Being supervised by NP

[sflkjweio]

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Short version:

I am on a 4 week psychiatry rotation and am working with a nurse practitioner who doesn't want a student for 2 weeks and then with an MD for 2 weeks. Should I complain to my course director at my school?

Long version:

I started the first day of my psychiatry rotation on yesterday. My site only has the capacity for 1 student but somehow accidentally took on 2 students. The attending physician realized the mistake and attempted to have both students do 2 weeks of inpatient psych with him and 2 weeks of psych with the consult team. In the meantime, he asked a nurse practitioner if I could work with her in the interim, and she literally told the attending "no" with me standing right next to her. I ended up having to work with her for today, and it was obvious that she didn't want a student. I don't blame her either. She didn't sign up for that.

At the end of the day, I went to touch base with the attending about working with the consult team. Apparently they don't want a student either, and it looks like I'll be working with the nurse practitioner who doesn't want me for 2 weeks. This feels like a waste of my team and a waste of my money. Should I just suck it up for 2 weeks or should I complain to the school? I'm not currently interested in psych at the moment, but it's not like I could exactly have a nurse write me a letter of recommendation for residency if I choose to do psych in the future.

 

[mppcc]

You need to explain your situation to the rotation director asap.

 

[ciestar]

Yeah this is something you should be bringing up with your clerkship director.

 

[Goro]

Yeah this is something you should be bringing up with your clerkship director.

And your school's Clinical deans!

 

[Psai]

You are spending good money to learn from doctors. It is not an np's responsibility to train doctors just as it is not our responsibility to train midlevels (although they seem to be put on our inpatient teams a lot).

 

[DocWinter]

Get your training from a physician. You’re not dropping all this $$ to learn from an unwilling Midlevel. Take this to the clinical dean stat

 

[Crayola227]

You are spending good money to learn from doctors. It is not an np's responsibility to train doctors just as it is not our responsibility to train midlevels (although they seem to be put on our inpatient teams a lot).

I don't know that I agree with that statement, in that if you are at an academic center that is all one institution and has a pharmacy school, nursing school, PA program, and MD program, it seems reasonable that just as MD students are taught alongside residents, that it's just one big healthcare team and PAs and others get put on teams too.

Where I went to school and then did training, in the ICU we did multidisciplinary rounds, with a pharmacist, and sometimes there was a pharmacist in training part of that. On my IM team in med school we have 1 PA with us. It's NBD.

It's one thing if people are being stuck with supervisors that have no place supervising them, like NPs that aren't part of a teaching service.

 

[evilbooyaa]

I agree with posts 2-6. This is unacceptable for a medical school - a screw up on their part should not mean your education goes to trash.

 

[Aerus]

NPs should not be supervising med students. I would be furious.

 

[Staphylococcus Aureus]

Report back to us after you have notified your school. This is in no way acceptable.

You’re hurting other future student physicians if you don’t step up and call this out to your school. You are paying an extreme amount to, at best, be trained for the wrong position? At worst you will kill someone because you didn’t learn something you needed to from a doctor but instead had a nurses level of understanding.

 

[ndafife]

Surprised that all the focus is directed toward the NP aspect of this.

OP, you've gotten the right advice here. If your forced to go with anyone regardless of their position (MD, DO, NP, PA) who has made it blantantly clear that they do not want a student, you need to report it.

 

[LutGholein]

You’re paying to be taught the art of medicine by its practitioners— especially going into 3rd year clinical exposure— I really hope what they did to you is more of an exception than a rule. Maybe try to contact your clinical dean/coordinator and explain the situation. This would really harm you if you did have a interest in that specialty.

 

[raiderette]

Surprised that all the focus is directed toward the NP aspect of this.

OP, you've gotten the right advice here. If your forced to go with anyone regardless of their position (MD, DO, NP, PA) who has made it blantantly clear that they do not want a student, you need to report it.

Why would you be surprised by the focus on NPs? They are taught and practice under a nursing model. We are learning to become physicians. NPs don't have a clear understanding of where we are in our training, and this particular NP doesn't want OP there. If it can't be changed, then OP should get equal time with the physician. It is a bad situation and students shouldn't have to pay for inferior training.

