DO residents working with MD students

[Superman DO]

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PLEASE, do not make this into an MD vs DO thread.

I hope to match at a MD residency for peds and to soon have the opportunity to pass down the knowledge I have gained so far with the MD students working with me and the team. Have any DO residents at ACGME residencies experienced any problems or negative attitudes from trying to teach their MD students because of being a DO? If so, how did you handle it?

 

[Bacchus]

If a medical student disrespects me when I try to teach them because of my degree, they better cut off all their fingers or hope their patients' don't have ***holes.

(That said, I haven't experience any bias yet)

Students are pretty clueless, depending on the rotation they're on with you. You can teach them something everyday. If it isn't content, it's at least how to function when a resident or how to improve as a student.

 

[rokshana]

you teach, they'll listen…esp in the beginning of 3rd year (after the match? eh not as much…🙂 ).

 

[Superman DO]

I love to teach, and cannot wait to do it as a resident. I don't anticipate any problems, and I'm glad you haven't experienced any kind of bias thus far.

 

[Superman DO]

you teach, they'll listen…esp in the beginning of 3rd year (after the match? eh not as much…🙂 ).

I am incredibly grateful to anybody who took the time to teach me things whether it be an md, do, pa, np, or nurse. But I agree, at this point in 4th year, it is hard to keep my mind from wondering. Luckily, my attendings are pretty awesome.

 

[Doctor Bagel]

PLEASE, do not make this into an MD vs DO thread.

I hope to match at a MD residency for peds and to soon have the opportunity to pass down the knowledge I have gained so far with the MD students working with me and the team. Have any DO residents at ACGME residencies experienced any problems or negative attitudes from trying to teach their MD students because of being a DO? If so, how did you handle it?

I've never heard of any DOs here getting negative reactions from MD students. I was an MD student with lots of DO residents, and I would never think of treating the DOs differently from the MDs. Surely, no MD students are that big of jerks. So, likely not a thing to worry about.

 

[MadHopsMD]

PLEASE, do not make this into an MD vs DO thread.

I hope to match at a MD residency for peds and to soon have the opportunity to pass down the knowledge I have gained so far with the MD students working with me and the team. Have any DO residents at ACGME residencies experienced any problems or negative attitudes from trying to teach their MD students because of being a DO? If so, how did you handle it?

Some of the best teaching residents/attendings at my allopathic hospital were DO. They were so darn good!!! I do not know why. They were just good people who were patient with us. I do not think it had anything to do with being an osteopath though 🙂 Just good teachers..

 

[shiftingmirage]

Students are pretty clueless.

Pretty much. Half the time, I don't know my resident's last name let alone his/her degree.

The default position of me, and most of my peers is one of respect. You know more than me until proven otherwise. If someone is pulling an attitude or being disrespectful, that is a reflection of him/her, and not your degree.

 

[dragonfly99]

I don't think it should be a problem...as a student I was just glad if residents were not yelling at me/ignoring me/scutting me out with noneducational tasks/making me look bad in front of an attending or pateint.

 

[link2swim06]

I never care about the degree as long as you teach material that is correct. During third year I would quickly stop paying attention to anyone who told me things to be wrong or outdated.

That generally happened when people just liked to hear themselves talk and said whatever they think might have been right.

 

[Doctor Bob]

I never care about the degree as long as you teach material that is correct. During third year I would quickly stop paying attention to anyone who told me things to be wrong or outdated.

That generally happened when people just liked to hear themselves talk and said whatever they think might have been right.

This touches on an interesting related tangent; how do you, as a medical student, respond when someone is teaching you something you believe is manifestly incorrect.

And it can be tough treading the line between genuinely asking the teacher (resident, attending, etc) to provide the literature that supports their position to improve your medical knowledge base, and sounding like a know-it-all student with no worldly experience to back up your position.

There is no way I can keep up with all of the advancements in medical knowledge in all of the fields that my line of work (emergency medicine) overlaps. So from time to time students may have just come from another rotation and know about some new therapy or recommendation that I'm not familiar with. And as such my information may be outdated. As an academic attending I learn a lot from the students and residents as well and they help keep my knowledge base up to date. So the learning goes both ways.

