Bad med students??

[Nerdoscience]

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Does anyone have advice for how to deal with/help bad med students? I am an intern, and I am working with a med student who doesn't seem to get it. In addition to being socially awkward (which I withhold judgment on until I see the rest of the picture), they also have no sense of what is clinically relevant at all.

Maybe you are thinking that this is normal this time of year. But the student is a fourth year! I have already sat down with them and had a long talk about rounding and presentations, but they didn't get any better. They just obsess over things that don't matter at all, and present things in a nearly random order. They will also mention things, then don't explain them. They have spent time taking very detailed social histories on patients who are oriented times one. They have presented in-depth information about a patient's pajamas. They have made utterly inappropriate comments, but seem to have no clue.

It's really frustrating, and I don't want to give them a bad eval unless I feel I made every effort to give them constructive feedback.

Any advice?

 

[thackl]

I don't have any advice, but I do appreciate your effort and concern 👍

 

[Faebinder]

Does anyone have advice for how to deal with/help bad med students? I am an intern, and I am working with a med student who doesn't seem to get it. In addition to being socially awkward (which I withhold judgment on until I see the rest of the picture), they also have no sense of what is clinically relevant at all.

Maybe you are thinking that this is normal this time of year. But the student is a fourth year! I have already sat down with them and had a long talk about rounding and presentations, but they didn't get any better. They just obsess over things that don't matter at all, and present things in a nearly random order. They will also mention things, then don't explain them. They have spent time taking very detailed social histories on patients who are oriented times one. They have presented in-depth information about a patient's pajamas. They have made utterly inappropriate comments, but seem to have no clue.

It's really frustrating, and I don't want to give them a bad eval unless I feel I made every effort to give them constructive feedback.

Any advice?

As an intern there is not much you can do... Let it go and hope they will improve or the system will weed them out somehow. If your main issue is the fact that your work load is increasing cause they are not pulling their weight, then take it up with the PD as a senior not as an intern. Life sucks as an intern... don't risk your image looking like a whiner, unless the students are affecting the way your PD and attendings are looking at you.

 

[Apollyon]

As an intern there is not much you can do... Let it go and hope they will improve or the system will weed them out somehow. If your main issue is the fact that your work load is increasing cause they are not pulling their weight, then take it up with the PD as a senior not as an intern. Life sucks as an intern... don't risk your image looking like a whiner, unless the students are affecting the way your PD and attendings are looking at you.

Waiting 2 years seems rather counterproductive.

To the OP: do you have a resident? In my two tours as an intern, I was never the final arbiter of student evaluations at the end of a rotation. Even where the attending solicited my input, still, mine was, at most, a suggestion. The R2 resident was the de facto grader if the attending didn't do it. If you have a resident, go to them.

If you are on a service that doesn't have a resident (eg, intern and attending), now is the time to ask for constructive help (such as, "I do not think I am doing an adequate job supervising the student; s/he does not seem to be in order, and my assistance does not seem to be helping. Do you have any advice?"). There are 3 possible scenarios: 1. the attending knows the student is a total f'up, 2. the attending will ask specific questions why the student is a screw-up, and here is where you have to be diplomatic ("the student is very disorganized on presentations, and I have tried to correct them and give them a model to follow, but it isn't sinking in"), or 3. the attending will give you advice as needed without more of your input.

 

[Nerdoscience]

I'm on a fellow-run team, and the resident and I both report directly to him. I haven't yet talked to the rest of the team about this. I guess one thing is that I think I know what I'm doing, and that I do it pretty well, but I am not so confident about my own skills at this point that I feel comfortable bringing up someone else's. I guess I should just get over that.

 

[KidDr]

I'm on a fellow-run team, and the resident and I both report directly to him. I haven't yet talked to the rest of the team about this. I guess one thing is that I think I know what I'm doing, and that I do it pretty well, but I am not so confident about my own skills at this point that I feel comfortable bringing up someone else's. I guess I should just get over that.

I would pass this one up the chain of command a little, at least to your resident. Life is hard enough as an intern. I've been the intern on a team with bad med students, and I've asked my senior for their help in continuing to work with the students on whatever issues they're have (the socially awkward thing, though, is a whole different challenge....I don't envy you at all on that one....). That should be part of the senior's job. As a senior resident I recognize that this is part of my job, and I'll take the extra time to work with med students who need it. BUT, this has limits for me too. I've been on a couple teams (one in particular), in which I felt the students were particularly bad (and my attending knew it, because she was there with me day in and day out), and so my attending and I sort of took them both on as a team, because trying to sort out all their issues was beyond me. Like your scenario, one of them was extremely socially awkward. It can be really difficult. But as long as your senior is cool, I'd at least involve him/her in trying to help you out with these students.

