ****) get my evaluations done today from my attendings/residents and the things they told me were the complete opposite of what you guys speak of. My favorite attending told me - You should spend as much time at the hospital to get the most experience you can doing some of the things other people take for granted - iv lines/intubations/whatever. You need to be prepared so that when you're a resident; you can be the guy your team/staff can go to for help without any hesitation.

Some of you might think "oh, right, whatever". But I'll be damned if I dismiss the things these attendings (AOA Neurosurgeons ZOMG L33T BETTER THAN EVERYONE GOD STATUS) tell me to my face without me saying anything. This has nothing to do with entitlement. Apparently you guys have the idea that wanting to be good at something comes across that way. Which is hilarious-ly stupid. The condescension and assumptions are just ridiculous. In the end; what I try to do pays off when I'm the intern/resident that doesn't look like an idiot knowing how to do things. I want to be as well-prepared as I can be for residency and that's the kind of attitude you can't fault a person for having.

If I'm asked to try to suture and I can't even hold anything in the right fashion; yeah, take it away from me. If I intubate someone but it wasn't deep enough - you're telling me I should feel thankful and not want to try again? Get out of here. That's giving up. Considering I'm interested in pursuing a field where "one try only" is the norm; I wanna be damn sure to get my screwups out of the way now so I don't do them later. Because when I'm in residency; I won't be doing this in a controlled environment all the time.

Also, what attitude? You think I go everywhere demanding I get to do things all the time? Where in the hell did you get that? Just because I post this on here doesn't mean I say this in person. The attitude that I want to become good at something and want to have more chances to try? Excuse me if I find that the $250k I paid for my school warrants the idea that I should be trained in medicine. This has nothing to do with arrogance. This has everything to do with being able to do my damn job. That's what this school is for. We're put in an environment that practically endorses it - academic hospitals. My wanting to become competent at this is the same thing as being able to report on my patient during rounds/do a physical exam/get a history/present. When they ask me to do it - I don't want to be the person who says he doesn't know how...or actually doesn't know how. Just like I don't want to be the doctor who writes a ****ty note - I don't want to be the resident who can't do an IV/intubate/suture.

In all honesty - all of this condescension/attitude stems from people who were probably treated like ****/didn't have any opportunities in med school. They feel that how they were taught is how students today should be taught. The problem? It's biased. It's subjective. This is made more obvious by people continuously posting **** like "Oh, it's entitlement and arrogance!"

Take that attitude elsewhere. I'm sorry you had a bad time at your school. I'm sorry you went to a school where you scrubbed and only watched cases. I'm sorry you weren't encouraged to try to do things/improve. But don't take it out on me.

But you're right - I shouldn't of tried to better myself or learn this. So that last week - when I was the only person with the attending during a cranial vault revision - I would've been able to respectfully say "Oh, I'm sorry. I'm a Medical Student. I'm not cut out to do ANY of this. Gosh, I should just grab some popcorn and watch while you work by yourself." Instead of assisted in the entire damn procedure without screwing up. And you know what? That moment made me so unbelievably happy because I was able to be there for that attending and help. I was competent enough to do what was asked of me. Those moments are why I do this. Just like the neurosurgeon told me - I want to be the person/teammate/colleague that is competent enough at his job so that I can be counted on for support/help.
 
This. If you have an attending that gave you a bad eval for missing cases due to lectures, take it to the course director and have it thrown out. If they won't listen, take it to the dean of students. If lectures are mandatory, you cannot and should not be dinged for going to them.

You must be incredibly naive... I guess you haven't figured out office politics yet, have you? The course director is friends with the surgeon and friends with the dean of students. Go ahead and tell me there isn't any bias. Please. I welcome it.

Your post reminds me of a lecture I had from nurses telling me that we shouldn't feel afraid to complain about an attending because we have every right to do so. Yes, we "can". But the backfire from doing it is worse than whatever benefit you might get. If I were to complain that my attending was "mean"... when he's the dean of professor for the surgery program... how would that work? This is all politics. So please stop trying to give me advice on how to "complain". It doesn't work unless your attending beats you to death with his dick in front of the OR staff while singing "Final Countdown".
 