So how do you go about approaching your teachers, and how have those approaches been received?

 

[Nasrudin]

This touches on an interesting related tangent; how do you, as a medical student, respond when someone is teaching you something you believe is manifestly incorrect.

And it can be tough treading the line between genuinely asking the teacher (resident, attending, etc) to provide the literature that supports their position to improve your medical knowledge base, and sounding like a know-it-all student with no worldly experience to back up your position.

There is no way I can keep up with all of the advancements in medical knowledge in all of the fields that my line of work (emergency medicine) overlaps. So from time to time students may have just come from another rotation and know about some new therapy or recommendation that I'm not familiar with. And as such my information may be outdated. As an academic attending I learn a lot from the students and residents as well and they help keep my knowledge base up to date. So the learning goes both ways.

So how do you go about approaching your teachers, and how have those approaches been received?

While your disposition is admirable, I usually don't say a word, unless asked a question. Well, more accurately, the occasion is unusually rare. I think one time I knew something more current about an infectious disease topic because I was studying the latest material for board review. I mentioned it conjecturally and was shot down for it by an attending who was one of the really nice ones I had.

I think except where they train noobs to be assertive above all else--surgery or your specialty to some degree--that you'll have to solicit most students.

 

[link2swim06]

This touches on an interesting related tangent; how do you, as a medical student, respond when someone is teaching you something you believe is manifestly incorrect.

And it can be tough treading the line between genuinely asking the teacher (resident, attending, etc) to provide the literature that supports their position to improve your medical knowledge base, and sounding like a know-it-all student with no worldly experience to back up your position.

There is no way I can keep up with all of the advancements in medical knowledge in all of the fields that my line of work (emergency medicine) overlaps. So from time to time students may have just come from another rotation and know about some new therapy or recommendation that I'm not familiar with. And as such my information may be outdated. As an academic attending I learn a lot from the students and residents as well and they help keep my knowledge base up to date. So the learning goes both ways.

So how do you go about approaching your teachers, and how have those approaches been received?

Right and just to clarify, I am not talking really about any specific patient's management. Any case can have mitigating factors and at the med student level it's impossible to call 99% of management wrong. I'm am talking about when there is a teaching session and I am more or less being pimped on stuff or theoretical patients.

There is a lot of gray area in medicine. However, our shelf exams and step exams are generally wrote to have questions with little or no gray area. If I am being taught something that directly conflicts with what the NBME (national board of medical examiners) then that is when I believe something is incorrect. One example, is the nbme says if the pre-test score for a PE is high enough you should start heparin before CTA. I have had residents try to teach me to always do a CTA first. For a theoretical patient/learning point this conflicts with the nbme and decrease my faith they have read the literature themselves. Frankly I will believe the nbme (which have peer reviewed questions) over any single resident, fellow, or attending. Again we are only talking as a teaching point...individual patients may have reasons unknown to me for doing it differently.

But to answer your question......unfortunately, a lot of times as a student I'd just agree with the attending, resident, etc and then go look it up on my own. Sometimes if I have time to find a paper then I can ask their opinion on it.

 

[rokshana]

Right and just to clarify, I am not talking really about any specific patient's management. Any case can have mitigating factors and at the med student level it's impossible to call 99% of management wrong. I'm am talking about when there is a teaching session and I am more or less being pimped on stuff or theoretical patients.

There is a lot of gray area in medicine. However, our shelf exams and step exams are generally wrote to have questions with little or no gray area. If I am being taught something that directly conflicts with what the NBME (national board of medical examiners) then that is when I believe something is incorrect. One example, is the nbme says if the pre-test score for a PE is high enough you should start heparin before CTA. I have had residents try to teach me to always do a CTA first. For a theoretical patient/learning point this conflicts with the nbme and decrease my faith they have read the literature themselves. Frankly I will believe the nbme (which have peer reviewed questions) over any single resident, fellow, or attending. Again we are only talking as a teaching point...individual patients may have reasons unknown to me for doing it differently.