 

[Nerdoscience]

Yeah, the other problem is that there are two med students. The other one is really good, and not socially awkward. I feel like I am constantly under pressure to distance myself from the good med student to avoid looking like I'm playing favorites.

I'll have to bring it up with the fellow. The resident has left the service, and a new one is coming on tomorrow.

 

[Mumpu]

Talk to your residents and fellows. These things are usually obvious to everyone on the team. I do empathize with your frustrations -- I had a student a couple of months ago who was making me look terrible on rounds because he would not meet with me before rounding to go over patient presentations and plans.

My preferred approach is to repeatedly head-butt the bad student in the chest while screaming "No! No! No!"

 

[chicamedica]

i think you'd be doing a HUGE disservice to this student if you dont give him some (constructive) feedback. He may be a 4th year med student but perhaps this is how all his residents approached him during 3rd year--just talking behind his back about how awful his presentations and history taking skills are, but never really explaining to him what they SHOULD be. It doesn't take much time on your part, and the 10-15 minutes you spend with him kinda teaching him this foundation may be all he needs to turn himself into a star on the floors.

As far as bad med students go, at least as far as MS3s go (i know this case is about an MS4), the ONLY thing that makes me consider a med student bad is if he or she is uninterested in learning. How do i see this? If i am considerate enough to take a student with me to go see something interesting or teach him/her how to do something useful and they make excuses (like they need to go type up an H&P that they were supposed to do on non-hospital time) or flat out REFUSE--THAT is a bad med student. I am actually working with an MS3 right now who is pretty good with the floorwork and the presentations. However, she lost total favor in my eyes when she refused to come with the team to see microscopy on an interesting urine specimen, because she'd "already seen urine being spun" on a prior rotation and wasn't interested!! Well, let me tell you, she missed out on a golden learning opportunity, because this was a complex case, and the most student friendly renal attending actually happened to stop by when we were looking at the urine and gave us some great teaching. Hey, her loss. . .bad med student though.

If it takes em forever to do things it's fine, I forgive that. If i offer advice and they dont improve, or if my advice or teaching is not wanted, that is a sign of a bad med student.

 

[DarksideAllstar]

i think you'd be doing a HUGE disservice to this student if you dont give him some (constructive) feedback. He may be a 4th year med student but perhaps this is how all his residents approached him during 3rd year--just talking behind his back about how awful his presentations and history taking skills are, but never really explaining to him what they SHOULD be. It doesn't take much time on your part, and the 10-15 minutes you spend with him kinda teaching him this foundation may be all he needs to turn himself into a star on the floors.

The OP had mentioned that he has already spent time with this student offering constructive criticism, but without seeing any improvement.

 

[SleepIsGood]

To the OP, hats off for taking time out and trying to teach the student. Here's my advice. I'm sure the residents/fellow on your team can see for themselves what you are describing. Med Students arent expected to be rock solid on their presentation skills, nor in my opinion are interns. Having said that. I think what mks a med student bad, is if they completely skip the rotation or do not show interest in anything. Sure they dont have to come with me to see urine being spun, but they should be there in the AM just as early as me to pre-round. Luckily I've yet to see a 'bad student' yet. I praise you for taking time out of your busy as heck day and attempt to teach the kid. He'll turn around. Plus, he may not need to, depending on what specialty he's going into.

 

[Hopefulmeds]

As a 4th year student myself, I can tell you that if that student hasn't 'gotten it' by now after doing 6 core rotations, he/she's probably not going to improve by listening to your comments. I think you have done your part in trying to help this student. I have been on rotations with students like that who have no idea what they are doing, and I'll tell you that many of them are hopeless and will probably only understand where they went wrong when they become residents themselves...I hope. I definitely think that, if this student is hindering you, you should bring it up with the senior resident.

I also don't think you should feel that you have distance yourself from the better medical student just because you don't want to play favorites. In fact, I think you should at least tell that medical student that he/she is doing really well so that they continue to keep up the good work.

 

[emtcsmith]

The best you can do is make sure the student knows the correct way to do things, that you explain and state in specific terms how everything is to be done. Like it was said it is possible that nobody ever showed them "it" and you can't blame the student for not knowing in that case. If they made it this far obviously they are not stupid so do what you can and then go up the chain of command if you can't

But on a lighter note....watching urine spin just doesn't seem all that exciting to me anyway.

