Everything wrong with medical school education

[Dantrolene FC]

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Here is my little rant for the day.

After reading the posts about the UNC PA residency, the guy who got screwed on his evaluation, and just general reflecting on my medical education, I have decided that the majority of what’s wrong with training medical students comes down to one thing... medical students are at the bottom of the totem pole and have the least priority for everyone in the hospital.

What I mean is, there are fellows, then residents, then medical students. Obviously the fellows get priority in training, the residents second, and the medical students third priority. But let’s be real, everyone there is there because they want to train fellows and residents. Medical students are just along for the ride.

That’s fine though. I’m sure that’s how’s it’s been for 50 or more years. But now there’s PA residents and PA students doing rotations along side medical students who also get priority over medical students because the PAs are expected to practice directly out of PA school while the MD students are just being shuffled through the system until they get to intern year.

And now my school is prioritizing teaching politics, social work, and political correctness in my curriculum, it seems like our knowledge of medicine increases every year, but my school is prioritizing medicine less and less each year.

Fell free to disagree with this post. I know a lot of you will.

 

[theonlytycrane]

can I have my 4 yrs of tuition back cause I just grinded Anki in my pajamas for yrs 1+2 and now I'm just paying to be a scut work slave yr 3 + looking forward to paying to build my own schedule/go on interviews m4 D:

I guess I'm funding the cushy lives of a few admin at my school

 

[medschoolmentors]

And now my school is prioritizing teaching politics, social work, and political correctness in my curriculum, it seems like our knowledge of medicine increases every year, but my school is prioritizing medicine less and less each year.

I think it's a positive thing that we're recognizing that medicine is much more than just the "science." I can definitely see where the frustration is coming from though, especially when people assume "oh you're a doctor, you're going to be rich" and don't realize the crazy amount of things we have to deal with in the journey (i.e. bottom of the totem pole, that we get almost no final say in how we spend our 20s).

The best attendings and residents I worked with were the ones who acknowledged the struggles of being a medical student. I remember even the smallest acts of kindness and empathy. I suppose that the most we can do in our corner of the universe is pass it forward as residents/attendings ourselves!

 

[deleted978973]

Your school doesn't give a **** about you beyond your tuition money. Just accept it. The system is extremely messed up. We all know that. The silver lining is that it at least goes by fast and med school will be a distant memory before you know it. Class of 2022, assuming a finishing date of 6/1/22 we only have 829 days left!!!

 

[Dantrolene FC]

Your school doesn't give a **** about you beyond your tuition money. Just accept it. The system is extremely messed up. We all know that. The silver lining is that it at least goes by fast and med school will be a distant memory before you know it. Class of 2022, assuming a finishing date of 6/1/22 we only have 829 days left!!!

Your school makes you go through June? That’s brutal. I graduate very early May. Plus I have the month of April off too

 

[deleted978973]

No, I'm just assuming that's around the latest that any school would go and officially have you listed in their systems as graduated.

 

[OnePunchBiopsy]

Everything is a balance.

Teach and praise medical students/residents/fellows enough that they learn what they can, but not so much so that they feel inadequate or get overinflated egos.

Recruits faculty who can teach, make money, do research, but don’t fire them if they’re not immensely passionate about one of those things at the expense of others.

Where it all falls short is when we have to put energy into dealing with those at the extremes at the expense of those doing an ok job.

 

[CyrilFiggis]

You can’t complain about doing scut as an MS3. You literally have no license and your school takes out $1 million liability to cover your clinical training. Does it suck, sure. But did you learn? What did you expect to do?

 

[raiderette]

I seriously considered becoming a certified nurse midwife because I value their role. One of my best friends went that route and she is happy delivery babies. If I had, I wouldn't have experienced surgery, and the scope of women who I can help would be diminished. I see a role for midlevels, but I am happy that I chose this route.

 

[Giovanotto]

You can’t complain about doing scut as an MS3. You literally have no license and your school takes out $1 million liability to cover your clinical training. Does it suck, sure. But did you learn? What did you expect to do?

Why does it cost them so much to cover me seeing patients as a peon and writing notes nobody will see? The days of medical students getting to do anything significant is gone. I've barely ever had the option of actually putting in orders. I approached everything I've done in medical school on eggshells, out of respect to patients and my lack of know-how. Turns out I could of just been throwing myself to do anything I wanted to with that kind of liability, aside from the fact that NPs/PAs are getting to do the same. My mistake in thinking having self awareness and morals is important.

 

[deleted407021]

And now my school is prioritizing teaching politics, social work, and political correctness in my curriculum, it seems like our knowledge of medicine increases every year, but my school is prioritizing medicine less and less each year.

Fell free to disagree with this post. I know a lot of you will.

I mean yeah, you’re posting cringe here.

 

[Goro]

Here is my little rant for the day.

After reading the posts about the UNC PA residency, the guy who got screwed on his evaluation, and just general reflecting on my medical education, I have decided that the majority of what’s wrong with training medical students comes down to one thing... medical students are at the bottom of the totem pole and have the least priority for everyone in the hospital.