But to answer your question......unfortunately, a lot of times as a student I'd just agree with the attending, resident, etc and then go look it up on my own. Sometimes if I have time to find a paper then I can ask their opinion on it.

realize that there are "test world" things and "real world" things…NBME and test material are usually at least 3 years old…the questions are tested and vetted to be fair, unbias, etc questions… newer material and new guidelines are not represented in study questions for the steps or the shelf exams.

its important that you realize that some of the things that you learn on clinicals, while conflicting with testing material, IS the SOP of clinical medicine.

For example both JNC8 and ATP4 guidelines just came out…but the shelf exams, USMLE, and even the ITE will be based on JNC 7 and ATP3 guidelines for at least the next year…teaching you the new guidelines during clinicals is the correct information…however it will be the wrong answers for the shelf.

 

[Doctor Bob]

There is a lot of gray area in medicine. However, our shelf exams and step exams are generally wrote to have questions with little or no gray area. If I am being taught something that directly conflicts with what the NBME (national board of medical examiners) then that is when I believe something is incorrect. One example, is the nbme says if the pre-test score for a PE is high enough you should start heparin before CTA. I have had residents try to teach me to always do a CTA first. For a theoretical patient/learning point this conflicts with the nbme and decrease my faith they have read the literature themselves. Frankly I will believe the nbme (which have peer reviewed questions) over any single resident, fellow, or attending. Again we are only talking as a teaching point...individual patients may have reasons unknown to me for doing it differently.

But to answer your question......unfortunately, a lot of times as a student I'd just agree with the attending, resident, etc and then go look it up on my own. Sometimes if I have time to find a paper then I can ask their opinion on it.

I find that a lot of residents teach from their institutional knowledge. "This is how we do it here" translates into "this is how process X should be worked up". And that's not wrong, it's just not always universal across all institutions. And it may not be the test answer. But the test answer is often not the right answer for clinical practice (due to a variety of reasons).

So for residents I have to teach "here's how we do it here". For medical students I have to teach "here's what the book says". Residents don't always make that distinction but that's ok because they're learning to be teachers as well (heck, so am I).

As a student I never came up with a good way to ask residents if they were teaching me the book answer or the clinical answer. It's easy for me to do as staff when I frame the questions to residents.

 

[Winged Scapula]

We were taught "this is the board answer/what the books say" and "this is how it's done". I try to make this same distinction when I teach.

 

[NontradICUdoc]

I have never had an issue, and I have both DO and MD students. They all want to learn if they want to. None of them questioned my degree and if they ever did, it would certainly be mentioned in their evaluation at the end. I also do OMT in the inpatient setting and had a couple of MD students with me wanting me to teach it.

 

[evilbooyaa]

I've had DO residents teaching me, and would never in a million years think to take them less seriously than the MD residents in the same program just because of their degree. If they managed to get into the same residency as these MDs, they're pretty much equal in my eyes.

 

[Superman DO]

I hope I didn't come across as insecure, but some comments on sdn leaves one wondering sometimes. I'm glad it will most likely be a non-issue, and I can focus on learning, teaching and being a good resident. Thanks for everyone's comments!

 

[nick_carraway]

As a student I never came up with a good way to ask residents if they were teaching me the book answer or the clinical answer. It's easy for me to do as staff when I frame the questions to residents.

As a student, I often phrase things like "what are your thoughts on X?" or "how come we did X instead of Y?" to understand the thought process. In the final year of med school, I've realized that learning a way to think is a bit higher yield than learning facts I'll likely forget once I rotate off service anyway.

 

[Law2Doc]

I think there's a lot that rapidly changes in medicine, and changes are usually adopted in practice long before those changes filter down to med school curriculum and tests. There a fair amount of stuff that was "fact" when it was originally put into your med school syllabus a few years back, and continued to be taught during your first two years, that's no longer thought to be true by clinicians. Research continues on everything. Technology doesnt stop. We learn new side effects and off label uses of drugs. So as a resident you teach med students, and they sometimes say " that's not what they taught us in med school or what first aid says". It's a tough sell to tell students that their knowledge is already outdated before they've even finished school.

As for the MD/DO issue, I doubt any med student cares what their residents white coat says.