 

[chicamedica]

The best you can do is make sure the student knows the correct way to do things, that you explain and state in specific terms how everything is to be done. Like it was said it is possible that nobody ever showed them "it" and you can't blame the student for not knowing in that case. If they made it this far obviously they are not stupid so do what you can and then go up the chain of command if you can't

But on a lighter note....watching urine spin just doesn't seem all that exciting to me anyway.

well that's cause the spinning of the urine was only a prelude to the more fasinating view of the sediment under the microscope as well as a valuable lesson about a lady that ended up dying cause my own attending was mistaken about the cause of her ARF. The med student missed out on what was a huge learning opportunity for everyone on the team. It wasn't like she was doing much else at the time either. I mean, if she were stuck in the middle of a procedure or going to do one, i could understand, but no. . .she was just idling.

btw to the OP, kudos to you if you tried giving some feedback to the med student. It might take more than just feedback though. . .perhaps every time he presents he should get comments like "that should go in the physical exam section" "that belongs in the labs section," "mention that at the end with the plan". These are comments the resident should give tho (not you), so i agree with turning to your seniors about this. Also in terms of history taking, it could benefit the student to see how you take histories. From personal experience, i thought there was not enough of that kind of instruction in med school. . .too much of it was just sending the students into the pt's room blindly and then just asking the students how it went, leaving them not much more in the know about what they should REALLY be doing. I learned the most from experiences where a resident or attending would observe me or when we would both "tag team" and take the H&P together. I think this student would really benefit from something like that.

 

[gutonc]

I learned the most from experiences where a resident or attending would observe me or when we would both "tag team" and take the H&P together. I think this student would really benefit from something like that.

Even as an intern, I like the tag team approach w/ my senior. I know I forget things and everybody has a method I can learn something from. I know it slows everything down a bit but I think it makes my H&P's better and, in a few months, I'll ripping through them, not skipping a beat and getting most/all of the information I need.

BE (now PE)

 

[chicamedica]

Even as an intern, I like the tag team approach w/ my senior. I know I forget things and everybody has a method I can learn something from. I know it slows everything down a bit but I think it makes my H&P's better and, in a few months, I'll ripping through them, not skipping a beat and getting most/all of the information I need.

BE (now PE)

same here, but actually i think it speeds things up!! That's why we do it, esp on overnight call. As a med student, at the very least,it really helped to go in to see the patient with the resident after i'd seen the patient on my own and presented to the resident. Most of the time, i had to do so on my own initiative (i.e. residents dont usually invite you to come with them). In retrospect though, i did learn a lot that way as well.

 

[8744]

...However, she lost total favor in my eyes when she refused to come with the team to see microscopy on an interesting urine specimen, because she'd "already seen urine being spun" on a prior rotation and wasn't interested!!

Good lord. Your medical student has more balls than most of us who would just kiss ass and pretend to be interested and she should be commneded. I know that the urine-spinning party turned out to be educational after all but it sure must not have sounded that way to her (or any rational observer) when initially presented.

"Hey gang! Let's go down to the lab and watch 'em spin some pee!"

I did a pediatric surgery rotation last month and had to scrub in on a lot of cases. I'm not a surgeon, all I did was hold retractors, and after a few minutes the anatomy wasn't even that interesting. I assure you, as an Emergency Medicine resident or physician I will never, ever, have to do a nissen fundiplication or a ventral hernia repair which was the typical procedure I had to suffer through.

Educational? maybe.

Useful? Definitely not. The eight hours I spent standing around holding an retractor could have been better spent reading Tintinalli. Hell, I would have rather been watching TV for all the good it did me.

I think your medical student just has a good idea of what's high yield, what's low yield, and more importantly, what's "no yield."

 

[tr]

I also don't think you should feel that you have distance yourself from the better medical student just because you don't want to play favorites.

Urgh, I think this is a bad scene. I just came off a rotation where I was the 'good' med student. First off, the two interns were complaining to me about the 'bad' med student and comparing us directly - so not cool. I felt like I had to defend the other student, or explain her behavior, or something. It was totally awkward. Second, the intern who was paired with the 'bad' med student basically gave up on her and started trying to give her work to me instead (stuff on her patients that he didn't think she was competent to complete). Absolutely, positively, incredibly not cool.

So I think too much distance is preferable to going too far in the other direction. It's too bad if you feel the 'bad' student is ruining your relationship with the 'good' one, but I would really try to avoid being obvious about treating them differently.

 

[SleepIsGood]

I think it's totally poor form when two or more residents criticize med students or other residents amongst each other. If a severe deficiency is seen, why not talk it over with an attending? I think students/interns reputations are wrongly maimed by residents and others talking unfairly about them in the public arena.

 

[Mumpu]

You guys have some ballsy med students. "No thanks, I don't want to learn" is not even an option, especially for an MS3.

