Do many residents like to teach?

GoodmanBrown

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    I'm on my surgery rotation (first one), and I can't help but wonder if surgery residents are especially unhelpful or if this same percentage don't care for all rotations. Most won't give me feedback when I ask, saying "Oh yeah, I have some pointers, but let's do it after x." After x, we never discuss it. Or I'm looking up a question an attending asked me, and the resident offers to help. He'll say, "Okay, first let's start by going to pubmed." One second later, as I type www.pubmed.com, the resident just turns and walks off without saying another word.

    I'm not asking for an hour-long discussion on my strengths and weaknesses, but it's surprising to me that only one resident so far has shown any interest in helping me learn anything useful. Is this on par with all rotations, and I better learn to suck it up?
     

    mordounhas

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      It really just depends. I worked with some great residents in many different fields and with some that were definitely less than stellar. Frankly, not that many residents went out of their way to teach and much of the teaching I received came in the form of a few pimp questions about whatever disease one of our patients had or was being worked up for.

      My advice would be to look for chances to learn and ask whatever questions you may have to residents (try to limit yourself to ones that can be answered reasonably quickly). If the resident seems to get annoyed at questions, it may not be the best time for them or they might just be that kind of resident.
       

      duckie99

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        nothing is going to be spoon fed to you. You'll need to take initiative to learn about things on your own.

        If you have questions I'd suggest only asking ones regarding some clinical aspect of patients your team is treating and stay away from more basic science stuff as no one likes those questions and likely they don't know the answers. Still even with clinical questions you'll often get the response "go look it up and tell us about it" usually because they don't know the answer but sometimes it really is good to learn to investigate these things yourself because you won't always have a resident or attending to answer all your questions.

        With regards to residents teaching I think they try to be efficient so if a teaching opportunity is present they usually ask pimp questions or give the student an "activity" to learn from like an interesting physical exam finding. Residents are usually very busy and most at this stage aren't very good at teaching anyway simply because they haven't done it very long. I'd stick to what I suggested above.

        Just go with the flow. Some will like to teach which can be nice but also bad since you may end up sitting around for hours waiting till the end of the day (when you were done earlier) because they wanted to teach something. I generally just like the pimp questions and when there is down time they answer clinical questions I have on patients. No need for structured teaching as that just isn't what real world practice in any medical field entails.
         
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        Soccer171983

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          I'll be graduating in the next few weeks and I was told that "teaching medical students is expected". How heavily we are expected to teach, I am not sure. I think most programs expect it but I feel like the way they implement this might not be so easy. I have had amazing residents who go out of there way and others who have done nothing but intimidate and make life hell. I can't say that any one particular residency ( I.e surgery, IM) tends to have more helpful residents. I feel like it depends entirely on the person and on the level of training. I feel that I would probably teach more towards the end of my residency than I would intern year purely because of knowledge and also because i would be "used to" things later.
           
          I love teaching, I just feel very pinched for time on a daily basis, and I don't get to teach much. After I've had a few dozen students rotate through for a grand total of a week or two with me, they start to run together and you can feel pretty apathetic at times.

          That, and we have a lot of students who just don't seem to care, so then I really don't care.
           

          LMarie_MD2b

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            I love teaching, I just feel very pinched for time on a daily basis, and I don't get to teach much. After I've had a few dozen students rotate through for a grand total of a week or two with me, they start to run together and you can feel pretty apathetic at times.

            That, and we have a lot of students who just don't seem to care, so then I really don't care.

            I think a lot of residents I worked with in MS3/4 wanted to do more teaching than they did with students on their service, but felt the same way TheProwler expressed above. There just isn't enough time in the day, most days, to get in all the patient care work (which includes an immense amount of paper work/phone calls/pages returned, call-backs missed, repeated, and returned again--if you haven't realized this, OP, you aren't paying attention), maybe a meal, and teach/give feedback to a handful of students--some of whom may or may not give a f**k, and just want to be sent home. The ROI, as a resident, is drastically higher when energy is focused on patient care rather than teaching, even if you are supervising enthusiastic, curious students.

