Dealing with subversive residents

[greenbean]

---

Members don't see this ad.

hey all
as im finally done with residency, i was curious if any of you(current residents and attendings feel free to chime in) had to deal with subversive residents.

i have encountered a lot of passive aggressive behavior: from nurses, techs, attendings. but i think seeing it from fellow residents was definitly the most shocking, b'c these are the people who are supposed to your colleagues, right?

ill give a couple of examples to help start the discussion, these both happened to me

1. while on wards, i let my students go early , our team census was 1 patient and we had done a good job of getting ppl dispo'd. apparently a student from another team ran into my students as they were leaving the building. and she then complained to her residents that my students left early. her resident then complained to the chief that i was allowing my students to leave early

2. while admitting on night float, i had an unusually busy night, with 11 admissions/transfers. some of the admissiions were bolused. one of them came to the er from a nursing home, a demented patient. he was also delirious(yeah!) his workup turned out + for uti and he got admitted. i couldnt get any info out of him, and when i called his snf to get info, since it was 2 am no body could give me info. so i documented all of this in my admission note. now, in the morning, when i signed out the admission to the morning resident i told her what the background was and that she would have to get some more information in the day time. the following day i heard from the chief that this resident was not happy that i had not put more information in the admission note. i had to explain the whole thing to him again and he was very understanding

so anyways, im just curious has this happened to other residents, or am i just a magnet for passive aggressive types?


also , how would u guy/gals handle these types of people?

 

[Law2Doc]

hey all
as im finally done with residency, i was curious if any of you(current residents and attendings feel free to chime in) had to deal with subversive residents.

i have encountered a lot of passive aggressive behavior: from nurses, techs, attendings. but i think seeing it from fellow residents was definitly the most shocking, b'c these are the people who are supposed to your colleagues, right?

ill give a couple of examples to help start the discussion, these both happened to me

1. while on wards, i let my students go early , our team census was 1 patient and we had done a good job of getting ppl dispo'd. apparently a student from another team ran into my students as they were leaving the building. and she then complained to her residents that my students left early. her resident then complained to the chief that i was allowing my students to leave early

2. while admitting on night float, i had an unusually busy night, with 11 admissions/transfers. some of the admissiions were bolused. one of them came to the er from a nursing home, a demented patient. he was also delirious(yeah!) his workup turned out + for uti and he got admitted. i couldnt get any info out of him, and when i called his snf to get info, since it was 2 am no body could give me info. so i documented all of this in my admission note. now, in the morning, when i signed out the admission to the morning resident i told her what the background was and that she would have to get some more information in the day time. the following day i heard from the chief that this resident was not happy that i had not put more information in the admission note. i had to explain the whole thing to him again and he was very understanding

so anyways, im just curious has this happened to other residents, or am i just a magnet for passive aggressive types?


also , how would u guy/gals handle these types of people?

I'm not sure either one is actually "passive aggressive" -- that's not really the right term. There is no passive aspect here. In both cases it sounds like the person was annoyed with you

The second one is just a communication issue -- a misunderstanding regarding why you left over work for the am person. nobody likes to walk into someone else's pile of undone work, and she may not have understood that you took this as far as possible.

The first one, I have to say I sympathize with, because your coresidents had to deal with whining med students, may have wanted med student help, and your actions which made you look like a great guy to your med students also equally managed to make her look like a jerk to hers. Since you have to work with coresidnt for a much longer time than the med student, honestly you are better off being a jerk to the student than burning the coresidents. Your job is to work with your attendings and residents, not to be the cool dude the students like because you let them out early. Probably a better course of action is to give the coresident a heads up that you are thinking of sending your med student home early, and does she need their help for anything.

 

[Hour30]

I wouldn't try to think too hard in order to explain these situations.

People can be jerks lol!

 

[handwriting]

I'm currently a med student. When I was doing my medicine rotation, some residents let their students out earlier than other residents. When I was on call with my team, I'd get out at 8 or 9PM. Other students were allowed to leave call at 5PM! Did I complain? No. That would have been totally rude and juvenile. So that's what that student that complained to her resident was: rude and juvenile. As for how the resident reacted...also not cool. That resident should have told the student that every team is different and one shouldn't compare...and that if the student doesn't want to be there then he/she should just leave.

 

[Bartelby]

Probably a better course of action is to give the coresident a heads up that you are thinking of sending your med student home early, and does she need their help for anything.

Personally I would just send them home, they can use the time to learn or take care of themselves (and they really shouldn't be scutting out for patients who aren't theirs). Not sure why that would anger a reasonable person.

 

[45408]

Probably a better course of action is to give the coresident a heads up that you are thinking of sending your med student home early, and does she need their help for anything.

It would be an extremely rare situation in which getting a med student from the other team would be of any use to us, to the extent that we would ask to keep them. Once in a while, you really do have a horribly slow day when everyone is discharged, and you've all sat down and talked about all the teaching points you can muster.

