dealing with cocky M3's

[jackieMD2007]

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Hey all--

What do you do with the new gung-ho M3's that go straight to the chief resident or attending with questions, etc when there is a team of more senior residents/students sitting right there?

As the subI (or higher) do you:
1-take the M3 aside and offer support
2-take the M3 aside and tell them to cool it
3-give them a giant wedgie/clothesline them on rounds/wet willie
4-all of the above

Seriously though, it is getting really old watching the M3 bug someone more senior with something that myself or the intern could have handled more quickly (and with less embarrassment for the M3). Most interesting, when the busy chief redirects (snaps) at the M3, etc the M3 gets all flustered and then talks later about how the resident "isn't making time to teach." 🙄

Now it is definitely funny watching this comedy of errors but am I supposed to be more aggressive with this student? I feel like maybe the senior would appreciate us taking this student under wing a little more but I am trying to not get all "chain of command" on people.

J: "Help me help you....." haha

 

[C5toC9]

you should let the M3 know, he/she might not be aware

 

[Deferoxamine]

Pull the plastics-wannabe M3 aside for 5 minutes when no one else on the team is around and educate him about the clinical years food chain. Tell him doing everything in moderation is the best method for the first month or two until he "gets it" - then step it up and have more swagger.

If, after your pep talk, he still fudges up on the social interactions, then it's his problem --- and at least you tried to help.

 

[cpants]

Honestly, I wouldn't say anything other than: If you have any questions you can always ask me if you don't want to go to the resident. It's almost impossible for the MS4 to educate on the food chain without coming off like a total tool.

If he brings up the chief not having time to teach, you could say, you know it usually falls on the interns and junior residents to educate the students, you might want to go through them first.

He'll figure it out.

 

[McGillGrad]

Honestly, I wouldn't say anything other than: If you have any questions you can always ask me if you don't want to go to the resident. It's almost impossible for the MS4 to educate on the food chain without coming off like a total tool.

If he brings up the chief not having time to teach, you could say, you know it usually falls on the interns and junior residents to educate the students, you might want to go through them first.

He'll figure it out.

👍
It's a no-win situation for the M4

 

[Depakote]

I like the wedgie/clothesline/wet-willie idea

 

[smq123]

What do you do with the new gung-ho M3's that go straight to the chief resident or attending with questions, etc when there is a team of more senior residents/students sitting right there?

As the subI (or higher) do you:
1-take the M3 aside and offer support
2-take the M3 aside and tell them to cool it
3-give them a giant wedgie/clothesline them on rounds/wet willie
4-all of the above

As an off-service intern on a gen surg rotation, I used to give the MS3s my cell phone #. That was because they could never manage to use the paging system correctly, and I was tired of getting paged to a janitor's closet or something.

One day, the med students were off at mandatory student lectures at the MotherShip. That night, I get a text from one of them:

"Hi, can you text me with the attending's pager #? I wasn't at the hospital and so I don't know what cases are going on tomorrow that I should read about."

😱 Keep in mind this was 9 PM. That's not going to go over so well.

So, I texted her back that she should, instead, arrive at the hospital 15 minutes early, look at the OR schedule, and read up on the cases before signout. The next day, I took her aside, and gently let her know that while we did have very nice attendings, in general, you should take questions to the person immediately senior to you - in her case, that would've been me. It would also have been nice if she'd thought of another solution to her predicament that didn't involve texting someone at 9 PM, but that's ok.

While it may sound douchey for an MS4 to "lecture" MS3s on this, it's really probably one of the most valuable pieces of information you can impart to them. If they give you flack for lording over them, just remind them that you're trying to spare them from getting their head chewed off by an angry attending/chief resident. Worst case scenario, let them know that by consistently going to the attending for all their questions, their evals will suffer. As someone who now grades med students, I can tell you that what they're doing is seen as a sign that they don't understand the value of teamwork and cannot understand the "culture" of medicine. That's a huge red flag.

If you do #1 and #2, and they still don't get it, then go straight to #3.

 

[Deferoxamine]

Honestly, I wouldn't say anything other than: If you have any questions you can always ask me if you don't want to go to the resident. It's almost impossible for the MS4 to educate on the food chain without coming off like a total tool.

Wrong.