 

[ndafife]

Why would you be surprised by the focus on NPs? They are taught and practice under a nursing model. We are learning to become physicians. NPs don't have a clear understanding of where we are in our training, and this particular NP doesn't want OP there. If it can't be changed, then OP should get equal time with the physician. It is a bad situation and students shouldn't have to pay for inferior training.

I figured the outrage would be more about OP being put at a site that clearly doesn't want them. Would this situation somehow be better if OP was with the consult team that also does not want a student?

 

[Taddy Mason]

If your forced to go with anyone regardless of their position (MD, DO, NP, PA) who has made it blantantly clear that they do not want a student, you need to report it.

Have you ever actually dealt with this, or any similar issues, with admin at your school? It’s an act of futility.

 

[ndafife]

Have you ever actually dealt with this, or any similar issues, with admin at your school? It’s an act of futility.

Yeah? And?

Its better there is some documentation than letting things go on so the administration can say, "Nobody complained about this so it must not be an issue"

 

[Taddy Mason]

Yeah? And?

Its better there is some documentation than letting things go on so the administration can say, "Nobody complained about this so it must not be an issue"

Admin is going to say that regardless unless you hold onto ALL documentation. If you’ve dealt with admin at said school you should know this....

 

[ndafife]

Admin is going to say that regardless unless you hold onto ALL documentation.

Yeah? And?

Then hold on to the documentation. Its not a difficult thing to do.

 

[Taddy Mason]

Yeah? And?

Then hold on to the documentation. Its not a difficult thing to do.

K. So you clearly haven’t ever dealt with these issues with admin - there’s a reason I put ALL in caps, it’s not as simple as just holding onto e-mails. To avoid derailing this thread further, the observation I’m making is the irony of your advice coming from a school that actually relies heavily on mid levels for educating 3rd and 4th years, regularly puts students with preceptors who make it clear they have no interest in teaching, and is extremely resistant to student concerns regarding these and numerous related issues. These were some of the main reasons said school barely missed being placed on probation by the LCME 3 years ago and had to go through 2 reaccreditation processes.

 

[ndafife]

K. So you clearly haven’t ever dealt with these issues with admin - there’s a reason I put ALL in caps, it’s not as simple as just holding onto e-mails. In light of derailing this thread further, the observation I’m making is the irony of your advice coming from a school that actually relies heavily on mid levels for educating 3rd and 4th years and is extremely resistant to student concerns regarding this and a plethora of other issues - this was one of the many reasons said school barely missed being placed on probation 3 years ago.

So because you didn't have success in your anecdotal scenario that means that I couldn't have had success dealing with administrative issues?

 

[Taddy Mason]

So because you didn't have success in your anecdotal scenario that means that I couldn't have had success dealing with administrative issues?

That wasn’t my point, which I made clear in the post you quoted after you failed to read between the lines.

 

[Ho0v-man]

Eff that! Ain’t writing a six figure check to these clowns to get trained by someone with an online degree in advanced nursing whatevernress.

To those who think this is no big deal and we’re all on the same team blah blah blah, just keep in mind that RN students are not allowed to be trained by LPNs. Seriously.

 

[Aerus]

I figured the outrage would be more about OP being put at a site that clearly doesn't want them. Would this situation somehow be better if OP was with the consult team that also does not want a student?

Yes it would better even if it's not ideal. Not all preceptors have the same enthusiasm for having to oversee a medical student. It happens. Doesn't mean the student can't learn medicine out of that.

 

[Staphylococcus Aureus]

“All on the same team” argument is laughable. No one would say a quarterback paying $50k/yr to be trained by linemen is a good idea. Yes they’re on the “same team with the same goal” but he’s going to be in trouble when everyone needs him at QB and he only knows how to stand up and block.

 

[sflkjweio]

Thanks to all the replies. I was just wanting to make sure I wasn't making a mountain out of a mole hill before talking to the school.