My guess is that the med student on the other team was being a huge baby and complained to the resident. The resident didn't really know what to do with the info and just passed it along to the chief. The chief is now hearing this third-hand and is just trying to figure out what's going on.

The med student should start hoping his/her classmates didn't find out it was him that tattled.

 

[LucidSplash]

It would be an extremely rare situation in which getting a med student from the other team would be of any use to us, to the extent that we would ask to keep them. Once in a while, you really do have a horribly slow day when everyone is discharged, and you've all sat down and talked about all the teaching points you can muster.

My guess is that the med student on the other team was being a huge baby and complained to the resident. The resident didn't really know what to do with the info and just passed it along to the chief. The chief is now hearing this third-hand and is just trying to figure out what's going on.

The med student should start hoping his/her classmates didn't find out it was him that tattled.

Agree with all of this. Additionally? Any med student that did this around here would instantly get a bad rep. We have no love for the "I'm miserable and therefore everyone else should be" attitude towards one's peers. Not really sure why the resident felt the need to bump that complaint up the chain, but I'll assume this wasn't GS or a surgical sub-specialty.

Also agreed with L2D pointing out that these situations aren't really "passive-aggressive." Sometimes things like this just happen. If you find yourself on the "fuzzy end of the lollipop" like this frequently, from multiple sources/positions, it may be time to really do some introspective self-auditing and see if you are the real issue, be it communication issues or otherwise. Obviously, no one here can really know your situation and it is possible that you are just surrounded by completely dysfunctional people... and yes, medicine is full of dysfunctional people; but if you really feel like most of the people you're working with are causing you a problem, you might want to consider what's the common denominator: you.

 

[greenbean]

interesting responses

as for the first situation, if one of my students complained to me that other students were being let out early, my response would 'yeah so? lets get our work done' and i would NEVER even think about complaining to the chief about this nonsense.

also, telling the other resident that i was dismissing my students early, doesnt seem like a necessary step, since we are both on the same level and i should have autonomous decision making on what to do with my team, if i dont care care what she did with her students, why should she fuss about mine? this seemed like a case of myob

i have found oodles of examples of residents who complain about other residents, i just use the two that happened to me has examples, but i just curious if this was something that folks saw at other programs too

and this was from an IM place

 

[greenbean]

i agree, i never saw the point of 'holding on' to the students til 5pm.
i really resented this behavior by residents when i was a student myself

if there was no learning to be accomplished, they have their exams to study for and i dont want to baby sit mature adults.

 

[Flopotomist]

. Since you have to work with coresidnt for a much longer time than the med student, honestly you are better off being a jerk to the student than burning the coresidents. Your job is to work with your attendings and residents, not to be the cool dude the students like because you let them out early. Probably a better course of action is to give the coresident a heads up that you are thinking of sending your med student home early, and does she need their help for anything.

I disagree here. If my med students help me out by busting their ass, work hard, and clear out the census, than they deserve to go home early. How I manage the time of my team is of no concern to the other resident. If the other resident feels that the division of labor is unequal, than take it up with the chief and redistribute the labor... but I am not going to be a dick to a med student and make him/her sit in the corner watching the clock because of some jerk coresident's inability to deal with his own whiny med students.

The students are PAYING to be here, they are not paid slaves like us. If there is no benefit to them (eg no hope of a learning opportunity) than there is nothing left that they can receive for their payment for that day, and they should be able to go home.

PLUS, If I want to earn a few "karma points" with my med studs so that they will stay later for me on a day that I really need their help, that is my own business with my own team, and the other resident needs to mind his or her own beeswax.

(grateful L2D wasn't my resident when I was a med student!)

 

[Substance]

I disagree here. If my med students help me out by busting their ass, work hard, and clear out the census, than they deserve to go home early. How I manage the time of my team is of no concern to the other resident. If the other resident feels that the division of labor is unequal, than take it up with the chief and redistribute the labor... but I am not going to be a dick to a med student and make him/her sit in the corner watching the clock because of some jerk coresident's inability to deal with his own whiny med students.

The students are PAYING to be here, they are not paid slaves like us. If there is no benefit to them (eg no hope of a learning opportunity) than there is nothing left that they can receive for their payment for that day, and they should be able to go home.

PLUS, If I want to earn a few "karma points" with my med studs so that they will stay later for me on a day that I really need their help, that is my own business with my own team, and the other resident needs to mind his or her own beeswax.

(grateful L2D wasn't my resident when I was a med student!)

I do agree with you here. The med student is here to learn. I'll take it a bit further: the med student has absolutely no responsibility to make my job easier. In fact, they should make it harder. I accept that.

I actually loathe residents who use medical students as nothing more than gofers and scutmonkeys. Those are the semi-weak residents who can't time manage and have a poor self-reflective capacity.

 

[Winged Scapula]

Med students are there for educational value; if there is little to do which would add to that education, then by all means they should be encouraged to go home. There is plenty of time to be worked to the bone during residency and afterwards.

