Between an Attending and a hard place

[Stare Decisis]

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Medical students are expected to be somewhat deferential to attendings and resident, with that in mind, tell me how you guys would approach the following situation. An attending is pimping one of the residents and the resident does not have the answer. To further denigrate the resident the attending goes to a medical student for the appropriate response. If you know the correct answer should you:

A. Pretend as though you do not know, because it does help medical student to have the support of residents when rank list are being made

B. Answer the question, hopefully impressing the attending but running the risk irritating the resident.

Neither of the above seems to be a satisfying route to take. I know the residents were on call throught the night and may have not had the time to read for lecture, it seems somewhat unfair for a medical student to capitalize on this. Why do attendings do this? They have to be aware of the position they are placing the students in.

On another note, as a student if you write a paper and do the majority of the writing, do you expect to be first author? I got into a discussion with a friend of mine and I feel that sometimes as students we take one for the team and hope to be rewarded on the back end. What do the residents and attendings on the forum think?

 

[rongeur]

Medical students are expected to be somewhat deferential to attendings and resident, with that in mind, tell me how you guys would approach the following situation. An attending is pimping one of the residents and the resident does not have the answer. To further denigrate the resident the attending goes to a medical student for the appropriate response.

It depends on the attending and the resident. You can't write rules for situations like this, you have to feel it out. If it's the chairman, you answer the question. If it's some malignant guy that nobody likes, take the hit and cover your resident. And it's also different whether he's asking "Describe step by step how you would repair a Tessier 9 cleft" or "What's this big pulsing pipey-looking thing next to the IVC?".

The only hard and fast rule IMO is don't open your mouth unless he specifically asks you.

 

[Gozar]

The only hard and fast rule IMO is don't open your mouth unless he specifically asks you.

Never jump on a drowning ship.

As far as papers go - you should not get to the point where the paper is finished and you don't know how authorship will work out. It is an incredibly difficult and awkward conversation to have, but you need to have it near the beginning of the project. As a med student you have very little to offer the project besides your time. For the most part they could easily replace you and get someone else to do the work instead. Sometimes this isn't true - but even in that situation, once the work is done and you lose total control. The PI is only guaranteed to be cordial to you before the work is completed, once they have the figures and the text they will start to do what they want and what is in their best interest. If you haven't discussed authorship at this point you should be prepared to be totally screwed over. People in these positions tend to have a very poor understanding of how much effort you put in and will vastly overstate how much they did get to the project to the end. Translation - you lose.

 

[deleted144060]

People in these positions tend to have a very poor understanding of how much effort you put in and will vastly overstate how much they did get to the project to the end. Translation - you lose.

I will take some exception to this. While students experiences might differ, I never felt like I got screwed over as a med student with paper writing. As an attending, I have (and I think most do) a very good understanding about how much work goes into a paper and who is doing the majority of it. While I have not always discussed authorship ahead of time, I and my partners do our best (and again, I would think that most would) apportion authors according to the amount of effort.

Communication is the key as is persistence. I have a couple of papers sitting on my desk that were supposed to be finished by students and residents. If I end up doing the writing, their names are going to move down the author list.

As an aside, you should be prepared to discuss any paper on which you are a listed author. Once or twice during the interview season, I'll ask a candidate questions about their paper that they can't answer. And they're not difficult questions. They're questions my mother could answer after she read it.

Cheers.

--M

 

[maxheadroom]

I think students underestimate their role in most of the papers. The idea is rarely theirs. The patients obviously aren't theirs. The funding to do the project is rarely theirs. The interpretation of the data is often quite dependent upon the attending. While the students often do the busy work of getting the data and compiling it in a way to do analysis, their role is usually fairly minor in the long run.

Don't worry about what position you're on as author when you're a student. All you want is to be listed on a paper and be able to talk about it when Moravian or one of his colleagues asks you about it. Worries about authorship are for junior faculty who are bucking for tenure.

 

[deleted144060]

I think students underestimate their role in most of the papers.