 

[Junge]

I'm an MD student. I admit I had some "bias" toward DO's when I first started my rotations. My best rotation in med
School was 4 weeks of general med where I had a DO intern, DO senior and an MD attending. From top to bottom those guys loved to teach and were the best 4 weeks in terms of education and was also the most fun I had. It shattered my viewpoint and realized as a third year I could learn from anyone from MD, PA/NP or RN. Some might come in with a bias but I bet if you take an interest in teaching them it will change for 90% of them. If they don't, well their pretty screwed when they realize they have to work with people from all kinds of degrees. They are also probably the type that don't think anyone is good enough to teach them.

 

[link2swim06]

I found this point pretty interesting and the only literature I found was a prospective study published in 2012. (http://www.ncbi.nlm.nih.gov/pubmed/22285109) I often explain to my students that a lot of what we do in medicine is guided by 'expert opinion' and that some of it may no longer hold in the 2 years that pass until they are house staff. Oddly, I get a negative reaction in about half of them when I explain that point to them.

As for a DO resident working with MD students, unless you're attempting to incorporate OMM into your daily teaching you will be viewed with in the same light as your MD colleagues. Though most DOs I have met don't even touch OMM unless it's for chronic pain patients, in which case why not? Would rather that 50 year old suburban wife be harmed from OMM than opioids.

Uworld quoted another study. I want to say that study found a benefit to giving heparin before CTA. Hence the question.

 

[nlax30]

Yea I agree in that there's usually a difference between the "board answer" and how it plays out in real world clinical medicine.

Maybe on the boards you'd give heparin first while in the real world you'll probably be spending the quick few extra minutes to get that CTA and make sure you're not missing a dissection or something else.

I'm at a DO program but did a SubI at an allopathic program with MD students under me and we all worked together and had no problems. Wherever you are you'll be looking to the more senior people for guidance and for the most part I haven't seen any degree bias.

 

[AnesThrow]

I'm a DO at an ACGME program and have never felt any bias; not from students, fellow residents, or attendings. The closest I've got is nurses asking me what a "DO" is. Of course, I bet if I was to perform cranial on any of the patients, I might be thrown in the loony bin 😉

 

[Shikima]

Ask the DO's on how they're able to use the force.

 

[shan564]

I'm at a "brand name"-type institution that has a reputation for the students being a bit arrogant at times, but I've never heard of a student being disrespectful to a DO resident.

 

[DermViser]

PLEASE, do not make this into an MD vs DO thread.

I hope to match at a MD residency for peds and to soon have the opportunity to pass down the knowledge I have gained so far with the MD students working with me and the team. Have any DO residents at ACGME residencies experienced any problems or negative attitudes from trying to teach their MD students because of being a DO? If so, how did you handle it?

When I was a medical student, I was more appreciative of the resident who helped me to shine during the rotation (when he/she could easily throw me under the bus), when many times I wasn't as confident in my own abilities. This made me then want to go home and do well not only for patient care, but to feel like I was actively contributing and helping the resident get things done. I could care less about the 2 letters monogramed on their white coat.

 

[DermViser]

I'm at a "brand name"-type institution that has a reputation for the students being a bit arrogant at times, but I've never heard of a student being disrespectful to a DO resident.

I can pretty much guess which institution this is based on your location. Not at all surprising as this institution has one of the highest GPAs/MCAT scores in the country. Not at all shocked the emotional intelligence quotient is quite low.

 

[shan564]

I can pretty much guess which institution this is based on your location. Not at all surprising as this institution has one of the highest GPAs/MCAT scores in the country. Not at all shocked the emotional intelligence quotient is quite low.

Just to be clear, I'd say that 90% of the students have an above-average emotional intelligence quotient, but the other 10% also would never disrespect a DO (or IMG) resident.

 

[DermViser]

Just to be clear, I'd say that 90% of the students have an above-average emotional intelligence quotient, but the other 10% also would never disrespect a DO (or IMG) resident.

Of course. They're not stupid to do it in front of one's face. They need an evaluation filled out on them after all.

 

[rokshana]

Of course. They're not stupid to do it in front of one's face. They need an evaluation filled out on them after all.

you obviously have the mind set that the DO or IMG physician is an inferior being to your exhaulted self…but don't project your feelings onto other people…not all US MDs are like you.