As for the other whiny medical student and resident, IMHO its none of their business whom I let go early nor am I obligated to offer my student to their team as extra labor.

 

[Law2Doc]

It would be an extremely rare situation in which getting a med student from the other team would be of any use to us, to the extent that we would ask to keep them...

it depends on the situation. Often it's not an "other team" but med students working with a particular resident on the same team, where they have divided up the service for efficiency. (not the OPs situation, but I can think of days where having an extra set of hands could get you out of there early even on a different team). And yes, med students do get passed around like two bit ****** In my experience.

Either way, my point wasn't that, but rather that if you gave the coresident a heads up that you were sending your students home, she could object and if she didn't, you wouldn't be the bad guy to her, it would be her own issue. You have to work with coresidents a long time. You see med students for a few weeks. It's easy math as to who you have to keep happy. You make the ask, she says no, everyone is cool.

As an aside, I used to send the med students home very early (mainly because you can often go faster without them), but got burned several times by attendings showing up unannounced and looking for students to teach. subsequent to that, nobody goes home early because frankly my job is to keep the attendings happy, not the students. Bring a book.

 

[Law2Doc]

I do agree with you here. The med student is here to learn. I'll take it a bit further: the med student has absolutely no responsibility to make my job easier. In fact, they should make it harder. I accept that.

I actually loathe residents who use medical students as nothing more than gofers and scutmonkeys. Those are the semi-weak residents who can't time manage and have a poor self-reflective capacity.

On rotation, what the med student is paying for is an opportunity to work with the residents, see what the residents do, and learn from it. You can't learn what happens on the wards if you are home studying. You can't get teaching from the resident, which almost always happens on the fly based on things that happen at various points during the day, if you aren't there. Most resident teaching isn't formal sit down present a topic type teaching, it's teaching based on a call from this person, or based on a change in patients labs, or based on follow-up imaging, or when a patient all of a sudden crashes and burns. In other words it's all tied to the daily, often relatively mundane, tasks. This notion that the med student can pick and choose what is going to be valuable learning versus scut is a copout. Much of what residents do every day could be retermed scut if your goal was to justify not being there, but then you wouldn't get what you are paying for. Claiming the med student is the paying customer and thus should leave early is kind of like saying you get your money's worth leaving a sporting event early. You might avoid post-game traffic, but you also might be leaving before you get your money's worth.

 

[Law2Doc]

...

(grateful L2D wasn't my resident when I was a med student!)

most of the med students I have worked with have actually seemed happy because I was one if the few residents who actually let them do stuff, rather than be a wall flower and watch their resident do stuff. different strokes, I guess.

 

[Substance]

On rotation, what the med student is paying for is an opportunity to work with the residents, see what the residents do, and learn from it. You can't learn what happens on the wards if you are home studying. You can't get teaching from the resident, which almost always happens on the fly based on things that happen at various points during the day, if you aren't there. Most resident teaching isn't formal sit down present a topic type teaching, it's teaching based on a call from this person, or based on a change in patients labs, or based on follow-up imaging, or when a patient all of a sudden crashes and burns. In other words it's all tied to the daily, often relatively mundane, tasks. This notion that the med student can pick and choose what is going to be valuable learning versus scut is a copout. Much of what residents do every day could be retermed scut if your goal was to justify not being there, but then you wouldn't get what you are paying for. Claiming the med student is the paying customer and thus should leave early is kind of like saying you get your money's worth leaving a sporting event early. You might avoid post-game traffic, but you also might be leaving before you get your money's worth.

Context, my friend.

If the med student gets his work done early, and there is no more work to be done on the census, then he is free to go. Scutting him out to your fellow residents just to save face with them later is a cop out.

And its nothing like your analogy. Med students are there to learn how to be physicians, not to make residents' lives easier. It's like saying the med student is the paying customer to a sporting event but needs to clean the locker rooms when the game is over.

 

[greenbean]

thanks substance, i guess we are the only ones seeing this eye to eye

L2D: i just dont see how i could predict that THAT resident would get her panties in a bunch over such a noncritical issue. for that matter, since we werenot the ONLY two residents that were on wards that month, that would mean i would have to go up to all 6 of them and tell them what i was doing. sorry but that would be outside of the norm of standard practice, aka strange/weird. and as ive said before, i dont see why should have to tell any other resident what i do with my med students.

now as for helping other teams, the only time ive seen that happen is in a code. ive never seen med students be traded over to help another team. there is only so much that a med student can do at their level, its not like they are interns who can put in all the orders etc. but i do get them involved so they dont feel like they are just sitting there and ive never had one ask me 'is there anything else?(code for can i leave now?' b'c either they are busy helping the team, in lecture or i let them go home.