The MS3 is on her team. It would be way more douchey (and perhaps gunnerish) to just let the MS3 crash-and-burn by continuing his tactics while she knows deep down there's a simple way to stop it. Additionally, if the MS3 keeps pissing off the people in power, her grades/evals could suffer by association (attending fills out the evals at the end and says, "Man, those students were annoying this time around. I'll give them both a P.")

Sometimes you just have to take one for the team and do something that might on the outside seem slightly toolish in order to benefit both of you. So the MS3 might be pissed for 5 minutes after you nicely fill him in on the hierarchy of the medical team - so what? He's a big boy, he'll get over it. If you spend all of your clinical years worrying about your image every second of every day, you're in for a bumpy ride. There are students I can tell struggle with the "moral compass" of speaking up in situations like this - and they are very often the students who are mad at the end because they feel like the attendings/residents "didn't like them" when it came to evaluations.

While it may sound douchey for an MS4 to "lecture" MS3s on this, it's really probably one of the most valuable pieces of information you can impart to them. If they give you flack for lording over them, just remind them that you're trying to spare them from getting their head chewed off by an angry attending/chief resident. Worst case scenario, let them know that by consistently going to the attending for all their questions, their evals will suffer. As someone who now grades med students, I can tell you that what they're doing is seen as a sign that they don't understand the value of teamwork and cannot understand the "culture" of medicine. That's a huge red flag.

👍

 

[docbill]

It depends if you like this M3 or if you can't stand them.

If i like the person, I usually tell them to watch out for the following.... blah blah blah. If I don't like this Gunner who thinks they will rule the world... I just let them learn the hard way.

What I like the most from my M3 days is when an M4 would start pimping me when the attending is around. I just flipped him the bird and told him to go fly a kite. Otherwise I will start pimping him when the attending was around.. or start saying... So and So told me this... (but I would give the wrong answer).

Since getting my M4 ID, I have been looking for a M3 to push around in the hallway... but no luck yet (joking). 😱

 

[C5toC9]

IDs for M3 and M4 are different? They are the same at my school.

 

[docbill]

IDs for M3 and M4 are different? They are the same at my school.

Not at the school.. at the hospital. 3rd year medical student vs. 4th year medical student on the hospital ID.

 

[jahbrony]

Perhaps it's different at my school, but the people determining my clinical grade are the senior resident, the interns, and the attending. Sub-I's aka 4th years don't have squat to do with it. And frankly, most of them don't know **** either. They've been a 'med student' a whopping one year more than MS3s and already think they know everything.

Also, if you never interact with the attending and they have no idea who you are, then good luck with your letters of rec.

 

[Perrotfish]

Hey all--

What do you do with the new gung-ho M3's that go straight to the chief resident or attending with questions, etc when there is a team of more senior residents/students sitting right there?

As the subI (or higher) do you:
1-take the M3 aside and offer support
2-take the M3 aside and tell them to cool it
3-give them a giant wedgie/clothesline them on rounds/wet willie
4-all of the above

Seriously though, it is getting really old watching the M3 bug someone more senior with something that myself or the intern could have handled more quickly (and with less embarrassment for the M3). Most interesting, when the busy chief redirects (snaps) at the M3, etc the M3 gets all flustered and then talks later about how the resident "isn't making time to teach." 🙄

Now it is definitely funny watching this comedy of errors but am I supposed to be more aggressive with this student? I feel like maybe the senior would appreciate us taking this student under wing a little more but I am trying to not get all "chain of command" on people.

J: "Help me help you....." haha

Granted I'm only 3 months into rotations, but so far Sub-Is and M3s at my school seem to be very much equally at the bottom of the food chain. M3s never go through sub-Is before going to the Interns, and I've never seen an M3 ask a sub-I any question more complicated than 'where do they keep the charts on this floor?'. Also while I agree that you should work up your A&P with your interns before you go to the attending, that doesn't mean you need to filter every single comment up the chain of command. If you have a question about case management I've always found the sane thing to do is to ask it of whoever is not in a panic about doing something else. On call and post-call days that tends to be the attending and, to a lesser extent, the resident, on all other days that's normally the Intern. The only time the whole chain of command thing has ever come up have been those rare occasions on call nights when everyone is in a panic and, at those times, honestly I've realized that nothing I need to ask is nearly important enough to bother anyone with.

Also, at my school, only residents and attendings determine your grades. Interns can only get at you indirectly, by going to the attending/resident, and I have yet to find the Intern who will take the time to complain that the medical students are bothering other people instead of them.