See, this is so funny.

But you're right - I shouldn't of tried to better myself or learn this. So that last week - when I was the only person with the attending during a cranial vault revision - I would've been able to respectfully say "Oh, I'm sorry. I'm a Medical Student. I'm not cut out to do ANY of this. Gosh, I should just grab some popcorn and watch while you work by yourself." Instead of assisted in the entire damn procedure without screwing up. And you know what? That moment made me so unbelievably happy because I was able to be there for that attending and help. I was competent enough to do what was asked of me. Those moments are why I do this. Just like the neurosurgeon told me - I want to be the person/teammate/colleague that is competent enough at his job so that I can be counted on for support/help.
dayum boi, wipe dat cum off yo lips
 
Well, Kaustikos, I guess you've figured it all out. Good luck to you in the future. (I'm sure general surgery residency will be right up your alley.)

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You must be incredibly naive... I guess you haven't figured out office politics yet, have you? The course director is friends with the surgeon and friends with the dean of students. Go ahead and tell me there isn't any bias. Please. I welcome it.

Your post reminds me of a lecture I had from nurses telling me that we shouldn't feel afraid to complain about an attending because we have every right to do so. Yes, we "can". But the backfire from doing it is worse than whatever benefit you might get. If I were to complain that my attending was "mean"... when he's the dean of professor for the surgery program... how would that work? This is all politics. So please stop trying to give me advice on how to "complain". It doesn't work unless your attending beats you to death with his dick in front of the OR staff while singing "Final Countdown".

I wouldn't care if there was bias. I'm not saying there isn't bias. Of course there is bias. Welcome to medical school. It's all about how you word it. I'm not saying the attending should be reprimanded for his actions, but that it is what you should do if you care about your grade. I was in a very similar situation last year (except on Ob). I went to the course director, and calmly explained that I believe that one of the attendings was unaware of the mandatory lecture policy, and thus I was 'dinged' for missing afternoon notes (as specifically stated) by the attending's eval. The course director saw the rest of my evals were good and did so.

I'm not saying to call the surgeon "a big fat meanie a-hole with no regard for medical students", or any disparaging terms at all. Stop acting like that the only way to deal with an issue is to offend someone. Maybe your school is completely unreasonable, and if that's true, I feel bad for you son. I got 99 problems but crappy evals ain't one.
 
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Kaustikos,

I have no interest in this debate and don't have a stake in it. But I remember being extremely disappointed in how the goal posts of clerkship success perpetually moved to suit the whimsy of attending after new attending. And that it wasn't about learning any sort of job at all.

Disappointments aside, if you're in the business of making striking, successful impressions in the sub specialty surgery game, then you're bound to mastering how the game is played. Hitting all the academic milestones is just as important. And being litigious with whimsical, unfavorable evals is more fruitful than trying to do extra this and that at every turn. You could do all that and still not do as well as the guy or girl who presents confidently and bolts to go study at every opportunity.

But....good luck. I'm pretty much just an observer of this. And am enormously satisfied to have been lucky enough not to have to give a **** about the game. Some people don't have the luxury. If that's you, I suggest not burning so much energy on the wrong things.
 
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Apparently you guys have the idea that wanting to be good at something comes across that way.

No, sweetheart. Most of us are good at a lot of things. We just realize that one of those things (for us) is social skills.

Which is hilarious-ly stupid. The condescension and assumptions are just ridiculous.

Also, what attitude? You think I go everywhere demanding I get to do things all the time? Where in the hell did you get that? Just because I post this on here doesn't mean I say this in person. The attitude that I want to become good at something and want to have more chances to try? Excuse me if I find that the $250k I paid for my school warrants the idea that I should be trained in medicine. This has nothing to do with arrogance. This has everything to do with being able to do my damn job.