            For SURGICAL residents, this is amplified exponentially, especially if they are trying to also get into the OR for a couple of cases a day. I think, especially as new clinical students, we have a hard time grasping just how much these people are responsible for, and what they accomplish when they "walk away" from you doing a non-critical, non-patient-care task. It's not a dig at the OP--it's just a big part of the transition between the basic science years and the clinical years. I had surgery as my first MS3 rotation, and it was a huge eye-opener.

            The worst thing I think you can do as a student seeking edification from a resident is to BE NEEDY. No one wants to teach you how to do a lit search, or sit down for 15 minutes and give you a soliloquy about your strengths and weaknesses when they could be eating lunch or signing out and going home themselves--especially if you wait until the end of the day to ask. However, you are much more likely to receive bonus teaching (including procedures, OR cases), practical feedback, and good eval comments if you are able to assimilate yourself a useful member of the team (think dressing supplies in your coat pockets, help with basic maneuvers on rounds, anticipate team needs, offer to return pages or do some clerical tasks between your cases) before requesting much feedback. I asked most of my questions during or after rounds, or while doing floor work with my residents--trying to keep things applicable to what we were DOING at the time, or some specific element of the plan for that patient. You'd be amazed at how much you can cover during a round of dressing changes! This is favorable because it should be much less likely to feel like you are pimping your resident (you aren't putting them on the spot), and it allows them to actually give you real-time information about their decision-making thought process. BONUS: This approach virtually ensures you are asking relevant questions, which are much more likely to get answered at the time of asking. You may still get the "Excellent question--you should look it up and tell us about it after rounds tomorrow" response, but that's the nature of the clinical years. Those presentations are usually much shorter on surgery, so enjoy that while it lasts.

            Good luck with the rest of your rotations, OP. Hope this helps some.
             
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            OveractiveBrain

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            1. Resident [Any Field]
              I'm on my surgery rotation (first one), and I can't help but wonder if surgery residents are especially unhelpful or if this same percentage don't care for all rotations. Most won't give me feedback when I ask, saying "Oh yeah, I have some pointers, but let's do it after x." After x, we never discuss it. Or I'm looking up a question an attending asked me, and the resident offers to help. He'll say, "Okay, first let's start by going to pubmed." One second later, as I type www.pubmed.com, the resident just turns and walks off without saying another word.

              I'm not asking for an hour-long discussion on my strengths and weaknesses, but it's surprising to me that only one resident so far has shown any interest in helping me learn anything useful. Is this on par with all rotations, and I better learn to suck it up?

              First realize that most people are just getting through residency so they can enter private practice or their fellowship. Its the wrong attitude, but thats the way it it. Even if people are interested in helping people grow, there are some barrier to it...

              No one is taught how to teach. Which is quite sad. Mostly people are bad at it. What they think is teaching, is blathering idiocy to you. What they think is an awesome learning experience, is homework to you. Its a product that they want you to learn the way they learned, because they just don't know anything else. So, most of the time, you want the teaching, they want to give it, they are just terrible at it.

              Imposter Syndrome. You know what the difference is between May 1st and July 1st? Two months. Just because you get an MD doesn't all-of-a-sudden mean you are dowsed with cosmic knowledge of anatomy and physiology, and it certainly doesnt make you immediately up to date on the standard of care. The point is, that not only does no one teach you how to teach, the people doing the teaching might themselves feel they don't know enough to teach. Worse as an intern than a resident, but still true as a resident.

              These are reasons why teaching DOESN'T happen, and its often justified by excuses like "we don't have enough time" or "medical students aren't interested.

              BULLSHIT

              Make time for teaching. Does it really wound the resident to leave 15 minutes later in a day? Certainly not. While the first thing to be sacrificed on a busy day is education, it most certainly should not be. Do you really need to leave the hour night float comes on? Should it really be your goal to get out as early as possible? I think the contrary. Obviously there will be exceptions (busy call days are an example), but I personally beleive that mandatory teaching time need be set aside; time for the resident to teach the interns, interns to students, attending to students and interns, whatever. Someone higher up should be spending time, on almost every day, teaching the people below them something.

              Teach outloud. Just by speaking what you're thinking; why you chose a beta blocker and not a diuretic, why you're doing a total colectomy vs a hemi, why this ASCUS patient is going to colposcopy while the last got rechecked in 3 months, just speaking your mind (even if it isnt a coherent lecture or chalk talk) IS TEACHING.