 

[smq123]

Perhaps it's different at my school, but the people determining my clinical grade are the senior resident, the interns, and the attending. Sub-I's aka 4th years don't have squat to do with it. And frankly, most of them don't know **** either. They've been a 'med student' a whopping one year more than MS3s and already think they know everything.

Also, if you never interact with the attending and they have no idea who you are, then good luck with your letters of rec.

No one is suggesting that MS4s grade the MS3s. Of course they don't. I have never heard of an MS4 grading another med student. EVER.

The point is, though, that I think it *IS* appropriate for an MS4 to guide an MS3 through the rotation. And, honestly, what the MS3 that the OP described is doing is pretty irritating.

Also, if all your interactions with the attending are that annoying, and they only have a negative impression of you, then good luck with your letters of rec.

(Anyways, most of your LORs for residency should come from your MS4 rotations, not from your beginning MS3 rotations.)

 

[jackieMD2007]

Hi everyone,

So a quick update. I pulled the M3 aside and tried to be as sweet as possible about offering help and support. I suggested that perhaps he ask me how to do things or where to find things or what he could do next for the team rather than interrupt someone on the team. Of course if I didn't know or whatever he certainly could wait and ask the intern or senior.

The M3 took this well. Some of the other M3's on some of the other teams have started coming over to me for help with little things as well--and I am happy to help them too. It is hard finding things in the hospital or actually performing the logistics of tasks (requesting charts from another hospital, calling a consult service--but making sure you have the information you need first, updating the sign-out forms, ordering the AM labs, etc). It doesn't help the team for the students to handle these jobs if someone has to stop working to explain how to do the actual job.

Today went so much more smoothly for the team. The senior said "well I think we have the teamwork down, good job you guys." So that was positive. And the intern thanked me for helping the other medical student so much. 😀

Obviously, I don't know everything about the management of our patients or how to do everything and I don't make any of those claims, but I do know how to work effectively (and in my role) as a medical student on the team. And obviously I don't grade other students---but I think if we work well together and are BOTH polished and professional we BOTH could receive a better evaluation!

 

[cushie]

.

 

[Rendar5]

Good job. It may seem silly, but if you've never been told this and you're not very smart socially, you may simply not think to go to someone lower on the totem pole for an issue or learning. And it applies to all levels

When I was an ER intern, where we generally work 1 on 1 with attendings, it was extremely useful to occasionally pull em2's and 3's aside to run management and workup ideas by them before presentning to attendings, even though they weren't caring for the patient. I didn't even think to do this until my fiancee pointed it out. My performance and knowledge definitely went up a lot doing this.

 

[vir0n]

Perhaps it's different at my school, but the people determining my clinical grade are the senior resident, the interns, and the attending. Sub-I's aka 4th years don't have squat to do with it. And frankly, most of them don't know **** either. They've been a 'med student' a whopping one year more than MS3s and already think they know everything.

Also, if you never interact with the attending and they have no idea who you are, then good luck with your letters of rec.

I am currently an internal medicine sub-i. My school has designed the clerkship to have me operate (as best as they can) as an intern. That includes grading and reviewing M3s at the end of the month. Part of my grade and review has a clinical education component where I am responsible for the education of medical students. Of course, if I am ever asked a question that I don't know the answer to, I do my best to find it out or pass it a long to an intern/supervisor resident that can teach the both of us. My grade is also dependent on my M3's review of me...so you bet your ass I'm going to do the best I can to provide them with every opportunity to succeed.

Do I know ****? No. In the grand scheme of things...I know ****. Do I know more than a M3? Of course not! There are plenty of M3s that know more than I do. Am I more experienced than an M3? Yes and at this point in time, that goes a long way.

 

[45408]

This early in the year, an M4 really does know more than an M3. I don't think it's bad to help clue them in on things that aren't readily obvious to an M3. When I started trauma surgery as an M3 (in October, so not even that early in the year), the two M4s led us around and showed us how everything worked on that team. It helped me and the other M3s get up to speed much faster than if we'd been thrown in with no help. The interns were much too busy to do what they did, and we're not going to ask the chief for a basic "how-to."

 

[psipsina]

This early in the year, an M4 really does know more than an M3. I don't think it's bad to help clue them in on things that aren't readily obvious to an M3. When I started trauma surgery as an M3 (in October, so not even that early in the year), the two M4s led us around and showed us how everything worked on that team. It helped me and the other M3s get up to speed much faster than if we'd been thrown in with no help. The interns were much too busy to do what they did, and we're not going to ask the chief for a basic "how-to."