 

[DermViser]

you obviously have the mind set that the DO or IMG physician is an inferior being to your exhaulted self…but don't project your feelings onto other people…not all US MDs are like you.

I'm not talking about myself. I'm talking about students at the medical school he is doing residency at. Try following the conversation before jumping to conclusions unnecessarily.

 

[DermViser]

We were taught "this is the board answer/what the books say" and "this is how it's done". I try to make this same distinction when I teach.

One of the many frustrations of medical education.

 

[Ronin786]

you obviously have the mind set that the DO or IMG physician is an inferior being to your exhaulted self…but don't project your feelings onto other people…not all US MDs are like you.

I'm not sure how you got that from his post. It seemed he was being critical of those med students rather than putting his own opinion. Heck a few posts above he says he couldn't care what letters are monogrammed on someone's white coat.

 

[ZuluHotel]

I can pretty much guess which institution this is based on your location. Not at all surprising as this institution has one of the highest GPAs/MCAT scores in the country. Not at all shocked the emotional intelligence quotient is quite low.

Wouldn't want to miss a chance to badmouth WashU, would ya

 

[DermViser]

Wouldn't want to miss a chance to badmouth WashU, would ya

I'm not "badmouthing" the institution. The institution along with its residency programs are well-respected. A posters had mentioned it as having a, "reputation for the students being a bit arrogant at times". Like I said, that's not surprising. No need to take offense, Premed from WashU leave the brownnosing for the interviews.

 

[ZuluHotel]

I'm not "badmouthing" the institution. The institution along with its residency programs are well-respected. A posters had mentioned it as having a, "reputation for the students being a bit arrogant at times". Like I said, that's not surprising. No need to take offense, Premed from WashU leave the brownnosing for the interviews.

Yes someone from WashU said that but you obviously know it's poor form to agree and double down on a self-deprecating comment. I recognize you from the WUSTL application thread where you spent a lot of time and energy arguing a strongly critical view of the school. It's not where I want to go and I'm already matriculating elsewhere but I wonder why you have such a bitter view of the place.

 

[DermViser]

Yes someone from WashU said that but you obviously know it's poor form to agree and double down on a self-deprecating comment. I recognize you from the WUSTL application thread where you spent a lot of time and energy arguing a strongly critical view of the school. It's not where I want to go and I'm already matriculating elsewhere but I wonder why you have such a bitter view of the place.

So it's "poor form" to agree with someone (who is a resident), just bc your sensibilities are offended and bc of my criticism of having a graded basic science curriculum, when I said students there are naturally already going to be internally motivated due to high matriculating GPAs and MCATs? Really? Buzz off premed.

 

[ZuluHotel]

So it's "poor form" to agree with someone (who is a resident), just bc your sensibilities are offended and bc of my criticism of having a graded basic science curriculum, when I said students there are naturally already going to be internally motivated due to high matriculating GPAs and MCATs? Really? Buzz off premed.

Yep that's about the size of it. Way to try and pull rank (twice) in a totally irrelevant context. Anyway it's clearly a sensitive topic for you, so that's enough said on it.

 

[DermViser]

Yep that's about the size of it. Way to try and pull rank (twice) in a totally irrelevant context. Anyway it's clearly a sensitive topic for you, so that's enough said on it.

It's not "pulling rank" and am hardly sensitive about it. He's a resident at the medical school institution in question who works with medical students there. Forgive me, if I give him more credence, than a petty undergrad premed at WashU whose sensibilities are easily offended.

 

[ZuluHotel]

It's not "pulling rank" and am hardly sensitive about it. He's a resident at the medical school institution in question who works with medical students there. Forgive me, if I give him more credence, than a petty undergrad premed at WashU whose sensibilities are easily offended.

Yes, by all means:

Just to be clear, I'd say that 90% of the students have an above-average emotional intelligence quotient, but the other 10% also would never disrespect a DO (or IMG) resident.

 

[DermViser]

Yes, by all means:

Yes, and he also said:

I'm at a "brand name"-type institution that has a reputation for the students being a bit arrogant at times, but I've never heard of a student being disrespectful to a DO resident.