For the record, spinning urine is always a "golden" learning opportunity.

 

[SleepIsGood]

You guys have some ballsy med students. "No thanks, I don't want to learn" is not even an option, especially for an MS3.

For the record, spinning urine is always a "golden" learning opportunity.

LOL.. yup. I dont think I would have ever said, forget about it as a med student. Now when you're a resident and you have seen somethng likethis done before and have 1000 things to do...it's a different story.

 

[tr]

"No thanks, I don't want to learn" is not even an option, especially for an MS3.

I'm with PandaBear on this one. It didn't sound like a likely learning opportunity if the student had already seen it once - bad luck that it turned out to be. I wouldn't do something that I thought was a waste of my time either. What does being an MS3 have to do with it?

 

[Faebinder]

I'm sorry you feel turned off by the student.. I agree with Panda Bear. What if the student wanted to be a psychiatrist.... how critical is that urine sample to his/her career?

I donno... I believe in learning and motivation but I do realize medicine is HUGE and if topic A sounds great and critical to me then it doesn't mean it is critical to everyone else.

*I am sure MS3/MS4 who are now applying to residency are thinking, I am going into XXXX field, I finished my boards, I am not very interested in this YYYY field.*

Now if the students slacked on their work on the floor.. that's a different ball game.

 

[chicamedica]

You guys have some ballsy med students. "No thanks, I don't want to learn" is not even an option, especially for an MS3.

For the record, spinning urine is always a "golden" learning opportunity.

TOTALLY agreed, with you Mumpu, and with you sleepisgood. As a med student i had a policy of never saying no to any opportunity offered to me. It wasn't because i was sucking up, but because i didn't want to miss out on a learning opportunity. There were so many situations in which the residents wouldn't even think about "inviting" the med students and where i had to be assertive and basically invite myself (assuming i heard about it in time--sometimes i found out after the fact 🙁 ), that i was always very grateful for any unsolicited teaching, no matter how small it might have seemed at first.

p.s. that urine was actually BLACK. i cant imagine how anyone wouldn't be curious to see what's in it.

 

[chicamedica]

I'm sorry you feel turned off by the student.. I agree with Panda Bear. What if the student wanted to be a psychiatrist.... how critical is that urine sample to his/her career?

I donno... I believe in learning and motivation but I do realize medicine is HUGE and if topic A sounds great and critical to me then it doesn't mean it is critical to everyone else.

*I am sure MS3/MS4 who are now applying to residency are thinking, I am going into XXXX field, I finished my boards, I am not very interested in this YYYY field.*

Now if the students slacked on their work on the floor.. that's a different ball game.

See now, i dont understand this philosophy people have. Everything in medicine is relevant and interconnected. If someone's going into psych, this could be the last time they GET to see a urine microscopy. Do psych patients never get ARF? Wouldn't it be helpful to know whether a patient is out of it cause of uremia, on a psych consult?

Anyway, what about just learning for the love of learning??? It's appalling how some people limit themselves to learning only what seems 'relevant' to their field. Everything's relevant.

I guess we have different grading criteria. I prefer that the student be inquisitive, curious, and not lazy. Good floorwork is a plus of course, but that is something that one learns with experience. Frankly every resident is still perfecting their own floorwork technique. The students' curiosity should extend to learning how to do various floorwork things because that is how they will learn. Of course slacking=laziness so that's never good. but if they're slow but trying hard that's totally excusable. . .they just need some pointers.

 

[tr]

Everything in medicine is relevant and interconnected. If someone's going into psych, this could be the last time they GET to see a urine microscopy... Anyway, what about just learning for the love of learning???

I agree with this; but again, some things on the floors are a great learning experience and others are an enormous waste of time. Seems like the med student in this case confused one for the other; but that doesn't sound like such a huge transgression to me.

 

[Nerdoscience]

We actually do use the "tag team" method. I usually end up having to re-direct the interview about 5 or 6 times. And once, they used my H+P to present with my permission, and STILL managed to leave out important facts. They would have done better just reading it off the page!

So, I don't report to a resident; it's a fellow-run team. Should I go to the fellow, then?

 

[chicamedica]

We actually do use the "tag team" method. I usually end up having to re-direct the interview about 5 or 6 times. And once, they used my H+P to present with my permission, and STILL managed to leave out important facts. They would have done better just reading it off the page!

So, I don't report to a resident; it's a fellow-run team. Should I go to the fellow, then?