In all honesty - all of this condescension/attitude stems from people who were probably treated like ****/didn't have any opportunities in med school. They feel that how they were taught is how students today should be taught. The problem? It's biased. It's subjective. This is made more obvious by people continuously posting **** like "Oh, it's entitlement and arrogance!

Take that attitude elsewhere. I'm sorry you had a bad time at your school. I'm sorry you went to a school where you scrubbed and only watched cases. I'm sorry you weren't encouraged to try to do things/improve. But don't take it out on me

I rest my case. I'd say good luck to you, but you'd take it as a slight.
 
See, this is so funny. I almost believed the idea you guys had until today. I had to (yeah, no ****) get my evaluations done today from my attendings/residents and the things they told me were the complete opposite of what you guys speak of. My favorite attending told me - You should spend as much time at the hospital to get the most experience you can doing some of the things other people take for granted - iv lines/intubations/whatever. You need to be prepared so that when you're a resident; you can be the guy your team/staff can go to for help without any hesitation.

Some of you might think "oh, right, whatever". But I'll be damned if I dismiss the things these attendings (AOA Neurosurgeons ZOMG L33T BETTER THAN EVERYONE GOD STATUS) tell me to my face without me saying anything. This has nothing to do with entitlement. Apparently you guys have the idea that wanting to be good at something comes across that way. Which is hilarious-ly stupid. The condescension and assumptions are just ridiculous. In the end; what I try to do pays off when I'm the intern/resident that doesn't look like an idiot knowing how to do things. I want to be as well-prepared as I can be for residency and that's the kind of attitude you can't fault a person for having.

If I'm asked to try to suture and I can't even hold anything in the right fashion; yeah, take it away from me. If I intubate someone but it wasn't deep enough - you're telling me I should feel thankful and not want to try again? Get out of here. That's giving up. Considering I'm interested in pursuing a field where "one try only" is the norm; I wanna be damn sure to get my screwups out of the way now so I don't do them later. Because when I'm in residency; I won't be doing this in a controlled environment all the time.

Also, what attitude? You think I go everywhere demanding I get to do things all the time? Where in the hell did you get that? Just because I post this on here doesn't mean I say this in person. The attitude that I want to become good at something and want to have more chances to try? Excuse me if I find that the $250k I paid for my school warrants the idea that I should be trained in medicine. This has nothing to do with arrogance. This has everything to do with being able to do my damn job. That's what this school is for. We're put in an environment that practically endorses it - academic hospitals. My wanting to become competent at this is the same thing as being able to report on my patient during rounds/do a physical exam/get a history/present. When they ask me to do it - I don't want to be the person who says he doesn't know how...or actually doesn't know how. Just like I don't want to be the doctor who writes a ****** note - I don't want to be the resident who can't do an IV/intubate/suture.

In all honesty - all of this condescension/attitude stems from people who were probably treated like ****/didn't have any opportunities in med school. They feel that how they were taught is how students today should be taught. The problem? It's biased. It's subjective. This is made more obvious by people continuously posting **** like "Oh, it's entitlement and arrogance!"

Take that attitude elsewhere. I'm sorry you had a bad time at your school. I'm sorry you went to a school where you scrubbed and only watched cases. I'm sorry you weren't encouraged to try to do things/improve. But don't take it out on me.

But you're right - I shouldn't of tried to better myself or learn this. So that last week - when I was the only person with the attending during a cranial vault revision - I would've been able to respectfully say "Oh, I'm sorry. I'm a Medical Student. I'm not cut out to do ANY of this. Gosh, I should just grab some popcorn and watch while you work by yourself." Instead of assisted in the entire damn procedure without screwing up. And you know what? That moment made me so unbelievably happy because I was able to be there for that attending and help. I was competent enough to do what was asked of me. Those moments are why I do this. Just like the neurosurgeon told me - I want to be the person/teammate/colleague that is competent enough at his job so that I can be counted on for support/help.