 

[greenbean]

On rotation, what the med student is paying for is an opportunity to work with the residents, see what the residents do, and learn from it. You can't learn what happens on the wards if you are home studying. You can't get teaching from the resident, which almost always happens on the fly based on things that happen at various points during the day, if you aren't there. Most resident teaching isn't formal sit down present a topic type teaching, it's teaching based on a call from this person, or based on a change in patients labs, or based on follow-up imaging, or when a patient all of a sudden crashes and burns. In other words it's all tied to the daily, often relatively mundane, tasks. This notion that the med student can pick and choose what is going to be valuable learning versus scut is a copout. Much of what residents do every day could be retermed scut if your goal was to justify not being there, but then you wouldn't get what you are paying for. Claiming the med student is the paying customer and thus should leave early is kind of like saying you get your money's worth leaving a sporting event early. You might avoid post-game traffic, but you also might be leaving before you get your money's worth.

yes, i agree, most of what we do(esp in IM) would be considered glorified secretarial work. i can see whymost get deterred by it. that is why i encourage my students to see as many procedures(caths, endoscopies, biopsies, bronchs) so that they realize there are many procedures done by the various IM subspecialties. and it might influence them when they choose a specialty

i think the analogy that they are paying customers can hold true in the sense, that if there is nothign going on(ie when our team had a census of 1 patient, total) and no teaching to be done at that point, its better to let the students go. what they do with their time is not my concern. i know that when i was in their shoes i loved going home early as that meant i had more time to read/study. those were shelf tests i did the best on, no surprise.

by that same token, if u didnt want them to miss anything, why not keep them every day , till 10 pm? they would have an even better chance to see more potential stuff? because none of us can stay in us house that long

but i think to get back to the point, i still dont understand why that resident would not have just addressed that issue with her student, instead, why did she feel it was needed to go the chief to complain about me? to me, that takes alot of effort and only served to create bad blood between her and myself. if the roles were reversed, i would never have complained to the chief about her, because i would have seen it as a distraction from what really counted: GETTING WORK DONE

 

[xanthomondo]

Med students are there for educational value; if there is little to do which would add to that education, then by all means they should be encouraged to go home. There is plenty of time to be worked to the bone during residency and afterwards.

As for the other whiny medical student and resident, IMHO its none of their business whom I let go early nor am I obligated to offer my student to their team as extra labor.

I couldn't agree with this more. There is always a point where the educational value of the day is completely exhausted. Time would much better be used for studying/reading rather than sitting around the hospital watching you surf the internet/eat/BS with other residents because something *may* come up.

 

[Top Gun]

If I was still a resident, and one of the other residents was complaining to the chief that I was sending my med students home early, I would have told that other resident to go pound sand. What I do with my students is no one else's business. The other resident's whiny med student is not my problem, and that resident needs to learn to deal with the med student on his/her own. Each team has their own rules to follow, including when med students leave.

 

[Law2Doc]

If I was still a resident, and one of the other residents was complaining to the chief that I was sending my med students home early, I would have told that other resident to go pound sand. What I do with my students is no one else's business. The other resident's whiny med student is not my problem, and that resident needs to learn to deal with the med student on his/her own. Each team has their own rules to follow, including when med students leave.

While I agree with you in principle, you are going to be working with this coresident, needing them to cover things for you, etc for years. Med students are gone in a month. If you have to look like a bad guy to somebody, you save yourself a lot of headaches making nice to your coworkers, regardless of their irrationality.

 

[KnuxNole]

I'd rather be nice to everyone. It seems with this idea of residents not caring about students, med students might be more prone to disrespect/cheat residents easily since the feeling would be mutual.

Then again, I dunno if every residency even has med students.

 

[MsKrispyKreme]

most of the med students I have worked with have actually seemed happy because I was one if the few residents who actually let them do stuff, rather than be a wall flower and watch their resident do stuff. different strokes, I guess.

No med student is going to tell a resident to his/her face that he/she sucks...

 

[Law2Doc]

thanks substance, i guess we are the only ones seeing this eye to eye....

interesting to note though that he's not training in the US... How things work in US residencies may differ.

 

[Law2Doc]

No med student is going to tell a resident to his/her face that he/she sucks...

You hear the buzz and see the anonymous evaluations. But if your attendings are happy, you honestly don't care.

 

[gutonc]

While I agree with you in principle, you are going to be working with this coresident, needing them to cover things for you, etc for years. Med students are gone in a month. If you have to look like a bad guy to somebody, you save yourself a lot of headaches making nice to your coworkers, regardless of their irrationality.

Nope. Said co-resident can either grow the F up or go F*** him/her-self. A whiny douchebagel like that is NEVER going to cover for anybody...ever. No need to ingratiate yourself with somebody like that.

To the OP...some people are whiners, other people suck. A (very) few put their heads down, do the work required of them and move on. Your former co-resident is both of the first two. Be the last.

 

[Law2Doc]

Nope. Said co-resident can either grow the F up or go F*** him/her-self. A whiny douchebagel like that is NEVER going to cover for anybody...ever. No need to ingratiate yourself with somebody like that....