Did you mean "overestimate?"

 

[Stare Decisis]

"While the students often do the busy work of getting the data and compiling it in a way to do analysis, their role is usually fairly minor in the long run."-Maxheadroom


I really wish this was the role I played in the majority of my papers. On one paper I did the grunt work and was put third on the paper. Although, the analysis and writing was done by the fellows and faculty. It was accepted to PRS and I was tickled pink and I thought it was more than fair. The rest of papers however, I received a hodgepodge of unanalyzed data and was told what journal we would submit to and to give the resident/fellow/faculty a draft in a reasonable amount of time. Most of the time they accepted 90% of my work unrevised, but it was a rush just to have my thoughts in print. Sometimes I ended up first and sometimes I didn't. I did not care, the experience and opportunity to impress was more than enough for me. I want to be trained as a plastic surgeon, if I write papers and then take a back seat, that is fine by me. The skills and knowledge I gained writing the paper are still mine and when I am hopefully an academic faculty member then I will be very well versed in the process. That was my point to my friend, I was just curious what the seasoned veterans thought.

If at the end of the day I can write a killer grant and do a killer Le Fort 3, I will claim victory.

 

[Stare Decisis]

dUPLICATE

 

[maxheadroom]

Whoops, "overestimate" would be what I meant.

 

[JackADeli]

...An attending is pimping one of the residents and the resident does not have the answer. To further denigrate the resident the attending goes to a medical student for the appropriate response. If you know the correct answer should you:

A. Pretend as though you do not know, because it does help medical student to have the support of residents when rank list are being made

B. Answer the question, hopefully impressing the attending but running the risk irritating the resident....

Always be honest. What are we back in the fifties where women were suppose to play dumb so as not to embarass their husbands at a cocktail part?

If you are asked a direct question and you know the answer, you answer it. Do not play dumb to falsely elevate the intellect of someone else or to falsely excuse the deficiencies of those around you. If the resident is worth anything, he/she will recognize you know the answer and he/she should also know the answer. If a student is learning more then the resident then it means the resident is not doing a good job and who is actually asking the question is irrelevant. Residents need tough skin. A resident that lacks knowledge should go and study and not misdirect their anger at the student. The resident should be irritated with themselves not the student.

The dynamics between the residents and attendings are in general not your concern and you should not be analizing it nor should you be trying to rationalize the performances of the residents. You do your job as a student, you study, and score well on your exams, etc...

...I know the residents were on call throught the night and may have not had the time to read for lecture, it seems somewhat unfair for a medical student to capitalize on this. Why do attendings do this? They have to be aware of the position they are placing the students in...

They are quite aware.... they are putting you in a position to learn... so learn. What if you didn't know the answer? Should the conversation stop there so as to not embarass someone or hurt someone's feelings? They should not refrain from teaching simply because your knowledge may embarass a resident. You knew the answer as a student. The resident was once a student long before that night of on-call... he/she needs to learn the answer.

 

[igap]

Medical students are expected to be somewhat deferential to attendings and resident, with that in mind, tell me how you guys would approach the following situation. An attending is pimping one of the residents and the resident does not have the answer. To further denigrate the resident the attending goes to a medical student for the appropriate response. If you know the correct answer should you:

A. Pretend as though you do not know, because it does help medical student to have the support of residents when rank list are being made

B. Answer the question, hopefully impressing the attending but running the risk irritating the resident.

Neither of the above seems to be a satisfying route to take. I know the residents were on call throught the night and may have not had the time to read for lecture, it seems somewhat unfair for a medical student to capitalize on this. Why do attendings do this? They have to be aware of the position they are placing the students in.

On another note, as a student if you write a paper and do the majority of the writing, do you expect to be first author? I got into a discussion with a friend of mine and I feel that sometimes as students we take one for the team and hope to be rewarded on the back end. What do the residents and attendings on the forum think?

