Dealing with bad ob resident

[jerseytrash]

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If the student is lazy/unmotivated then I agree the student doesn't deserve the resident's time. If the student is genuinely trying hard, asking for feedback, and yet still can't figure out what he/she is doing wrong, then the resident probably isn't communicating properly. It really is a two-way street.

Yeah but I think residents sometimes misunderstand what comes off as lazy and unmotivated. My OB residents thought I was unmotivated simply because I was honest about going into a different specialty - which ticked me off because I worked hard, went to many deliveries, and enjoyed what I was doing. Ditto for many of my classmates...

 

[ijn]

Play the game bro. Residents and attendings don't want the truth despite what they say publicly on an internet forum. Suck their metaphorical dicks and tickle their metaphorical *******s. Yeah, you're not sure what you want to do yet and you're keeping an open mind. Oh man, yes your kids and dog pictures are SOOOOO interesting! Tell me more about your horrible boyfriend and/or husband! YES! This is all more important in getting honor level evals than if you can list the top 5 causes of postpartum hemorrhage off the top of your head, suture worth a damn, or even show up every day. If they like you personally then everything else benefits from the halo effect. Helps if you're handsome too (but not so handsome that they suspect you're gay.)

 

[jakeislove]

Skipped ahead because I wanted to ask mimelim a question.

Do you think a part of the problem is some students just going through the motions so residents feel their time is being wasted?

 

[Perrotfish]

Skipped ahead because I wanted to ask mimelim a question.

Do you think a part of the problem is some students just going through the motions so residents feel their time is being wasted?

I think you're giving residents too much credit for knowing what's going on with their students. Professional teachers, who have multi-year educations in teaching, who do nothing but teach and evaluate students for their entire work day, and who work with each class of students for a semester at a time still have a difficult time evaluating students in a fair, objective, and useful way without resorting to scantron tests. A resident has no training in education, no time allotted to educate people, often no interest in educating anyone, and works with you for a maximum of a month (normally much less). Do you honestly think your resident has any real idea whether you're really interested vs. going through the motions?

 

[jakeislove]

I think you're giving residents too much credit for knowing what's going on with their students. Professional teachers, who have multi-year educations in teaching, who do nothing but teach and evaluate students for their entire work day, and who work with each class of students for a semester at a time still have a difficult time evaluating students in a fair, objective, and useful way without resorting to scantron tests. A resident has no training in education, no time allotted to educate people, often no interest in educating anyone, and works with you for a maximum of a month (normally much less). Do you honestly think your resident has any real idea whether you're really interested vs. going through the motions?

It's pretty easy to recognize when someone's paying attention or improving over time, if you're paying attention.

I appreciate the perspective, though.

 

[mimelim]

Skipped ahead because I wanted to ask mimelim a question.

Do you think a part of the problem is some students just going through the motions so residents feel their time is being wasted?

To answer your question, yes it is a component. But, it is only a small piece of the puzzle. I agree 100% with Perrotfish, to add a little...

My personal philosophy toward education and what I think would be the ideal system for medical education is:

[fantasy land]As a student/junior resident, your job is to make your senior's job as easy as possible and ultimately make them look good in front of an attending.

As a resident, you are responsible in total for a student's education. A student screwing up while doing something the first time is the resident's fault. It is the responsibility of the resident to teach the student to the point that they understand enough to practice on their own.[/fantasy land]

[reality]It is completely unreasonable to expect people without an education background with zero outside motivation who are working 80 hours a week to go out of their way to look out for students. Even if the student is interested in the material, it is time consuming and requires energy that a lot of residents simply don't have.[/reality]

Personally, I get annoyed when people are disinterested. Not because I care what they are going into, in fact, I'd say I almost prefer the people not going into surgery, but because it is a waste of their and my time. I have things to teach any medical student, regardless of what specialty they are going into. And yes, I think a lot of residents feel the same way.

 

[jakeislove]

mimelim,

Thanks so much for the thoughtful reply!

Jake

 

[yappy]

I've heard ob was bad... Do you guys think it is because women self select for ob and are not great at handling chronic stress? I have worked with many women and they often lash out inappropriately when confronted with moderate stress plus work duties.