Reputation of medical students, who later apply for and participate in residencies, doesn't just come out of thin air.

 

[rokshana]

I'm not talking about myself. I'm talking about students at the medical school he is doing residency at. Try following the conversation before jumping to conclusions unnecessarily.

the tone of your posts demonstrate what your opinion is of those other that US MDs…I know you were talking about those at the poster's school…THE poster states that your view is not the one they share…

 

[DermViser]

the tone of your posts demonstrate what your opinion is of those other that US MDs…I know you were talking about those at the poster's school…THE poster states that your view is not the one they share…

Yeah my "tone" also said this to the OP:

When I was a medical student, I was more appreciative of the resident who helped me to shine during the rotation (when he/she could easily throw me under the bus), when many times I wasn't as confident in my own abilities. This made me then want to go home and do well not only for patient care, but to feel like I was actively contributing and helping the resident get things done. I could care less about the 2 letters monogramed on their white coat.

Yet according to your reading comprehension, you concluded: "you obviously have the mind set that the DO or IMG physician is an inferior being to your exhaulted self…but don't project your feelings onto other people…not all US MDs are like you."

The poster himself even said, "I'm at a "brand name"-type institution that has a reputation for the students being a bit arrogant at times". Those reputations aren't created in a vacuum.

 

[Typhlitis]

This touches on an interesting related tangent; how do you, as a medical student, respond when someone is teaching you something you believe is manifestly incorrect.

And it can be tough treading the line between genuinely asking the teacher (resident, attending, etc) to provide the literature that supports their position to improve your medical knowledge base, and sounding like a know-it-all student with no worldly experience to back up your position.

There is no way I can keep up with all of the advancements in medical knowledge in all of the fields that my line of work (emergency medicine) overlaps. So from time to time students may have just come from another rotation and know about some new therapy or recommendation that I'm not familiar with. And as such my information may be outdated. As an academic attending I learn a lot from the students and residents as well and they help keep my knowledge base up to date. So the learning goes both ways.

So how do you go about approaching your teachers, and how have those approaches been received?

I got bad feedback from a rotation because I would up-to-date a topic while we discuss it, or directly after. One time a resident told me something wrong- it was the opposite of the truth, she was kind of flip floppy about it and I said I'd look it up- and I let her know the correct info because I would want to know the right answer... wouldn't you? Who cares if you're almost done with your residency. Anyway feedback was that I "looked things up in front of the residents to prove them wrong" or some garbage.

It's called "Qualify, Validate, Verify" for a reason. Residents are so thin skinned with students sometimes... glad to be graduating this year.

 

[QofQuimica]

Uworld quoted another study. I want to say that study found a benefit to giving heparin before CTA. Hence the question.

But there are also significant risks to giving people heparin, like life-threatening bleeding or HIT. No one sues you for bad outcomes on the boards and there is always one best answer, so they don't tend to consider gray areas like evaluating risk/benefit ratios on practice board questions. But we do have to consider them in real life. Also, what happens if that guy you think has a PE actually has a thoracic aortic dissection, and now you've gone and bolused him with high dose heparin before even making an effort to find out what's going on? Oops. Did Uworld tell you to discuss with the patient the risk that your tx could kill them if your diagnosis was wrong prior to starting that heparin? Telling these two dx (PE vs. TAD) apart is not trivial. See for example this case report: http://casereports.bmj.com/content/2013/bcr-2013-009367.abstract

In practice at my institution, the only time I have ever given someone heparin without a CTA first was because the dude was too darn big to fit into the CT scanner, and we didn't have any other explanation for why he was so hypoxic/tachycardic and we couldn't wean him off the vent. But it took us a few days and multiple discussions with the family to make that decision to start empiric heparin.