Seriously dude, you need to let this go. So one attending didn't want to give you a second shot at the intubation. I know you wanted a second chance to get the intubation right, but in the big scheme of things, its really not that big of a deal. There are other patients you can try intubating, and maybe some other attending will be more generous than the first in allowing you more than one attempt to get the tube in, and will try harder to talk you through it. And by the way, in case you've forgotten, there's a lot more to being a good doctor than being skilled at procedures.

To tell you the truth, even though you say you don't feel entitled to procedures, you're coming across that way with your long rants. You sound like a fourth-grader throwing a tantrum and arguing with the umpire after striking out during a Little League game.
 
Ill be honest I have not read this entire thread but as an attending who supervises intubations maybe there are some unique things that haven't been brought up...

1. Hospital policies
Some depts and hospitals have policies regarding intubation that play a role in my interest in allowing a learner chances at airways. My hospital has a rule that on the third attempt an anesthesiologist is called by protocol by the respiratory therapist. So if I give a student two attempts and for whatever reason I need two, anesthesia is contacted and the case is tracked for review.

2. Airway changes
Every attempt causes more airway edema and potential for bleeding. If a student has two attempts the third one gets even harder potentially.

3. Drugs
The more time spent trying and retrying intubation means the drugs may need redosed.

4. Attending factors
When I was a new attending, supervising an airway was very stressful because my own airway experience was more limited than it is now. I will probably be even more relaxed five more years from now. Then again as I go further in a teaching hospital the number of attempts I get goes down too and can affect my patience with novice learners. Also, if I have a long list of other urgent tasks, my ability to mentor a learner in an intubation goes down. Overnights in the ED, I am the only attending and if I have lots of new patients who have not been evaluated, it's not a good time for me to spend extra teaching time.

5. Patient factors
Each intubation is different. Patient factors like asthma cops etc., make pre-oxygenation difficult and procedural complications more likely. A difficult intubation is going to have less leeway for learners, and attendings to offer learners

6. Student factors
If I don't know a student, I give fewer opportunities. If I see someone who is prepared and working hard on non glamorous things, I give them more leeway. If before the intubation the student can tell me the types of drugs commonly used and doses and side effects and describe the two blades commonly used... I am more giving. Whereas, if someone holds the blade in the wrong hand that is an automatic end to their attempt.

I bring these up because there can be lots of factors to intubation supervision, unlike suturing or fracture reductions, etc. maybe none of these are applicable to your specific experience, but just in case I am offering them.

As for becoming a great doctor...care for the patients and try and prevent them from needing procedures. Understand that the compassion at the bedside, the science of the physical exam, clinical decision making and follow up care is far more important than the procedures. Being able to setup an intubation with positioning, drugs, consent, post-intubation care etc., are all amazingly important maybe even more important. Master everything around the procedure and you'll find the procedure opportunities will come flooding in.

(If a student has the drugs and doses, patient consented and positioned and a plan for tube confirmation and post intubation sedation and a backup plan...it's hard to not cheer them on in the procedure.)
 
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I don't think I'm unique in seeing the dichotomy between how medical students and residents are taught airways. As a medical student my experience was similar to the OP: one shot, lots of pressure, very little instruction, often going months in between attempts. When I got my first (presurgical, not RSI) airway as a resident I was expecting a similar experience. One minute in I said "I'm sorry I can't visualize the cords" and mournfully expected the attending to swoop in and grab the mac. Then the attending helped correct my technique. Then he helped me reposition. Then I STILL missed, we took the blade out, bagged the patient back up, and tried again and I got it. Rinse and repeat with several different attendings and I started to get a little more comfortable (and need less correction/many fewer attempts). Its a skill. It takes time, instruction, and lots of reps.