              It is the responsibility of the leader to motivate. You should not have to motivate a student to learn, but often you must. Students are as interested in what you have to share as you are interested in them. This has never failed me. Take the purposeful time to get to know your students. Show them you care. Sounds care-bare my-little-pony purple rainbow nonesense, but its legit. Show interest in them, and you bet they'll show interest in you, and what you have to say.

              1. Most people just don't want to teach, if they do want to, they don't know how.
              2. Teaching is the first thing to be sacrificed. It shouldn't be
              3. Leaders motivate, leaders teach, leaders lead. It has to be top-down to work; bottom up is begging, top down is leading
               
              Make time for teaching. Does it really wound the resident to leave 15 minutes later in a day? Certainly not. While the first thing to be sacrificed on a busy day is education, it most certainly should not be. Do you really need to leave the hour night float comes on? Should it really be your goal to get out as early as possible? I think the contrary. Obviously there will be exceptions (busy call days are an example), but I personally beleive that mandatory teaching time need be set aside; time for the resident to teach the interns, interns to students, attending to students and interns, whatever. Someone higher up should be spending time, on almost every day, teaching the people below them something.
              Sure, set aside for teaching. Why does it have to be at the end of the day, when I could be at home? If they really value it, carve out some time in the middle of the day.

              Your goal should be to leave as late as possible? No thanks.
               

              BigRedBeta

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                Agree with much of what Overactive Brain posted.

                I love to teach and have put forth the effort to put together several talks that I can condense or expand as needed to fill a time slot, but most residents either can't or don't want to put in that preparation. Of course it means that I get to talk about what I want to talk about, if the students don't care for those topics, well in a sense "too bad". I certainly have picked topics that are broadly applicable to most fields, but in the end I'm going to talk about things that have a peds critical care lean to them because that's what I'm going to do with my life. That works out fine for those going into IM fields, surgery or anesthesia, but it's impossible for me to make a connection between ventilator basics and say psych or radiology.

                The problem is that students for as much as they claim they want teaching, rarely make it very rewarding. It's rare for me to get a single "thank you" out of a group of 3-4 students after spending an hour with them. And if a resident doesn't have things prepared to talk about, asking the students "what do you want to learn" and getting a lot of hemming and hawing and "anything" sort of answers doesn't provide much positive feedback. Being in peds (although I know it happens to residents in other fields too), there are a lot of students who aren't going to do peds who give a sh!tton of attitude back during their clerkship too - either with false sentiments of "well I'm not really sure but I'm thinking <fill in the blank with current clerkship> or radiology/derm/urology/whatever" or just outright disdain - which only further exacerbates the situation. Throw in a hefty chunk of having to worry about whether students think you're mean or intimidating or malignant and it ends up being in a lot of cases that it's easier to just ignore the students for many residents.
                 

                KnuxNole

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                  There are a lot of residents who like to teach, which is good for the med student side. They may not sit you down for an hour, but like 5-10 minutes with tidbits, talking about how to diagnose/manage things, etc. Like others have said, residents are SWAMPED with work...but usually it does happen, as long as you have a good nice attitude.


                  There also seems to be a lot of residents who feel as if they aren't required to teach or get mad if people suggest it, with the "it's not my job/not in my contract, I don't need to do it!". I dont think that's the majority though(at least from my experience...maybe other places it's universal). I remember one of the OB/GYN residents who were wondering why med students are still staying beyond the morning into the afternoon, and mentioned during med school she never stayed more than 3 hours >.<
                   

                  MossPoh

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                    I have limited exposure to resident teaching in general because of the way my school does things. As voiced above, the major constraint is time. Many of them want to teach or go through a problem, but get swamped. If it is a reasonable time then you can ask to talk through or compare a note you wrote with the one they did.

                    Teaching does take practice and there is an art to constructing questions that few seem to learn.
                     

                    Law2Doc

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                      I love teaching, I just feel very pinched for time on a daily basis, and I don't get to teach much. After I've had a few dozen students rotate through for a grand total of a week or two with me, they start to run together and you can feel pretty apathetic at times.

                      That, and we have a lot of students who just don't seem to care, so then I really don't care.