What I mean is, there are fellows, then residents, then medical students. Obviously the fellows get priority in training, the residents second, and the medical students third priority. But let’s be real, everyone there is there because they want to train fellows and residents. Medical students are just along for the ride.

That’s fine though. I’m sure that’s how’s it’s been for 50 or more years. But now there’s PA residents and PA students doing rotations along side medical students who also get priority over medical students because the PAs are expected to practice directly out of PA school while the MD students are just being shuffled through the system until they get to intern year.

And now my school is prioritizing teaching politics, social work, and political correctness in my curriculum, it seems like our knowledge of medicine increases every year, but my school is prioritizing medicine less and less each year.

Fell free to disagree with this post. I know a lot of you will.

Could you kindly show us the gun that was placed against your temple and forced you to go to medical school????

 

[libertyyne]

I think the problem is an outcropping of kicking the bucket down the line. It used to be the medical students had responsibilities and expectations on the wards. Now its mostly glorified shadowing , because everyone just assumes you will learn it come intern year, and in intern year in surgical subs you get stuck doing scut. there are people in my school that rotated surgery and were never even given the chance to close. My school literally boasts about its clinical training.

Like how the hell am I going to learn to function as an intern if you are not going to give me an opportunity to own my patients. How the heck am i going to learn any surgical skills if you wont even give me the opportunity to close?

People will say you have to seek out opportunity,Sure, but when i seek it i should also be given that opportunity once in a while. The second year surgical resident wanted to close because they just started getting the chance to do so, the interns wanted to change the ports on the divinci because anything is better than floor scut, and this lack of opportunity roles downhill to where ms3s are fifth scrubed into a robotic case, after the fellow, the senior and the intern and attending are all scrubbed in. The interns want to hoard the LPs because they need a certain volume or just enjoy the procedure.
There have absolutely been rare instances where i was given some autonomy , and opportunity and those instances still stick with me.

like give me one patient, show me how to close, let me at least fumble before you take the needle driver away. I was always affable, available, and able. I dont even want to think bout the less interested people in my class and what their experience was like.

 

[Dantrolene FC]

Could you kindly show us the gun that was placed against your temple and forced you to go to medical school????

Really? You kinda escalated that quickly.

All I was saying is we are the bottom of the totem pole and the lowest priority to be educated.

 

[Goro]

Really? You kinda escalated that quickly.

All I was saying is we are the bottom of the totem pole and the lowest priority to be educated.

You knew what you were getting into.

A medical career requires a lot of sacrifice and delayed gratification.

 

[Dantrolene FC]

You knew what you were getting into.

A medical career requires a lot of sacrifice and delayed gratification.

I never complained about that. I just said we don’t get priority in the hospital.

 

[deleted915325]

I never complained about that. I just said we don’t get priority in the hospital.

I would just disregard his comment lol. It doesnt add anything to the discussion and he’s just looking for a reaction, per usual

 

[redsox93]

You knew what you were getting into.

A medical career requires a lot of sacrifice and delayed gratification.

That’s not the point anyone was making. I think the general concern is that we aren’t learning the skills necessary to be good interns. I don’t care about gratification but I do care about being able to integrate into residency when I’m suddenly expected to know how to put in orders and handle way more patient load than I ever did as a 3rd year.

 

[nimbus]

I think the problem is an outcropping of kicking the bucket down the line. It used to be the medical students had responsibilities and expectations on the wards. Now its mostly glorified shadowing , because everyone just assumes you will learn it come intern year, and in intern year in surgical subs you get stuck doing scut. there are people in my school that rotated surgery and were never even given the chance to close. My school literally boasts about its clinical training.

Like how the hell am I going to learn to function as an intern if you are not going to give me an opportunity to own my patients. How the heck am i going to learn any surgical skills if you wont even give me the opportunity to close?

People will say you have to seek out opportunity,Sure, but when i seek it i should also be given that opportunity once in a while. The second year surgical resident wanted to close because they just started getting the chance to do so, the interns wanted to change the ports on the divinci because anything is better than floor scut, and this lack of opportunity roles downhill to where ms3s are fifth scrubed into a robotic case, after the fellow, the senior and the intern and attending are all scrubbed in. The interns want to hoard the LPs because they need a certain volume or just enjoy the procedure.
There have absolutely been rare instances where i was given some autonomy , and opportunity and those instances still stick with me.

like give me one patient, show me how to close, let me at least fumble before you take the needle driver away. I was always affable, available, and able. I dont even want to think bout the less interested people in my class and what their experience was like.

All those procedures may seem important now but they really aren’t. When you arrive at the stage in your training when you really need to learn them, you will get more than you want. Procedures aren’t for bragging rights so you can say I did 2 LPs, intubations, chest tubes, whatever as a medical student. Goro is right, everybody needs to be patient and chill.