 

[ijn]

I've heard ob was bad... Do you guys think it is because women self select for ob and are not great at handling chronic stress? I have worked with many women and they often lash out inappropriately with moderate stress.

😍

 

[hrandani]

I've heard ob was bad... Do you guys think it is because women self select for ob and are not great at handling chronic stress? I have worked with many women and they often lash out inappropriately when confronted with moderate stress plus work duties.

It's not that often I laugh at something until I'm in tears but this really did the trick.

Ironic or in earnestness, it doesn't really matter. Five star comment.

 

[45408]

Yup mine too, it's actually even more explicit than I expected:

"The Resident/Fellow will ... as authorized by the teaching staff ... assume responsibility for teaching and supervising other residents/fellows and students."

I'm fairly sure most academic residencies, whether IM or surgical or peds, do have something about teaching because they are either affiliated with or are part of a medical school.

My program has a formal affiliation with a med school, and my contract says nothing at all about med students or teaching. I still try to teach, because people did it for me when I was a student.

 

[jerseytrash]

My program has a formal affiliation with a med school, and my contract says nothing at all about med students or teaching. I still try to teach, because people did it for me when I was a student.

Then you sound like a great resident. Maybe it's a surgery thing to not put it down in the contract? I dunno.

 

[Dwindlin]

Then you sound like a great resident. Maybe it's a surgery thing to not put it down in the contract? I dunno.

Doing a prelim surg. year and it's in mine.

 

[Stellar Clouds]

Then you sound like a great resident. Maybe it's a surgery thing to not put it down in the contract? I dunno.

I think it's an institutional specific thing. Residents from every specialty at my institution sign the exact same contract.

My contract does state that I must abide by the house staff manual, which does contain some specific paragraphs about teaching.

 

[jerseytrash]

Doing a prelim surg. year and it's in mine.

Well then... I got nothing

 

[NontradICUdoc]

I get evaluated by students and their evaluations are brought up in the 6 mon review. We are expected to teach students who are in our services.

 

[DarthNeurology]

Everyone I've come across, seems to have hated their OB rotation.

Some OBs are very nice people who care about teaching students. Understanding OB/GYN is critical for Family Practice, Peds (teenage female patients), IM (pregnant adult patients), and probably every other field out there to a greater or lesser extent.

However, I really believe that some OBs went into the field because they romanticized it too much, thought that they would mostly experience the joy helping parents bring their kids into the world. They get patients, and more often their family members, who get really pissed at them, and their job is not to *cure* patients, per se, but to make sure that nothing goes wrong and everything is peachy so that the mom goes through labor OK. Seriously, I think a lot of OBs went into the field because they thought it would be "happy".

For whatever reason, a lot of OBs feel entitled to treat students like crap, and to abuse and harass them. Is it cultural? Does OB self-select the really mean spirited? There are a lot of OBs I could not see being oncologists, or IM, Peds or a lot of other specialties as some of them are kinda rough.

 

[JourneyAgent]

I get evaluated by students and their evaluations are brought up in the 6 mon review. We are expected to teach students who are in our services.

That sucks actually. At what point did this constant evaluation become normal interaction. I should have a face to face conversation with my supervisor at the end of each rotation. They tell me how to improve. And I give them feedback on the learning environment. Done.

Making these things into scores is f'n ridiculous.

I keep a self-consistent philosophy that holds true north to the pointlessness of all of this. I give everyone perfect evaluations. Specific if positive. Otherwise generically perfect. And I never look at my evaluation. If they say it to me face to face its worth noting on how to improve.

We need a culture of rebellion against this perverse development of superficial customer service style of interactions. It's not the least bit educational. It's just a useless distraction from getting good at medicine.

And any med student who slams their overworked resident for not be overflowing with educational jewels should be punched in the throat.

 

[45408]

That sucks actually. At what point did this constant evaluation become normal interaction. I should have a face to face conversation with my supervisor at the end of each rotation. They tell me how to improve. And I give them feedback on the learning environment. Done.

Making these things into scores is f'n ridiculous.