Here's the update: I was very adamant with the attending and said three times that I wanted to be with an MD. Now I'm with the attending for 4 weeks, but there's also another student so it's a less than ideal situation. Since there's two students, and the attending said that's too much, I definitely get the feeling that I'm only getting the half the experience that I should. However, I'm just going to suck it up because I don't think there's a better alternative.

 

[evilbooyaa]

Thanks to all the replies. I was just wanting to make sure I wasn't making a mountain out of a mole hill before talking to the school.

Here's the update: I was very adamant with the attending and said three times that I wanted to be with an MD. Now I'm with the attending for 4 weeks, but there's also another student so it's a less than ideal situation. Since there's two students, and the attending said that's too much, I definitely get the feeling that I'm only getting the half the experience that I should. However, I'm just going to suck it up because I don't think there's a better alternative.

Good. However, your school still needs to know about this, including the clerkship director, and if you don't get an adequate response of "oh yes this is bad we need to make sure this doesn't happen again", then you move it up the chain. You're right that unfortunately there isn't a whole lot else you can do for this rotation for yourself. However, you may save somebody next year from the same situation by speaking up.

When a rotation is supposed to have 1 student and it has more than 1, (especially in a clinical scenario) then it is less than ideal education. We all slam admin all the time but most of the time, but they likely want their students to feel like they got a good education (or at least as much of an education as the student wanted), because although you may see yourself as just dollar signs to them, you're going to be their indirect marketing for the rest of your career, when you mentor other students, etc. They'd prefer that marketing be positive than negative.

 

[RNthenDoc]

Was the NP a cathopathic physician?! That makes all the difference, tbqh.


This is a joke. Please treat it as such.

 

[IMGASMD]

Was the NP a cathopathic physician?! That makes all the difference, tbqh.


This is a joke. Please treat it as such.

I don’t understand... I thought they are doctors too. /s

 

[ortnakas]

I had one rotation third year when I spent some days with a NP; I didn’t mind because I actually got to see/do more, it wasn’t every day, she was happy to teach me, and you could learn how to do Pap smears from pretty much anybody. We should be mostly training with physicians, but I don’t think a day or two with an allied health professional is going to be the death nail in anybody’s education.

However, if any of those things weren’t the case, I definitely would have brought it up to my school, and you should too.

 

[Winged Scapula]

Students need to stand up and present a united front about this.

The LCME has admitted that with the growth in number of schools (including Caribbean programs and DO programs with the merger) there will continue to be difficulty in finding clinical placements for all future students.

Their own standards do not require clinical faculty to have an MD or DO, instead using (perhaps intentionally) vague requirements that faculty be “lifelong learners“ etc. This opens the window to allow them to use mid levels and other non-physician faculty to teach medicine. Schools may individually set standards which exceed those of LCME Which should be available to all students freely.

 

[Goro]

Students need to stand up and present a united front about this.

The LCME has admitted that with the growth in number of schools (including Caribbean programs and DO programs with the merger) there will continue to be difficulty in finding clinical placements for all future students.

Their own standards do not require clinical faculty to have an MD or DO, instead using (perhaps intentionally) vague requirements that faculty be “lifelong learners“ etc. This opens the window to allow them to use mid levels and other non-physician faculty to teach medicine. Schools may individually set standards which exceed those of LCME Which should be available to all students freely.

I suspect that it will now be incumbent upon med school interviewees to ask whether rotations are precepted by midlevels....but do ask in a neutral manner.

 

[IMreshopeful]

As a medical student the only service I had midlevels on directly working with me were outpatient OB (midwives in clinic seeing well pregnant followups the OB couldn’t be bothered about) and a bunch of PA/NP providers on our trauma surgery team. The midwives guided me through a pelvic exam but that was about it. The PA and NP providers didn’t actually teach much and spent most of their time doing paperwork and notes. So my experience wasn’t great with them. And even so, the attending was obviously still a physician so we learned from him on rounds.

I think by and large medical students should not be directly precepted by mid level providers unless there is an attending present to teach. As it were, many midlevels are already involved in teaching their own students and can’t split their time. So why make it harder?