Tubing a sedated patient with health lungs is not an emergency and should not be treated like one. There is no indication whatsoever for the anesthesiologist to snatch the mac from your hands after one attempt. It takes healthy adults a long time to desat, they're hooked up to monitors so you should know exactly when it happens, and even if they do start to desat you should be able to bag mask the patient indefinitely if you needed to. Also the attitude that medical student intubations is a privilege is a disservice not just to our students but to our patients. This isn't a procedure like a lap chole or a delivery, which only a minority of physicians will need to ever do, this is part of ACLS. And right now, by making medical student airways a last priority, we produce interns who might be responsible for doing their first successful intubation during an RSI on a crashing asthmatic. That IS an emergency, and if you miss you might spend 20 minutes bagging the patient back up if you get them back at all.

Perrot what is your specialty?

Acls is not about intubation by anyone and everyone.

Once paralytics are in...it IS an emergency. EVERYTIME. Your casual nature about airway management is very surprising and in my experience reeks of inexperience and lack of knowledge. Maybe I'm wrong with you in particular but that is my previous experience with people who speak like this.

To say that adults desaturate over a long period of time…is true for many. However, many desaturate quickly. Hypercarbia is generally the first problem which is the problem; for this reason, continuous ETCO2 is a better marker for need for intervention.

As for the "no reason" for an attending anesthesiologist to take the blade...the attending is the ONLY ONE in a position to know. There can be plenty of reasons (as I articulated above) that are possible.

Regarding the difference between medical student training and residents? When I work with my residents and I know the amount of time they have dedicated to intubation and I have worked with them quarter after quarter it's a different level of comfort than my comfort with a student who is rotating with me for their first day of a one month rotation. Students have usually not read, and practiced under the supervision of me or my team and has not completed our resident orientation etc.

Yes they are different and appropriately so.
 
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Ill be honest I have not read this entire thread but as an attending who supervises intubations maybe there are some unique things that haven't been brought up...

As a resident who has read the whole thread, thank you for laying out most of the important factors. When I let a medical student attempt to intubate, it is in an environment that I deem it safe, as someone who has some, albeit limited, experience intubating. At my institution, we can always call anesthesia. While I can not recall that actually happening, it is a nice reassurance to have. Similarly, if anesthesia shows up and can not intubate, I have to know how to crich a patient (which I have actually done). So it goes both ways.
 
To tell you the truth, even though you say you don't feel entitled to procedures, you're coming across that way with your long rants. You sound like a fourth-grader throwing a tantrum and arguing with the umpire after striking out during a Little League game.

I'm confused. I'm not the one that brings this up. I'm the one explaining how my actions have nothing to do with entitlement but about being prepared.

I guess that was lost in translation or whatever.
 
But forreal - If I say I know/can do one, I'm not lying. And if my attempt isn't 100% perfect it's because you guys don't let us really try. Practice dummy's don't help...

Kaustikos, this is what you said in your first post. This isn't confidence; it's arrogance, and it is a classic manifestation of narcissism and entitlement.

You proudly state you cannot be wrong and that if you are imperfect it is someone else's fault. You go on to state that you can learn only in one manner (live v dummy). That's narcissism.

You go on in several other posts to demonstrate that because you have done X you should be able to do Y. When you do so in the immature and melodramatic manner that you have, you have fulfilled every definition of the word "entitlement" that is used to broadly label your generation.

Your attitude doesn't impress me, and your type never will. You give the loads of hard working medical students a bad name, and you make our entire profession seem like a bunch of whining entitled rich brats.
 
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well he is a whiny entitled rich brat and is dating a whiny entitled rich brat / daddy's money spender, so it's no wonder....
 
Perrot what is your specialty?

Acls is not about intubation by anyone and everyone.

Once paralytics are in...it IS an emergency. EVERYTIME. Your casual nature about airway management is very surprising and in my experience reeks of inexperience and lack of knowledge. Maybe I'm wrong with you in particular but that is my previous experience with people who speak like this.

To say that adults desaturate over a long period of time…is true for many. However, many desaturate quickly. Hypercarbia is generally the first problem which is the problem; for this reason, continuous ETCO2 is a better marker for need for intervention.