Hmmmm, well i remember one thing that helped me learn what's pertinent and what's not when i was on my first MS3 rotation (which happened to be inpatient medicine) was when the resident had me highlight the pertinent stuff in my H&P with a highlighter before rounds and going over that together. That said, as an intern, i'm still not always perfect about it 😛

Another thing you could do is. . .before going in to see the patient together, have the student think of the differential and go over what would be the important questions to ask.

 

[8744]

...Anyway, what about just learning for the love of learning??? It's appalling how some people limit themselves to learning only what seems 'relevant' to their field. Everything's relevant...

I agree. On the other hand at the end of the day I just want to go home. Especially when I'm post call. Your attending can be enthusiastic for teaching but he wasn't up all night and has had a shower and a shave.

 

[lattimer13]

Does anyone have advice for how to deal with/help bad med students? I am an intern, and I am working with a med student who doesn't seem to get it. In addition to being socially awkward (which I withhold judgment on until I see the rest of the picture), they also have no sense of what is clinically relevant at all.

Maybe you are thinking that this is normal this time of year. But the student is a fourth year! I have already sat down with them and had a long talk about rounding and presentations, but they didn't get any better. They just obsess over things that don't matter at all, and present things in a nearly random order. They will also mention things, then don't explain them. They have spent time taking very detailed social histories on patients who are oriented times one. They have presented in-depth information about a patient's pajamas. They have made utterly inappropriate comments, but seem to have no clue.

It's really frustrating, and I don't want to give them a bad eval unless I feel I made every effort to give them constructive feedback.

Any advice?

are you talking about me? 🙁

 

[Samoa]

OK, speaking from a student perspective, I would have gone to see some black urine get spun. But good Lord, people come to medical school from all different backgrounds, and what's educational for one may be a total waste of time for another.

 

[Nerdoscience]

I might have to use the highlighter thing. That might help. I do encourage the students to do any exam (that doesn't inconvenience the patient) or do any research that they want to on any of the patients if they have time. But I'm not talking about that. I'm talking about when it's time to get down to business with the team.

 

[erichaj]

Set by example, when they don't present correctly, slow them down, make them go back to where you feel they have to start from. Give them a template to what they should present first.

If they don't present a patient the way you want, YOU present the patient as an example for them.

This is teaching. I know it takes lots of effort. But, you sound like you care enough to teach this or these med-students how to be better.

If you have done all of that and they still don't want to make an effort, then you have done all you can do.

Also remember that if you are noticing this problem, other are too.

 

[Mumpu]

It shouldn't matter what specialty you go into. If you don't pay attention in psych because it's "not relevant", you won't know how to do a depression screen or how to work up delirium. If you don't pay attention in medicine or surgery, you can kill your psych patient by failing to recognize a problem. This is why psychiatrists rotate through IM and neurology during their residency.

Urine micro and blood smears are fairly "old school" procedures. You won't learn them from books and a lot of residents and attendings don't know how to read them. To say "no" to something like that is pretty stupid.

 

[allylz]

These med students are stupid if they don't know how grading works. Either that or just apathetic and deserve bad grades.

For all my core rotations I was provided with a copy of the form used to evaluate me. Therefore I always knew that people were going to rank me on 'personal attitudes' (enthusiasm) and several of them included places to be ranked on 'feedback' (which the form would explain meant that the student actively sought feedback, and that they worked to improve based on feedback).

So to me there's no question that students who ignore these opportunities to make a good impression deserve bad grades. After all there is a lot of grade inflation in the clinical years anyway because I believe that the majority of medical students know how to act like decent people (at least I hope!) and also because of very kind residents and attendings like you guys. At least at my school, like 50% of students on many rotations get High Pass.

 

[tr]

These med students are stupid if they don't know how grading works. Either that or just apathetic and deserve bad grades.

I am neither stupid nor apathetic. Actually, I just don't give a fig for my grades. I am interested in learning this stuff for its own sake, because I find medicine kind of cool and because I am going to need to know it and use it pretty soon. But I am entering a specialty where the competition is pretty minimal, and frankly I see no reason to pretend I'm interested in something that isn't actually going to be a learning experience for me. I'm way too old and grumpy to go kissing some 25-year-old intern's @ss for something as irrelevant as a grade.

And I think it's kind of funny and telling when people use this 'grade' business as a carrot or a stick. It just reveals them to be typical grade-grubbers, the very same ones who were always asking "Is this on the test?" back in the premed days. It was pathetic then and it's pathetic now.

(Btw I agree about the black urine example specifically being interesting; but there are plenty of other 'opportunities' on the wards to waste your time and learn nothing of any utility.)

For the OP: I wouldn't spend any more time on this student than you have on any other. The student is an independent adult human being; just give him appropriate feedback and let him make of it what he will. Then evaluate the student fairly. Why stress yourself out about it?