                      Agree more with Prowler and less with OveractiveBrain, although i suspect it varies by specialty. Most residents I know like to teach, and do see it as part of the job, and work in teaching when there is time, but frequently on a busy service time is at a premium, and the med students don't always, or even often, appreciate what times represent tense time crunches for the residents. So there will be times when med students ask for teaching and the resident has to say "we can talk about it but not right now". the resident has multiple duties, but not giving enough teaching is rarely the one he ever gets chastised for, so it tends to be on the back burner a lot. Which is unfortunate, but a necessary. Imagine as a med student if you were given assignments X, Y and Z, but were only going to be graded on Y and Z and really only had time to do two of the assignments fully. Do you think X would suffer? Well the resident teaching obligation is an X in the life of a resident. Moreso thanks to the new duty hours I suspect. It has very little to do with how skilled a teacher the resident is -- all will have something to impart but simply may not have the time to sit down and do it at exactly the time you want. you have to catch the resident at the right time and they'll be thrilled to teach, but those windows close quickly. As Knuxhole suggests, if you make yourself useful to the resident and don't disappear for long stretches you will probably pick up teaching in 5-10 minute nuggets throughout the day.
                       

                      SLUser11

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                        No one is taught how to teach. Which is quite sad.

                        I disagree with your conclusions, but I sort of agree with some of your points. Nobody is taught how to teach, and there should be more formal instruction on the matter. However, it's hard to organize and enact. Also, I've gone through some of the curriculum that is recommended for residents, and a lot of it is crap.

                        Imposter Syndrome. You know what the difference is between May 1st and July 1st? Two months.

                        Very rarely are students and residents separated by a mere 2 months. At the least, they are separated by an entire year of experience, so your whole witty comment is sort of flawed.

                        Also, if you are as wise as you think you are, you know how steep the learning curve is in medicine, so a year of experience on the wards is an awful lot. Only naive and arrogant students refuse to learn from an intern based on your "two months" concept.

                        Teach outloud. Just by speaking what you're thinking; why you chose a beta blocker and not a diuretic, why you're doing a total colectomy vs a hemi, why this ASCUS patient is going to colposcopy while the last got rechecked in 3 months, just speaking your mind (even if it isnt a coherent lecture or chalk talk) IS TEACHING.

                        I agree with this. Hour-long didactics from a resident are rarely helpful, but a resident that can narrate his/her work to the student is priceless. I also find that this narration approach is more effective than cold pimping.


                        It is the responsibility of the leader to motivate.

                        Most students don't see their residents as leaders, unfortunately. Also, I think it's important that students take a front-seat role in their medical education. Marginal students will always be able to scrape by under the radar, but they will go on to be the weak intern.

                        There are a lot of residents who like to teach, which is good for the med student side. They may not sit you down for an hour, but like 5-10 minutes with tidbits, talking about how to diagnose/manage things, etc. Like others have said, residents are SWAMPED with work...but usually it does happen, as long as you have a good nice attitude.

                        Agree 100%. Short, goal-directed interactions are the highest yield for students.
                         
                        if you make yourself useful to the resident and don't disappear for long stretches you will probably pick up teaching in 5-10 minute nuggets throughout the day.
                        The other problem I often run into is all the students' conferences and lectures. I try to help them out with some useful learning opportunity (good case, good consult), and they have to take off for an hour or two.
                         

                        NontradICUdoc

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                          Over the last year that I have been an intern, I was actually told by my PD's that we are expected to teach students are are with us. They are not just there to do our scut work. That being said, teaching students is a wonderful opportunity to review things yourself as well.

                          When I have a student, I use the time while reviewing labs and information to teach. By going over an abnormal lab value, it opens up the opportunity to ask the student "what is your plan to address this value?" That opens up a nice discussion about the pathology of the disease, the course of the disease, and the management of the disease. In addition, especially with new patients that have radiology, it is a great chance to sit and have them learn how to read the films/CT scans what have you and put this together with their physical exam. For example, a patient with acute CHF exacerbation with rales bilaterlally and the patient has cardiomegaly with effusions on their PA view.

                          Granted our time comes at a premium, especially on the floors even more so during on-call days. But little things can be taught and then have the student review them that night. What I have found is the quality of the lesson that is remembered and not the quantity.
                           
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