Ok, so I thought I'd share a little bit of my recent experience as a 4th year extern (inpatient acute), and see if any of you had comments... First, let it be known, that I seriously wanted to attend this program, and continued to believe I would like to attend after the following events occurred due to other aspects of the program and my belief that I was completely at fault in all of the scenarios... But, since talking to some other folks, I am starting to question whether perhaps I was not quite all in the wrong... here we go: 1. Week 1 - I follow a PGY-1 intern to check-in with one of her "regular" patients, and she is doing her daily "How are you" spiel, along with wrapping things up b/c this patient is to be d/c'ed the next day. I ask a follow-up question to one of her statements (making sure she has someone coming to pick her up on d/c). - Upon leaving the interview room, the PGY-1 intern gently explains to me that I am not to interrupt her during her interview (not as in, interrupt in the middle of her speaking, but as in do not speak at all until she gives me permission, at the end). - I am a little surprised and aghast that I have committed a faux pas, apologize profusely and then try very hard to not speak during any of her interviews until she turns to me and says "Do you have any further questions?" 2. Week 2 - PGY-1 intern and I go do a first interview with one of her patients, who promptly says "Show me your teeth." The intern replies (a great response): "Why do you want me to show you my teeth?" And the patient gets up and leaves. We return to give a report to the PGY-4 in charge of our team. But, the intern only says "We didn't get anything." So, I was trying to be helpful, and started explaining about the teeth exchange... And we HAD read all of his history (previoius diagnoses and meds), so I thought maybe the PGY-4 would like to know about that, so the intern and I sort of tag-team tell the background. In the midst of this, the PGY-4 pulls out a post-it note, and starts writing on it. I thought she was trying to organize what we were saying, and that if I saw what she was writing, I could tailor what I said (both this time and in the future). So, I stand up to look at it. On it, she has written "Stop Talking!" with 4 arrows all pointing at me. This post-it note was meant for the intern to see, not me. I was stunned and surprised and sad, but I got the message and stopped talking. Later on, when word gets back to her that I mentionned this during an interview as a "weakness" - she apologizes for "having acted out," but is "surprised" that I didn't learn how to "behave" in medical school - and that "while there's no hierarchy per se, medical students do not speak to PGY-4 or attendings, only to the PGY-1 intern, and only when given permission. Medical students do NOT interrupt anyone. We realize that you are trying to impress us, but it shows a real lack of respect." I was surprised because I really hadn't been trying to impress them during these exchanges - I really was just trying to be helpful, not "steal the light" or anything from the intern. I thought we were cooperating. I guess I read that whole situation wrong. Anyway, I make a point of never speaking or asking questions to the PGY-4 unless given express permission. 3. week 3 - we change teams, and I get a new PGY-1 intern. We go in to interview one of MY new patients. To me, this is a new scenario (different than either of the previous ones). Anyway, I interview the patient, and at the end, the new PGY-1 intern asks some follow-up questions regarding the patient's exact history of alcohol use. Because this is my patient, I do not think the old "rules" apply, and ask a follow-up question along the lines of "Wait, was that before or after your last arrest for DUI?" to try and clarify the time-line. Afterwards, the intern very gently explains that I am not to interrupt in the future when he is speaking. I realize that it might seem like I am an extremely slow learner, but to me, this was a different situation because I thought it was MY interview and it was okay for me to ask clarifying questions. I did not consider it to be interrupting because no one was speaking. True, however, I had not been given permission to speak after the intern began his questionning. He was very nice about explaining it to me, but I was feeling like I was extremely dense for not having somehow figured this out already... 4. later on week 3 - we are before the judge, explaining why one of our patients should be held in-patient against his will. The patient advocate explains that the patient has a plan to go live in the woods with the racoons. (This is true). I think that it is relevant and funny to add "Well, yeah, but his plans for food is to 'eat the racoons.'" The advocate and judge both laugh, but the PGY-1 intern does not. Afterwards, I am told that this was inappropriate and that I should not interrupt the patient advocate in the future. Whoops. I understand, but this is now my 4th explanation within 3 weeks about how I interrupt too much. Eep. So, prior to this externship, I thought I was free to ask questions or make comments, as I seemed appropriate, not when given express permission. I somehow did not realize that silence was expected unless told otherwise - did you guys have that experience as well? Do you really not ask questions during interviews unless given permission? Do you really not try and help give additional information during the presentation? I feel stupid for not having known this beforehand. And I really was only trying to be helpful, not "impressive" despite their interpretation of my behavior. I guess that's kind of selfish of me, or egotistical, to think that I, as a lowly medical student, could be at all helpful to the higher-ups, but I guess I was naive to believe that. Eep. Comments? Questions? Is this a West Coast vs. East Coast thing? (I am from the East Coast; This program was in the West Coast).