BS. I've worked with some very difficult personalities in my day, and you can always work deals, even with the worst of them. So if you need to go to a wedding and trade a weekend on short notice, you really are better off having kept even your more difficult folks relatively happy with you. especially true in small programs where horse trading partners are limited. The med students are gone in a few weeks, the difficult coresidents are eternal. You need to lay groundwork in case you need it, and you will.

 

[mercaptovizadeh]

For some reason I always find myself irritated reading L2D's posts and the logic (s)he elaborates. Usually it amounts to something along the lines of "medicine is not a career for making a good income, so abandon all hope of that, you should have done business, law, etc." or "students are fungible units who should be freely exchanged between residents" [like the two-bit ****** they are] or "students appreciate my working them to the bone, as it enhances the learning experience" [sound of whip cracking]

I concur with what most people have said here, even though I am not yet a resident or even a 3rd year student. It is totally the resident's business when he or she releases their student, unless a clear superior (i.e. attending, more senior residents) had something else in mind.

The whining med student who complained on other students being released is a total ******. In my book, it would automatically drop my evaluation a whole notch down (HP > P).

Her resident, who actually entertained that kind of BS, is even more ******ed for passing it up to more senior people. He/she should have dressed down that whiny brat and explained that she should shut up and do her work until it's all done.

 

[Substance]

interesting to note though that he's not training in the US... How things work in US residencies may differ.

There you go again, trying to discredit my opinion because I'm Canadian. Being a jerk to your medical students, however, knows no boundaries or borders, so I fail to see how my place of training is relevant.

Sometimes I wonder if SDN is kind of a game to you where you challenge yourself to take the unpopular opinion on all topics. I don't blame you for doing that, but sometimes what you say can be a bit weird, as in this case.

 

[wild0ne]

This thread reminds me of a quote I found and think often when in the hospital: "The greater a man is in power above others, the more he ought to excel them in virtue. None ought to govern who is not better than the governed - Publius Syrus".

It comes down to your character and leadership. As a resident, you can choose to let the **** roll downhill, or put an end to it. Choosing the former may make your life easier in the short-term, but it catches up to you. Attendings know the difference. You'll know the difference when you're an attending too, since we've all been there. Evaluations and buzz work both ways.

I distinctly remember being on call with my senior resident as a 3rd year. As we were talking over the dinner he bought me, he showed me a pencil-written list entitled "10 things he would never do to his student" scribbled on a notecard. He made that notecard when he was a 3rd year, after his IM residents made his life hell. The list included things like not make me go hungry, not keep me there if nothing was going on, not pimp me with malignant intent, etc.

He went on to be Chief at the IM program at my institution, elected by his peers. Got a great fellowship too. I'm sure he's doing very well right now.

Oh, and, he made sure we did as many procedures as we wanted.

 

[mercaptovizadeh]

...The list included things like not make me go hungry, not keep me there if nothing was going on, not pimp me with malignant intent, etc.

He went on to be Chief at the IM program at my institution, elected by his peers....

That's just at your institution. Contrariwise, other institutions may differ...

 

[Law2Doc]

There you go again, trying to discredit my opinion because I'm Canadian. Being a jerk to your medical students, however, knows no boundaries or borders, so I fail to see how my place of training is relevant.

Sometimes I wonder if SDN is kind of a game to you where you challenge yourself to take the unpopular opinion on all topics. I don't blame you for doing that, but sometimes what you say can be a bit weird, as in this case.

First, reminding folks you are in the Canadian system and thus in a somewhat different type of residency system isn't discrediting you. I didn't say it was worse, just that it wasn't the same. Your system is different. Thus your views as to residency may not be exactly on point. You have in multiple threads indicated that US residencies are "inhumane", so context here is important, particularly when a poster cites you as the only one who agrees with him.

Second, I think the value of learning on med student rotations is directly proportional to the extent they actually are there doing things, rather than being wall flowers for a few hours and sent home early. As a med student I saw both versions, and honestly I didn't mind being on rotation to the extent I was given stuff to do, and hated those rotations where I was underutilized.

Third, I don't see SDN as a "game" to take unpopular positions, (although I do find it entertaining) but I do see a role in being "real" on here. Too many people come on here and talk about how medicine should be this easy path where nobody should do any scut and everybody should go home early and get 10 hours of sleep a night and somehow become good doctors who only have to work 30 hours a week for a seven digit salary. There have always been one or two folks on here who have a more realistic viewpoint to temper these kinds of notions, and I think this viewpoint is important for these discussions. I'm not the first to take these views, nor the only one who has them.

Finally, I don't really advocate "being a jerk" to med students. I advocate keeping them around and teaching them. I see a difference. But yes, at some of the places I've been at, med students work with the residents collectively, so you do share them if another resident needs help, and you send them home at your own peril if the attendings choose an unexpected time to pop by and teach. It's also not really a finish the work and go home early kind of job. The resident stays until sign out. Things can, and do, happen until sign out. You may be doing consults, running codes, troubleshooting, etc at any time up until you sign out to the next guy. The med student you sent home misses that. And some of that is precisely what he's paying for. So yeah, it's exactly like my sporting analogy. You leave early maybe you don't miss anything, but maybe you miss that exciting end of the game rally.