As for the "no reason" for an attending anesthesiologist to take the blade...the attending is the ONLY ONE in a position to know. There can be plenty of reasons (as I articulated above) that are possible.

Regarding the difference between medical student training and residents? When I work with my residents and I know the amount of time they have dedicated to intubation and I have worked with them quarter after quarter it's a different level of comfort than my comfort with a student who is rotating with me for their first day of a one month rotation. Students have usually not read, and practiced under the supervision of me or my team and has not completed our resident orientation etc.

Yes they are different and appropriately so.

I'm in Peds. I'm certainly not claiming to be an expert on anesthesia or airway management, I'm actually pretty bad at it and would like more training to even begin to feel comfortable with the role I am in. I'm just commenting on the different attitude towards the training provided to me as an Intern and as a medical student. It certainly makes sense in more critical situations to either do it yourself or reserve management for more experienced residents, my comments were exclusively on the difference in attitude I perceive between the way a completely inexperienced medical student is taught compared to an equally inexperienced brand new Intern. If you feel your orientation provides a significant knowledge base for the Intern that the student doesn't have that makes the comparison more difficult, but as our orientation had zero airway training it was a very easy comparison for me. I know part of it is a difference in attendings, but FWIW when I was on my sedation rotation as a resident I felt I received much more patient, calm teaching compared to when I was a medical student with an equal dearth of experience. Heck, even when I was managing neonates I was given more guidance and time to work than when I was a medical student trying to tube an otherwise healthy cholecystectomy. I feel like that's a dichotomy that shouldn't exist.
 
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I'm in Pediatrics. We definitely aren't anesthesiologists and dont' have a lot of formal orientation training on airways. [...] Anyway I'm certainly not claiming to be an expert on anesthesia or airway management, I'm actually pretty bad at it and would like more training to even begin to feel comfortable with the role I am in.

It strikes me as odd that you would start off your thread with commentary that seems to position you as someone who has precisely the opposite comfort level with intubation and airway management and as one who has enough experience to make a blanket statement about the issues.

Obviously I wasn't the only one who was drawn to that statement.

I feel like that's a dichotomy that shouldn't exist.

That's an arguable point; however, for practical, medical and legal reasons, it exists.
 
I'm in Peds. I'm certainly not claiming to be an expert on anesthesia or airway management, I'm actually pretty bad at it and would like more training to even begin to feel comfortable with the role I am in. I'm just commenting on the different attitude towards the training provided to me as an Intern and as a medical student. It certainly makes sense in more critical situations to either do it yourself or reserve management for more experienced residents, my comments were exclusively on the difference in attitude I perceive between the way a completely inexperienced medical student is taught compared to an equally inexperienced brand new Intern. If you feel your orientation provides a significant knowledge base for the Intern that the student doesn't have that makes the comparison more difficult, but as our orientation had zero airway training it was a very easy comparison for me. I know part of it is a difference in attendings, but FWIW when I was on my sedation rotation as a resident I felt I received much more patient, calm teaching compared to when I was a medical student with an equal dearth of experience. Heck, even when I was managing neonates I was given more guidance and time to work than when I was a medical student trying to tube an otherwise healthy cholecystectomy. I feel like that's a dichotomy that shouldn't exist.


Thank you for being honest about the difficulties you had and are currently experiencing.

From your post, it sounds as though you are being asked to perform high risk intubations (the smaller the person, the more high risk the intubation) with very little support. This sounds like a real problem.

As a father, and an attending in a specialty that intubates babies, kids, adolescents, adults, in all states of mishealth, let me say, i would not let you or any other junior resident intubate my child without an attending present. Furthermore, it is possible that your shop is unique, but I have not met a general pediatrician (meaning not an peds EM, peds anesthesia, etc) who I would trust as an airway specialist. This is not a statement to be mean, but rather a statement of my experience and the expertise required to manage airways.