With respect to your first question:

At my institution the questions are usually directed toward the students first, and then on up the chain all the way to chief resident until someone gets the answer, not the other way around. Same thing when I was in med school. But, to answer your question, go ahead and answer any question you get asked. Good residents aren't going to look down on you because you're taking your education seriously, and are reading. I usually prep the students before a case on the attending-specific pimp questions because if the students miss them then my attendings give me a hard time for not ensuring that the students are adequately prepared to enter the OR. That said, don't blurt out answers to questions that are not directed to you. No one likes a show-off.

For the paper-writing question:

As a medical student, you need to decide what your goals are. If you are writing a paper with a plastics attending, and are trying to match, then you should not care where your name is on the paper as long as it's there somewhere. In that scenario, the goal is not to be first author but to get a publication and to be helpful to the team so that you can get a good recommendation and be thought of well at match time. Most, but not all, attendings will recognize the work that you have put in and assign credit appropriately.

Good luck!

 

[deleted144060]

The dynamics between the residents and attendings are in general not your concern and you should not be analizing it nor should you be trying to rationalize the performances of the residents.

Amen to that.

--M

 

[Stare Decisis]

Amen to that.

--M

That is interesting, because a student who was rotating at my home program always piped up when a question was directed toward the crowd. On occasion she answered questions from the chariman who had indeed asked a resident first. She appeared very well read and generally got the question correct. After she left, the residents stated how annoying she was and how she was unaware of her place as a medical student. The residents have informed that they have considerable say on how students are evaluated and ranked, this would appear to hurt the aforementioned student

On the other hand observing the relationships between attendings and residents would seem relevant, since you hope to be in that position someday. I have been instructed that a good way to judge a program is to evaluate how the residents interact with the faculty.

There does not appear to be a "cookbook" answer to this question, but hopefully the problem will not come up at other places.

Thanks for your responses

 

[deleted144060]

Don't misunderstand me. If a resident doesn't have the answer to a question and the students are asked, they should not play stupid. We get a lot of students on the service and not a lot of time to evaluate them. For me, if my resident doesn't have an answer, I will generally take that opportunity to teach rather than see if the students can embarrass him/her. Unless, of course, they haven't read for the case they're about to do and then they're fair game.

On the other hand, students who speak out of turn are generally disliked by everyone. That is a great way to annoy the residents and, by proxy, the attendings. There are few things that bother me more than students who try to make themselves look good at the expense of others.

As to your other comment, as a student you really only know what happens on the surface between attendings and residents. There might be ongoing issues with which you are completely unaware. These are six year residencies and you only get a 2 or 4 week window to catch a glimpse of how things work.

--M

 

[maxheadroom]

I agree with Moravian. He's a smart guy . . . most of the time.

Students should answer all questions posed to them to the best of their ability. If you start jumping on questions that were intended for someone else, you will quickly be labeled a showboat/know-it-all/tool and the residents will go out of their way to make sure that you don't match.

 

[JackADeli]

...as a student you really only know what happens on the surface between attendings and residents. There might be ongoing issues with which you are completely unaware. These are six year residencies and you only get a 2 or 4 week window to catch a glimpse of how things work...

Exactly!!! These residents/fellows/etc... are the ones working with these attendings daily over periods of years, through in-service examinations, operative pimping, conferences, etc... These are the people attendings speak to at 02:00 in the morning. You are not going to have any real perception of how deep the water runs just because of the relatively few pimp sessions you happen to be at during your medical school rotation. While a specific chapter may have been assigned... that is really for the med-students benefit/guidance. Regular, daily reading and case specific reading is expected and should be ongoing regardless of this or that difficult call night encountered by the resident on this or that occasion. If you knew the answer as the student.... it is reasonable to expect the resident to know the answer.

 

[deleted144060]

I agree with Moravian. He's a smart guy . . . most of the time.

Right up until that time when I decided to be a craniofacial surgeon.

Thanks Max.

 

[maxheadroom]

Right up until that time when I decided to be a craniofacial surgeon.

Thanks Max.

Hey, it's still not too late to make the jump to Hand! Come see the light!!