 

[Substance]

First, reminding folks you are in the Canadian system and thus in a somewhat different type of residency system isn't discrediting you. I didn't say it was worse, just that it wasn't the same. Your system is different. Thus your views as to residency may not be exactly on point. You have in multiple threads indicated that US residencies are "inhumane", so context here is important, particularly when a poster cites you as the only one who agrees with him.

Second, I think the value of learning on med student rotations is directly proportional to the extent they actually are there doing things, rather than being wall flowers for a few hours and sent home early. As a med student I saw both versions, and honestly I didn't mind being on rotation to the extent I was given stuff to do, and hated those rotations where I was underutilized.

Third, I don't see SDN as a "game" to take unpopular positions, (although I do find it entertaining) but I do see a role in being "real" on here. Too many people come on here and talk about how medicine should be this easy path where nobody should do any scut and everybody should go home early and get 10 hours of sleep a night and somehow become good doctors who only have to work 30 hours a week for a seven digit salary. There have always been one or two folks on here who have a more realistic viewpoint to temper these kinds of notions, and I think this viewpoint is important for these discussions. I'm not the first to take these views, nor the only one who has them.

Finally, I don't really advocate "being a jerk" to med students. I advocate keeping them around and teaching them. I see a difference. But yes, at some of the places I've been at, med students work with the residents collectively, so you do share them if another resident needs help, and you send them home at your own peril if the attendings choose an unexpected time to pop by and teach. It's also not really a finish the work and go home early kind of job. The resident stays until sign out. Things can, and do, happen until sign out. You may be doing consults, running codes, troubleshooting, etc at any time up until you sign out to the next guy. The med student you sent home misses that. And some of that is precisely what he's paying for. So yeah, it's exactly like my sporting analogy. You leave early maybe you don't miss anything, but maybe you miss that exciting end of the game rally.

Our systems aren't very different. Depending on the province you work in, things are either better or worse for residents than in the USA. That being said, my Canadian-ness has nothing to do with the discussion.

I agree with you on utilizing students to their full extent while on a rotation. I make it a point to get the students out there and using their minds, because most of them won't be going into my field, yet they still need to know basics from it. I give them the opportunity to practice their skills. What I do not do is get them to do secretary work, since like was already said, they paid for their educations, and we already have clerks and secretaries and porters to do that.

And frankly, farming out students to co-residents to help them with their scut, and to assauge any resentment your co-residents might have for sending students home without making them help out, is a very Machiavellian thing and is kind of dishonorable. To continue with your sports analogy, its like watching a baseball game, and then being forced to go over to the next stadium to watch - no, be the linesmen for - another game starting from the 8th inning.

 

[Law2Doc]

Our systems aren't very different. Depending on the province you work in, things are either better or worse for residents than in the USA. That being said, my Canadian-ness has nothing to do with the discussion.

I agree with you on utilizing students to their full extent while on a rotation. I make it a point to get the students out there and using their minds, because most of them won't be going into my field, yet they still need to know basics from it. I give them the opportunity to practice their skills. What I do not do is get them to do secretary work, since like was already said, they paid for their educations, and we already have clerks and secretaries and porters to do that.

And frankly, farming out students to co-residents to help them with their scut, and to assauge any resentment your co-residents might have for sending students home without making them help out, is a very Machiavellian thing and is kind of dishonorable. To continue with your sports analogy, its like watching a baseball game, and then being forced to go over to the next stadium to watch - no, be the linesmen for - another game starting from the 8th inning.

I don't think I ever said med students were there to do secretarial work or that farming them out to a coresident automatically meant they would be doing clerical scut rather than something potentially educational. And silly to say something is " dishonorable " if its standard practice certain places -- again you like to throw the adjectives around about US residency practices (dishonorable, inhumane) and I think this goes back to my suggestion that there are, in act, key differences between US and Canadian systems and cultures.

Your baseball analogy is not at all precise because both games are running simultaneously -- so you wouldn't be starting over at the 8th inning after a full game -- it would be more like you left one game in the seventh, and caught the end of the game from the 8th on at the other. still only 9 innings, but yes you are paying for the whole 9 so you get your money's worth. And I'm not sure why the second one you are asked to be the linesman in the second and not the first -- your roles as med student are identical in both. my point is if you are on service, potential educational value can happen up until sign out. Codes can happen, consults can happen. The shift isn't technically over, so you are leaving before the game is over.

 

[eforest]

I'm surprised that students tattled in the first place. I'm even more surprised that their resident cared enough to tell the chief. I'm even more surprised that the chief decided to bring it up. It's like people are looking for drama where there doesn't have to be any. Life is tough enough as it is!