Again, because you are being put in an unreasonable task of learning to intubate complicated encounters with limited support and education now does not mean that medical students should be able to try and retry etc intraoperative intubations around the country…it means you need more support.

My residents go through an airway course every year (regardless of their PGY year) during which they intbuate per 50 cadavers in different ways and with different equipment. Emergency physicians are present and directly supervising all intubations in the emergency department where the patients share the same characteristics (some worse, some better) than those you described. I still make sure I am there when a resident is intubating even the day before they graduate.

In fact, there are times when I call a colleague, or anesthesiologist, or ENT etc to join me even before an intubation occurs.

Please, if you are truly so unsupervised…ask for help with your department leadership. There should be experienced airway providers present at all intubations. Do not advocate unsafe teaching practices to try and compensate for what seems like a hospital specific problem.
 
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From your post, it sounds as though you are being asked to perform high risk intubations (the smaller the person, the more high risk the intubation) with very little support. This sounds like a real problem.

Again, because you are being put in an unreasonable task of learning to intubate complicated encounters with limited support and education now does not mean that medical students should be able to try and retry etc intraoperative intubations around the country…it means you need more support.

Please, if you are truly so unsupervised…ask for help with your department leadership. There should be experienced airway providers present at all intubations. Do not advocate unsafe teaching practices to try and compensate for what seems like a hospital specific problem.


For what it's worth, I highly doubt Perrot is intubating neonates without direct suprevision. He said it was while he was on a sedation service. While I don't know what that is, it sounds like it would likely be Peds Anesthesia (which should fit under your description of 'experienced airway provider'). I believe what he is saying is that the attending teaching him is much more patient with him now (when he's intubating a higher risk patient) than while Perrot was a medical student (intubating significantly lower risk patients).
 
For what it's worth, I highly doubt Perrot is intubating neonates without direct suprevision. He said it was while he was on a sedation service. While I don't know what that is, it sounds like it would likely be Peds Anesthesia (which should fit under your description of 'experienced airway provider'). I believe what he is saying is that the attending teaching him is much more patient with him now (when he's intubating a higher risk patient) than while Perrot was a medical student (intubating significantly lower risk patients).

I think you're right as I'm rereading this.

Perrot, my apologies for misunderstanding. If you have great supervision then that's perfect.

I still emphasize the reasons teaching a medical student are different than teaching your resident.
 
I think you're right as I'm rereading this.

Perrot, my apologies for misunderstanding. If you have great supervision then that's perfect.

I still emphasize the reasons teaching a medical student are different than teaching your resident.

I realize this may be politically incorrect, but it's absolutely true in my experience that if you train at a place with lower SES patients then medical students (and even residents) do more. I bring this up b/c I see you are in Rochester so I'm guessing your at Mayo. Rich, privileged people feel entitled to the "best care from the best specialist" and hence no way in hell a medical student and even sometimes a resident is doing any procedure on them or caring for them in any way. Everything has to run through the attending and there is less decision making from the resident. The attending also has more heat on them b/c these rich, entitled patients are more likely to sue and also the hospital system as a whole (May0) protects their VIP patients by having less hands on care from anyone except the attending.

Some of my best learning experiences were on the poor, underprivleged patients because the vast majority of them don't care if a medical student is doing a procedure or resident running the show making decisions as they are happy to get care.

In summary, I think the type of patients (poor, middle class, rich) one is caring for plays a big role in how much hands on learning/decision making one is afforded. Yes, all patients should be treated equal, but this is the real world.
 
I realize this may be politically incorrect, but it's absolutely true in my experience that if you train at a place with lower SES patients then medical students (and even residents) do more. I bring this up b/c I see you are in Rochester so I'm guessing your at Mayo. Rich, privileged people feel entitled to the "best care from the best specialist" and hence no way in hell a medical student and even sometimes a resident is doing any procedure on them or caring for them in any way. Everything has to run through the attending and there is less decision making from the resident. The attending also has more heat on them b/c these rich, entitled patients are more likely to sue and also the hospital system as a whole (May0) protects their VIP patients by having less hands on care from anyone except the attending.