My surg team didn't have a 4th year but the intern on day one said to come to him first with questions or what to do next etc and not to bug the chief. I had plenty of opportunity to interact with the chief and the attending but I was never pestering them with the little things. I think that as a 3rd year its great when people orient you to your role clearly like that. I definitely don't think its out of line for a fourth year to try and do that for a third year. There is a ton of social learning that occurs through the third year as you are immersed in the culture of medicine, and not all of it is intuitive to everyone.

 

[Perrotfish]

...

 

[werd]

i think the moral of the story is that, in general, you shouldn't go 2 levels up without talking first to the person 1 level up.

med students go to intern before senior resident (or ask another student)
intern goes to senior resident before attending (or ask another intern)
consults go to fellow before attending
with program problems, go to chief resident before program director
etc.

(btw, remember this sort of thing when you're an intern... orient the new students to how the team works, what's expected, and to come to you with questions about their patients/updates about their patients)

 

[cpants]

i think the moral of the story is that, in general, you shouldn't go 2 levels up without talking first to the person 1 level up.

med students go to intern before senior resident (or ask another student)
intern goes to senior resident before attending (or ask another intern)
consults go to fellow before attending
with program problems, go to chief resident before program director
etc.

(btw, remember this sort of thing when you're an intern... orient the new students to how the team works, what's expected, and to come to you with questions about their patients/updates about their patients)

I don't think this hierarchy is necessarily true in all cases. Many programs are a lot less rigid and formal. What is true is that all places will have a specific way of doing things which you will need to figure out ASAP.

Regardless of hierarchy, if you are getting pissed off when someone comes to you with a legitimate question, you are probably being a dick.

 

[njbmd]

Hey all--

What do you do with the new gung-ho M3's that go straight to the chief resident or attending with questions, etc when there is a team of more senior residents/students sitting right there?

As the subI (or higher) do you:
1-take the M3 aside and offer support
2-take the M3 aside and tell them to cool it
3-give them a giant wedgie/clothesline them on rounds/wet willie
4-all of the above

Seriously though, it is getting really old watching the M3 bug someone more senior with something that myself or the intern could have handled more quickly (and with less embarrassment for the M3). Most interesting, when the busy chief redirects (snaps) at the M3, etc the M3 gets all flustered and then talks later about how the resident "isn't making time to teach." 🙄

Now it is definitely funny watching this comedy of errors but am I supposed to be more aggressive with this student? I feel like maybe the senior would appreciate us taking this student under wing a little more but I am trying to not get all "chain of command" on people.

J: "Help me help you....." haha

Don't waste your time. If the attending/chief resident gets annoyed, they will let the MS-3 know pretty quickly.

If you chief wants to you "take this student under wing" they will ask you. Just enjoy the show and get your work done. Many times, those annoying MS-3 find a "grade surprise" on their transcript.

 

[PokerDoc]

M3 here:

Started my very first rotation (surgery) 3 whole days ago, and I've gotta say, my interns have been so amazing and helpful, I almost feel like they're my friends more than my superiors. It is so nice to have people like that to learn from.. I already feel really comfortable talking to them about anything, even casual talk.

I actually had to make it a point to introduce myself to the two main attendings on my service today since I have no real reason to ever talk to them, but I want them to know I exist and that I am interested. I haven't had any real questions for them though. I literally had to make something up just so one would turn and look at me.

 

[cpants]

M3 here:

Started my very first rotation (surgery) 3 whole days ago, and I've gotta say, my interns have been so amazing and helpful, I almost feel like they're my friends more than my superiors. It is so nice to have people like that to learn from.. I already feel really comfortable talking to them about anything, even casual talk.

I actually had to make it a point to introduce myself to the two main attendings on my service today since I have no real reason to ever talk to them, but I want them to know I exist and that I am interested. I haven't had any real questions for them though. I literally had to make something up just so one would turn and look at me.

It's good that you have a close relationship with the 'terns. Just remember that no matter what it feels like, while you are rotating, they are not your friends. Don't let it get too casual. I would be extremely cautious discussing anything the least bit sensitive (drugs/EtOH, relationships, complaints about school/hospital/staff, politics, religion, etc).