 

[Mattchiavelli]

I agree that the OP is using the wrong wording here, not really subversive but probably passive aggressive. It's unfortunate that your co-resident didn't have the capability to shut down the whining on his/her own and instead had to let it reverberate to the chief. I would have told the students that the other students are a part of team X and we are a part of team Y and team Y has work to do. It sounds like those two deserve each other.

 

[KnuxNole]

The douchey co-resident was probably an uggo gunner/whiny med student. 🙂

 

[cpants]

In my opinion, if there is work to do, the students should for the most part be there (provided it's something they can get involved in). I don't think the 'bring a book' philosophy is too legit. In the rare cases where there is literally nothing going on that afternoon, I will go over cases with them or lead a discussion. When that gets old, or if I have resident stuff to do, they go. Frankly, I feel a little uncomfortable sitting there dictating op notes or something while 2 medical students stare at me.

 

[Law2Doc]

In my opinion, if there is work to do, the students should for the most part be there (provided it's something they can get involved in). I don't think the 'bring a book' philosophy is too legit. In the rare cases where there is literally nothing going on that afternoon, I will go over cases with them or lead a discussion. When that gets old, or if I have resident stuff to do, they go. Frankly, I feel a little uncomfortable sitting there dictating op notes or something while 2 medical students stare at me.

Things can and do happen at any time right up to sign out. If I could predict the days when "literally nothing" was going to happen, id take that skill to Vegas. I'd say more times than not something interesting like a consult or code slips in at the end of a shift.

 

[45408]

Things can and do happen at any time right up to sign out. If I could predict the days when "literally nothing" was going to happen, id take that skill to Vegas. I'd say more times than not something interesting like a consult or code slips in at the end of a shift.

When we're not on consults, our cases have concluded for the day, and all of our discharges have left the building, I can't say I've ever been surprised with new business.

 

[QofQuimica]

With the extreme exception of my med school classmate who matriculated at age 17, medical students are adults. They are not performing an essential function in the hospital, and if they feel like they have better places to be, that's their choice to make. Whether they're physically present or not, they will only get as much out of their education as they put in. I am happy to teach them and have their help if they're interested and motivated to be there. But if they aren't, I'd just as soon have them leave. I work with enough disgruntled people who hate their jobs and gripe and moan about being in the hospital. Unfortunately, I'm not in a position to be able to send most of them home even though sometimes I'd really like to.

 

[gutonc]

I am happy to teach them and have their help if they're interested and motivated to be there. But if they aren't, I'd just as soon have them leave. I work with enough disgruntled people who hate their jobs and gripe and moan about being in the hospital. Unfortunately, I'm not in a position to be able to send most of them home even though sometimes I'd really like to.

Totally OT, but this reminds me of the time I actually sent my senior home in the ICU post-call. We'd had a rough night and he was trying to "help" me finish up our notes and consults. So he said he'd take half the notes which I said was unnecessary but if he really wanted to, that was fine.

He then proceeded to ask me what I felt the pertinent physical exam findings were on each patient, what labs and study results I was worried about and what I thought we should do for each problem. At this point (well past the 30h point), I politely asked him to either actually be helpful and do the notes himself or just go home and I'd finish the notes since he was keeping me from getting the notes I was working on finished.

 

[KnuxNole]

In my opinion, if there is work to do, the students should for the most part be there (provided it's something they can get involved in). I don't think the 'bring a book' philosophy is too legit. In the rare cases where there is literally nothing going on that afternoon, I will go over cases with them or lead a discussion. When that gets old, or if I have resident stuff to do, they go. Frankly, I feel a little uncomfortable sitting there dictating op notes or something while 2 medical students stare at me.

Lol that is awkward. The med students should have at least pulled out an Iphone to browse or a book. Especially since there is a lot of downtime in certain rotations.

There were days in which "literally nothing happened". I remember feeling bored, like the hospital is dead and there is nothing to do D:

 

[GOMERE]

Law 11 in the House of God:
SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.

That being said, let the med student go home. Tell the chief to kiss his own $$. And tell your med students to tell their friends who got jealous to stop pissing around.

 

[Groove]

To the OP:

What you're describing is just the run-of-the-mill hospital drama and inter-personal conflicts. As someone else said.. I really wouldn't think "too" hard about it. Both of your examples sound fairly justified. Although it's usual to have people complain about you on occasion, if it's happening frequently... you should stop and try to figure out "why". Generally... it's counterproductive to complain about your colleagues on a frequent basis for exactly he reason you mentioned... you have to work with them! If people are complaining about you regularly, you should stop and try to figure out why. Are you abrasive? Arrogant? Do you have any interpersonal or communication or professionalism issues that need to be dealt with? If so, and even if it's not your fault... I would tackle some of those issues first and work on improving your interpersonal relationships because very few people really go out of their way to malignantly try to get a colleague in trouble. It's just not productive whatsoever, and opens themselves up for complaint by yourself if you ever notice anything. (i.e. You rat on me, I'll rat on you!)