I keep a self-consistent philosophy that holds true north to the pointlessness of all of this. I give everyone perfect evaluations. Specific if positive. Otherwise generically perfect. And I never look at my evaluation. If they say it to me face to face its worth noting on how to improve.

We need a culture of rebellion against this perverse development of superficial customer service style of interactions. It's not the least bit educational. It's just a useless distraction from getting good at medicine.

And any med student who slams their overworked resident for not be overflowing with educational jewels should be punched in the throat.

I make sure to give as much face-to-face feedback as possible. It's really not that hard...

 

[JourneyAgent]

I make sure to give as much face-to-face feedback as possible. It's really not that hard...

Exactly. We should do it occasionally. Not religiously and incessantly. A 2week rotation doesn't need a half way feedback and final and a grade. Then the grading becomes a dancing contest, instead of an education.

There's just too much god d@mn evaluation going on. It's aberrant behavior become normalized. We believe in it without question.

 

[ijn]

Exactly. We should do it occasionally. Not religiously and incessantly. A 2week rotation doesn't need a half way feedback and final and a grade. Then the grading becomes a dancing contest, instead of an education.

There's just too much god d@mn evaluation going on. It's aberrant behavior become normalized. We believe in it without question.

Can you please rate your pain on a scale from 0 to 10?

 

[jerseytrash]

I think it's an institutional specific thing. Residents from every specialty at my institution sign the exact same contract.

My contract does state that I must abide by the house staff manual, which does contain some specific paragraphs about teaching.

Yeah, makes sense. Weird, you'd think most teaching institutions would mandate it.

 

[jerseytrash]

Some OBs are very nice people who care about teaching students. Understanding OB/GYN is critical for Family Practice, Peds (teenage female patients), IM (pregnant adult patients), and probably every other field out there to a greater or lesser extent.

However, I really believe that some OBs went into the field because they romanticized it too much, thought that they would mostly experience the joy helping parents bring their kids into the world. They get patients, and more often their family members, who get really pissed at them, and their job is not to *cure* patients, per se, but to make sure that nothing goes wrong and everything is peachy so that the mom goes through labor OK. Seriously, I think a lot of OBs went into the field because they thought it would be "happy".

For whatever reason, a lot of OBs feel entitled to treat students like crap, and to abuse and harass them. Is it cultural? Does OB self-select the really mean spirited? There are a lot of OBs I could not see being oncologists, or IM, Peds or a lot of other specialties as some of them are kinda rough.

That's the age old question to be honest; I think the residents at academic institutions do tend to be more overworked and more mean spirited, but I've seen it at private institutions, with private attendings, and while the OB residents are doing their rotations at the private hospital affiliated with the academic center as well. Yet, some of the students I know going into OB seem to be genuinely nice people who are excited about what they're going to do. So...

The other thing that I find weird is that a lot of OBs want to think of themselves as surgeons, but they also want to be considered primary care authorities for women. I just don't think you can have it both ways.

 

[Stellar Clouds]

Some OBs are very nice people who care about teaching students. Understanding OB/GYN is critical for Family Practice, Peds (teenage female patients), IM (pregnant adult patients), and probably every other field out there to a greater or lesser extent.

However, I really believe that some OBs went into the field because they romanticized it too much, thought that they would mostly experience the joy helping parents bring their kids into the world. They get patients, and more often their family members, who get really pissed at them, and their job is not to *cure* patients, per se, but to make sure that nothing goes wrong and everything is peachy so that the mom goes through labor OK. Seriously, I think a lot of OBs went into the field because they thought it would be "happy".

For whatever reason, a lot of OBs feel entitled to treat students like crap, and to abuse and harass them. Is it cultural? Does OB self-select the really mean spirited? There are a lot of OBs I could not see being oncologists, or IM, Peds or a lot of other specialties as some of them are kinda rough.

In my experience, then attendings have been very nice, pleasant people to work with (minus 1 or 2, but this is certainly no more than any other field), but it's the residents who treated me like crap/could care less if I was still alive (except 1 or 2 who were genuinely nice and actually wanted me to learn something).