Some of my best learning experiences were on the poor, underprivleged patients because the vast majority of them don't care if a medical student is doing a procedure or resident running the show making decisions as they are happy to get care.

In summary, I think the type of patients (poor, middle class, rich) one is caring for plays a big role in how much hands on learning/decision making one is afforded. Yes, all patients should be treated equal, but this is the real world.

Wow. There is a lot of misunderstanding packed into a small body of text here.

You're right in that I am an attending at Mayo Clinic in Rochester, Minnesota.

I have worked in "less resourced" settings throughout Washington DC, in Jacksonville, in Ohio, etc. I can guarantee that I have never let an intubation occur on one of my patients without me or my colleague (attending) being present. I don't care if the person is homeless, or a CEO, or a famous actor / actress. Your implication that attendings will care less about the safety of a patient when it comes to life threatening procedures like intubation is generally disappointing. I am sure there are individuals who live down to your portrayal but in general every institution I have worked no matter how small or under resourced or underprivileged the patients I have seen will get the same level of attention from me during an intubation.

As for Mayo Clinic….We do care for "Rich" people. We also care for not so rich people. We care for people with insurance, we care for people without insurance. After all we have a 2200 bed hospital in Minnesota with the largest resident force in the country (probably the world) and 20-40 medical students per class. You're probably fair in saying that medical students some times don't get the same procedural opportunities because there are many residents there to step in, but its not because the attendings and hospital have unusual expectations that the attendings should see everyone to protect our standing with rich people…thats entirely the wrong motivation. Every hospital i have worked at has an expectation that an attending is intimately involved in the care of the patient. I believe this is part of Medicare reimbursement that an attending has seen and examined the patient (could be wrong on that).

Residents get a lot of decision making opportunities. Considering in our ED we have over 60 beds, and we turn them over at an average one per three hours, the resident doesn't have to transport patients, place foleys (once they demonstrate they can), place IVs (once they demonstrate they can) etc…they are only making physician level decisions. They do it over and over and over because we don't board the same patient in the ED, we don't take them away from care to do nonphysician level tasks.

About your learning opportunities being best when "resident runs the show," etc. This is again misunderstanding that getting to do procedures and make decisions with little oversight is somehow better. A resident who was taught by another resident who was taught by another resident is likely not practicing at a level of mastery. Probably they know enough to get by, but when you have an expert whose entire passion is for the case you are about to see, the procedure you are about to do, the discussion you are about to have as your coach…thats when true learning happens. Don't worry so much about procedures…they are overrated…the true art of medicine is in the way you establish rapport rapidly with someone who has never met you, the way you can distill what they may tell you in an hour long story (hopefully not in the ED) into a concise and coherent medical description, you can consider a wide but thoughtful differential and perform directed physical assessments and serum, urine, and radiographic testing to confirm or refute your hypothesis and you can communicate the findings in a way that everyone (even someone distant from medical terminology) can understand and then explain to their loved ones who ask them about it. If you can build a useable foundation of these skills in medical school (not expertise because we are always in pursuit of expertise in these things), I can teach you how to suture up a wound, place a chest tube, central line, power up an ultrasound machine…those are easy to teach someone who has put in the investment to master the more important aspects of care. I mean every word of this.

Mayo Clinic is a unique place with lots of resources but the thing that makes it special is not the resources or the rich patients…its the fact that we believe our focus should be on the needs of our patients. Every person lives this philosophy even though it may sound cheesy or unbelievable…its true, and its amazing. Because of that people (even poor people, homeless people) travel from around the country and world to come here to be seen and cared for. I routinely see people who spent everything have to travel here to get evaluated and happily do so. If you ever really want to know what its like, please have more faith in people and come visit as a rotating student and see for yourself.

Again, I hope you can stop spreading such misinformation…because my friend, you are very misinformed.
 
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