Other things you can do to minimize these types of things are simple human and social politics. You don't even have to be the most garrulous, charismatic person on the planet to do these things...

1) Get on the good side of all your staff, PD, chair, etc... Offer to do minor (or major) activities "for the residency" that don't necessarily fit your job description but that the dept will be grateful for... If you are a hard worker and get a long with most of them... your colleagues will know this and be less apt to complain about a resident who is in favor with the majority of staff and in very good standing within the dept. It's basic human politics 101 and it doesn't even involve butt kissing.

The other thing is that you should always try to improve relationships with your colleagues and be polite and helpful to the residents that don't even like you and probably never will. You can't please everyone, but you can be polite, helpful and give people less of a reason to complain.

Get along with the nurses. Bring bags of chocolate, strike up frequent conversations, ask them about their kids...etc.. The nurses carry a lot of power and swing within learning institutions and their complaining can be just as damaging as a colleagues, if not more so. If you get a long with the nurses and they generally like you... Especially if you help them out with stuff that you might consider "beneath" your job description, then again... people are less likely to complain about you. It's not wise to complain about someone that a) The staff generally like... b) The nurses generally like... c) The rest of your colleagues generally like...

It's basic human politics 101. Nobody does it perfectly, but the same principle applies in corporate america and probably just about any work environment.

Your second example could take some minor criticism. In that case, you should have probably expected someone to complain about an H&P that was missing much information. If you could have spent some extra time calling a family member, or even making sure the right people knew about this extenuating circumstance in advance of you leaving... you would have had someone to defend your lack of information instead of being justified but nobody being aware...

Seems like all that should matter is being a good doctor, right? I often wonder that myself as even though I can be charismatic at times, I'm more often moody, introverted, and like to keep to myself... I have an old habit from past career of keeping work relationships/friendships AT work, and don't fraternize with people much outside of work that I tend to work with. I don't know if that's wise or not, but it's left over ingrained from being a manager for so long in my past life, so you have to work hard (and I'm certainly not the best at this...) of trying to keep people from perceiving you as completely anti-social or "not liking" them, because that's rarely the case. I'm very laid back and generally can't think of any of my colleagues, who I have the most respect for, that I genuinely just don't care for... Maybe a handful out of our ~40 residents.

Don't think about it too hard... I gave you a lengthy answer because you gave a lengthy question about something that really doesn't even deserve this much brain power in worrying about. It sounds like your doing a relatively good job so don't worry too much about it.

 

[Psych2014]

I read some of the posts, and there seems to be analysis about the appropriateness of your feelings about the 2 subversive situations. Regardless of how others would have handled it, both of those issues were subversive because those co-residents should have been mature enough to talk directly to you about it before a superior. Going upward is for obvious violations of policy and ethics, not style.

Yes, I've experience subversion. Some people will do anything to look good, including knocking down their fellow residents when they aren't looking. Bummer.

Good, great topic.

 

[in1Q84]

I'm so sorry. I do occasionally come across bad attendings, nurses, consults, and patients. BUT, my fellow residents have been awesome all the way. I guess it's my one consolation. Your program must be a large program... and a malignant one at that. Geez. I really find it annoying when people don't tell you directly when they have a problem but go through other people (especially your superior). It is really cowardly. They should tell you directly first if they have problem with you.

Residency is hard period. It's hard trying to please everybody when there are so many different personalities. Don't take it personally.

 

[Doctor Bob]

This is what's nice about working in the ED. For medical students there, there's no issue of "going home early". Your shift begins at X and ends at Y, unlike the floor where the sooner you get your work done the sooner you can potentially go home.

Imagine... this entire thread could have been avoided if these students had just been rotating in the ED.

 

[High Roller]

The first one, I have to say I sympathize with, because your coresidents had to deal with whining med students, may have wanted med student help, and your actions which made you look like a great guy to your med students also equally managed to make her look like a jerk to hers. Since you have to work with coresidnt for a much longer time than the med student, honestly you are better off being a jerk to the student than burning the coresidents. Your job is to work with your attendings and residents, not to be the cool dude the students like because you let them out early. Probably a better course of action is to give the coresident a heads up that you are thinking of sending your med student home early, and does she need their help for anything.

Come on...BS. Your job is to work with both attending, residents, and STUDENTS. This whole attitude of f'em, they're only gonna be around a few weeks is selfish. Just because your co-resident isn't team player doesn't excuse being completely inconsiderate to the powerless people on your team.

 

[High Roller]

Nope. Said co-resident can either grow the F up or go F*** him/her-self. A whiny douchebagel like that is NEVER going to cover for anybody...ever. No need to ingratiate yourself with somebody like that.

To the OP...some people are whiners, other people suck. A (very) few put their heads down, do the work required of them and move on. Your former co-resident is both of the first two. Be the last.

Agreed.