I think it is the atmosphere that does this. Starting as a medical student, they were probably treated like crap on their own obgyn rotations, so they think it's perfectly acceptable to treat their med students like crap when they become residents. On top of that, as interns, they are treated like crap by their upper levels, so they decide to take their anger out on the medical students. Perhaps there are a few who decide this is ridiculous and decide to treat med students like decent human beings, but it seems these are few and far between.

 

[jerseytrash]

I think it is the atmosphere that does this. Starting as a medical student, they were probably treated like crap on their own obgyn rotations, so they think it's perfectly acceptable to treat their med students like crap when they become residents. On top of that, as interns, they are treated like crap by their upper levels, so they decide to take their anger out on the medical students. Perhaps there are a few who decide this is ridiculous and decide to treat med students like decent human beings, but it seems these are few and far between.

This is definitely true not just in OB but plenty of other fields, I think. Poor behavior begets poor behavior.

 

[DarthNeurology]

That's the age old question to be honest; I think the residents at academic institutions do tend to be more overworked and more mean spirited, but I've seen it at private institutions, with private attendings, and while the OB residents are doing their rotations at the private hospital affiliated with the academic center as well. Yet, some of the students I know going into OB seem to be genuinely nice people who are excited about what they're going to do. So...

The other thing that I find weird is that a lot of OBs want to think of themselves as surgeons, but they also want to be considered primary care authorities for women. I just don't think you can have it both ways.

A lot of OBs might be students who considered surgery, but for some reason wanted the cache of having more input into the whole care of a patient, i.e. seeing them in both the outpatient clinic and the operating room. The dual aspect of being an OB is interesting, but I think some OBs are on a power trip, and overestimate their primary care skills. There's just a haughtiness that some residents have that doesn't make sense, and seems out of place in medicine. OB is the only rotation I was on where there was this seemingly universal attitude among residents and attendings that the students could never do what they do, and that nobody could understand their mysterious craft.

I think that a lot of OBs are upset with insurance premiums and figure that perhaps the fewer students going into OB the better.

While I'm pro-choice, that's different from being OK with having to perform abortions yourself. Plus OBs have to be OK with hearing women scream in labor for hours. Does this self-select for students who have a high tolerance to the discomfort of others?

For whatever reason, a lot of OB attendings and residents are just outright hateful of students. Past SDN polls have shown that students have the most trouble with OB, despite it being a short rotation.

I'm sure OBs get questions about the abortion angle, among other things, when socializing with friends. Maybe overtime they get disgruntled as they realize that a lot of people are squimish around them.

 

[mercaptovizadeh]

A few points:

1.) Today I learned that general surgeons do not consider Ob/Gyn to be a surgical subspeciality. I've never seen that attitude with ENT or urology, so I'm guessing they find ob/gyn surgical technique subpar or something.

2.) My experienced was NOT that all the residents and attendings were mean. On the contrary, I had maybe 2 slightly mean residents but everyone else was great. I think they were more sensitive than some other specialties in that they expected you to read up on and be informed on what they do - much of which may not interest most med students, like interpreting fetal heart tracings, stages of labor, contraception, etc.

3.) Ob/gyns are by no-means universally performing abortions, nor even pro-choice. There are lots who are very much against abortion. I do agree with what DarthNeurology mentions in that I am always a bit wary around ob/gyns and sort of wonder "Does s/he perform abortions?" even if the topic never came up on the rotation. Finding out that one of the most popular ob/gyn attendings at my school is also the advisory faculty to the student pro-life group was a breath of fresh air.

 

[ijn]

Prolife ob/gyns? ew...

 

[mercaptovizadeh]

Prolife ob/gyns? ew...

Why ew?

 

[ijn]

Why ew?

because ob/gyns should be protecting a woman's right to choose if they actually believe in women's health

 

[45408]

1.) Today I learned that general surgeons do not consider Ob/Gyn to be a surgical subspeciality. I've never seen that attitude with ENT or urology, so I'm guessing they find ob/gyn surgical technique subpar or something.

In a nutshell...

Some of the gyn-oncs can really operate, but most OB/gyns do C-sections, hysterectomies, and not a whole lot else more complicated.

Prolife ob/gyns? ew...