 

[link2swim06]

But there are also significant risks to giving people heparin, like life-threatening bleeding or HIT. No one sues you for bad outcomes on the boards and there is always one best answer, so they don't tend to consider gray areas like evaluating risk/benefit ratios on practice board questions. But we do have to consider them in real life. Also, what happens if that guy you think has a PE actually has a thoracic aortic dissection, and now you've gone and bolused him with high dose heparin before even making an effort to find out what's going on? Oops. Did Uworld tell you to discuss with the patient the risk that your tx could kill them if your diagnosis was wrong prior to starting that heparin? Telling these two dx (PE vs. TAD) apart is not trivial. See for example this case report: http://casereports.bmj.com/content/2013/bcr-2013-009367.abstract

In practice at my institution, the only time I have ever given someone heparin without a CTA first was because the dude was too darn big to fit into the CT scanner, and we didn't have any other explanation for why he was so hypoxic/tachycardic and we couldn't wean him off the vent. But it took us a few days and multiple discussions with the family to make that decision to start empiric heparin.

Ya...I agree with you that the real world is different than the test. It's why we do residency.

However, my point is that people need to know what the literature says too...it's a vital part of understanding medicine. I think the test question made it pretty clear that it was a PE and not a dissection. The entire point was testing to see if you knew there was a guideline telling us to do heparin before CTA in certain situations.

Obviously in real life it is not multiple choice and you have to discuss treatments with the pt, etc...

http://www.guideline.gov/content.aspx?id=35268

Initial Treatment of Acute Pulmonary Embolism (PE)

Initial Anticoagulation for Acute PE

In patients with acute PE, the expert panel recommends initial treatment with parenteral anticoagulation (LMWH, fondaparinux, IV UFH, or SC UFH) over no such initial treatment (Grade 1B).

Whether to Treat with Parenteral Anticoagulation While Awaiting the Results of Diagnostic Work-up for PE

In patients with a high clinical suspicion of acute PE, the expert panel suggests treatment with parenteral anticoagulants compared with no treatment while awaiting the results of diagnostic tests (Grade 2C).

In patients with an intermediate clinical suspicion of acute PE, the expert panel suggests treatment with parenteral anticoagulants compared with no treatment if the results of diagnostic tests are expected to be delayed for more than 4 h (Grade 2C).

In patients with a low clinical suspicion of acute PE, the expert panel suggests not treating with parenteral anticoagulants while awaiting the results of diagnostic tests, provided that test results are expected within 24 h (Grade 2C).

 

[rokshana]

Grade 2C recommendation
A Grade 2C recommendation is a very weak recommendation; other alternatives may be equally reasonable.
Explanation:
A Grade 2 recommendation is a weak recommendation. It means "this is our suggestion, but you may want to think about it." It is unlikely that you should follow the suggested approach in all your patients, and you might reasonably choose an alternative approach. For Grade 2 recommendations, benefits and risks may be finely balanced, or the benefits and risks may be uncertain. In deciding whether to follow a Grade 2 recommendation in an individual patient, you may want to think about your patient's values and preferences or about your patient's risk aversion.
Grade C means the evidence comes from observational studies, unsystematic clinical experience, or from randomized, controlled trials with serious flaws. Any estimate of effect is uncertain.
Recommendation grades
1. Strong recommendation: Benefits clearly outweigh the risks and burdens (or vice versa) for most, if not all, patients
2. Weak recommendation: Benefits and risks closely balanced and/or uncertain

Evidence grades
A. High-quality evidence: Consistent evidence from randomized trials, or overwhelming evidence of some other form
B. Moderate-quality evidence: Evidence from randomized trials with important limitations, or very strong evidence of some other form
C. Low-quality evidence: Evidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws

even the guidelines seem to state that its a suggestion but you may want to think about other options.

 

[caffeinemia]

this thread got very confusing and petty at the end -- like toothless fishmongers squabbling at the third world market... But to the OP, you are the resident and you have the power. If the students are eager to learn and respectful -- then lay down the knowledge. If they are douches, then make them your beetches. Plenty of options - including making them stay till sign out, requiring them to pre-round, making them grab numbers on all patients (can peds count? hah), IGNORING THEM when they ask you for help/questions/knowledge/signing orders/directions. Sorry to be sadistic, but I cringe to see your mild insecurity regarding a bunch of twats.

(FYI, I have a few more weeks of being said **** and can attest that arrogance and douchiness may not be so institutionally dependent -- but appear to be linked genetic recessive traits that have reached some sort of Hardy Weinberg equilibrium within the general population of medical students)