Never rotated at a Catholic hospital, I take it?

 

[evilbooyaa]

On OB, I had a resident yell at me for doing a 1-handed tie that I had learned on Surgery (I had been reprimanded for doing 2-handed ties in Surgery and wasting suture, so I quickly learned the 1-hand tie). This resident put in some interrupted stitches.... one stitch --> cut the needle and waste a whole suture length for one regular interrupted (not even a vertical mattress). I was blown away.

 

[NontradICUdoc]

As physicians your job is also to be an educator, especially of new crop of physicians. That being said, what I tend to do it find out what my student would like to do. As an IM resident I get all sorts from surgery to psychiatry. I think that it is important to tailor the teaching to what the student wants. And not just lecture. Each resident has their own way of doing it. But the student also needs to realize how busy residents are. I am not talking about interns. I am talking about PGY2s and above.

More importantly, if I ask a student to prepare something to talk about I expect it to be done. There is no excuse to not being able to prepare a 5 minute chit chat about a topic. The basics is all that is needed. I have had students that I assigned a quick 1.5 page article to read as a talking point at the start of their rotation and by the end, still did not read it. Even after I reminded them several times. Needless to say, they did not prepare the little chit chats as well.

This to me, means that you are not interested and are just going through the motions. If that is the case, then do not expect me to waste my time teaching you because I have 20 patients to take care of, 2 interns to oversee and to teach, and my own studying to do. Not to mention, review the student's note, co-sign it and write my own. Add to that on call days where we need to do admissions and set up teaching rounds with attendings.

Now imagine if this same student gives the resident a poor review for "not teaching"? I would be upset also and it will leave a bad taste in my mouth too. However, that is no excuse to take it out on other students. But take that scenario into account with the resident. Try to find out why the resident is feeling this way. Remember they were a medical student as well and were likely in the same position as you were but somewhere in the middle something happened. Either that, or that is their personality and you will just have to make the best of it.

 

[VenusinFurs]

I've heard ob was bad... Do you guys think it is because women self select for ob and are not great at handling chronic stress? I have worked with many women and they often lash out inappropriately when confronted with moderate stress plus work duties.

ARGHBLARGH THIS SEXIST COMMENT MAKES ME SO ANGRY YOU *$&@(

Lol, this definitely describes me, but I don't think it's a gender thing, because I am exactly like my dad in that respect. My mother, when she's stressed, just gets it done with occasional complaints about how stressed she is, and at other times becomes really quiet and wrapped up in her own head if it's something that can't be addressed right away. But anyway, I look at my own character pathology and I understand how a woman (or man) who feels beset upon by life can be tempted to take it out on a lower life-form (the med-stud). I will do everything in my power not to become that resident but I might have to actively fight it.

Also, is it bad that I haven't combed through my contract yet and therefore have no idea if I'm supposed to be responsible for medical student teaching?

 

[VenusinFurs]

because ob/gyns should be protecting a woman's right to choose if they actually believe in women's health

This is ACOG's position on the matter too.

 

[proteominer]

A few points:

1.) Today I learned that general surgeons do not consider Ob/Gyn to be a surgical subspeciality. I've never seen that attitude with ENT or urology, so I'm guessing they find ob/gyn surgical technique subpar or something.

2.) My experienced was NOT that all the residents and attendings were mean. On the contrary, I had maybe 2 slightly mean residents but everyone else was great. I think they were more sensitive than some other specialties in that they expected you to read up on and be informed on what they do - much of which may not interest most med students, like interpreting fetal heart tracings, stages of labor, contraception, etc.

1. I think this goes back to the fact that ob/gyn residents do not complete a surgical internship (unlike ENT or urology). The perioperative experience that an ob/gyn gets is seen as quite different from the perioperative education in the more traditional surgical residencies. The training gives a different perspective on surgical management. (Gyn onc is an exception.)

2. There are mean residents and attendings in every field. I got along great with my ob/gyn residents and attendings. I enjoyed my ob/gyn rotation. I even considered it as a specialty (more for gyn or gyn-onc than ob, however). I think the field stereotypes we hear about aren't as applicable these days.