 

[libertyyne]

All those procedures seem important now but they really aren’t. When you arrive at the stage in your training when you really need to learn them, you will get more than you want. Procedures aren’t for bragging rights so you can say I did 2 LPs, intubations, chest tubes, whatever as a medical student. Goro is right, everybody needs to be patient and chill.

Not even asking for bragging rights. I just want to be a competent intern come intern year. Can’t learn how to be a good intern if you treat me like an ms1 , talk me through the steps of a procedure, involve me in the care of a human being, integrate me into the team. Give me a role. I know everyone is overworked and most good trainees are hungry for more autonomy. But throw me a Bone. You were in my shoes within the last 30 years.

 

[NotAProgDirector]

Your point is valid. But there isn't a grand conspiracy -- the system we have has created this. Several major factors:

A. Nothing medical students do "counts" for anything. I need to write a whole note, I need to cosign and check any orders, etc. (Note: new Medicare guidelines may change the role of student notes for billing, maybe).
B. Seeing patients with students slows me down.
C. I get no credit of any sort for working with students. My schedule / patient load remains the same. My RVU targets are the same. It doesn't count for promotion in any way. Etc.

Together, these create the system we have now. Students can't carry a large load of patients because the inefficiencies it would cause for me would eb enormous, and my day is already full. You want to close an OR case? Sure, but remember that surgeons are evaluated on total time of the case -- you closing slowly = they get penalized. In the past students did "scut work" currently done by techs or solved with technology -- drawing blood, getting CXR's to review. So students are left doing, well, not much.

It's a problem. The rule changes for student notes might help, at least a bit.

 

[CyrilFiggis]

Why does it cost them so much to cover me seeing patients as a peon and writing notes nobody will see? The days of medical students getting to do anything significant is gone. I've barely ever had the option of actually putting in orders. I approached everything I've done in medical school on eggshells, out of respect to patients and my lack of know-how. Turns out I could of just been throwing myself to do anything I wanted to with that kind of liability, aside from the fact that NPs/PAs are getting to do the same. My mistake in thinking having self awareness and morals is important.

Because you have zero licensing and minimal experience and could potentially kill someone?

 

[deleted978973]

Could you kindly show us the gun that was placed against your temple and forced you to go to medical school????

It's at the Department of Education. Betsy Devos is holding it. It's currently worth $101,000.

 

[Oedipa Maas]

let me at least fumble before you take the needle driver away.

One of the most positive experiences I had was my first time closing. I was having difficulty cocking my wrist the correct way and the fellow on the case came over, put his hand over mine, positioned my hand correctly a few times, and let me continue. I remember feeling super emotional because I had heard so many surgery horror stories and here I was receiving one of the most kind acts of third year. He then worked on suturing with me in the sim lab for the entire afternoon. And then later in the rotation I had a resident slap my hands away when I tried to help remove the drape at the end of the case but you know, win some lose some.

 

[libertyyne]

 

[sharkbyte]

I think the problem is an outcropping of kicking the bucket down the line. It used to be the medical students had responsibilities and expectations on the wards. Now its mostly glorified shadowing , because everyone just assumes you will learn it come intern year, and in intern year in surgical subs you get stuck doing scut. there are people in my school that rotated surgery and were never even given the chance to close. My school literally boasts about its clinical training.

Like how the hell am I going to learn to function as an intern if you are not going to give me an opportunity to own my patients. How the heck am i going to learn any surgical skills if you wont even give me the opportunity to close?

People will say you have to seek out opportunity,Sure, but when i seek it i should also be given that opportunity once in a while. The second year surgical resident wanted to close because they just started getting the chance to do so, the interns wanted to change the ports on the divinci because anything is better than floor scut, and this lack of opportunity roles downhill to where ms3s are fifth scrubed into a robotic case, after the fellow, the senior and the intern and attending are all scrubbed in. The interns want to hoard the LPs because they need a certain volume or just enjoy the procedure.
There have absolutely been rare instances where i was given some autonomy , and opportunity and those instances still stick with me.

like give me one patient, show me how to close, let me at least fumble before you take the needle driver away. I was always affable, available, and able. I dont even want to think bout the less interested people in my class and what their experience was like.

When I was on the second half of my surgery rotation there was an attending who was notorious for letting his students do little in the OR. Even the residents sometimes didn't get to do much when he was operating. I remember one case, a relatively uncomplicated one, he didn't even let the RESIDENT suture the skin. He did it himself. You'd think a guy who's been practicing for 20, 25 years would want to get the hell out of there after doing his thing and wouldn't even have an interest in closing anymore. There was another day where I went into 3 of his cases and didn't get to do a single thing. I just stood there, scrubbed in, for the first two cases contributing absolutely nothing. I didn't even bother scrubbing in for the last case, I just sat there on a stool watching the case on the screen and then bounced early to go to an afternoon conference. Was the biggest waste of my time.

 

[Detective SnowBucket]

When I was on the second half of my surgery rotation there was an attending who was notorious for letting his students do little in the OR. Even the residents sometimes didn't get to do much when he was operating. I remember one case, a relatively uncomplicated one, he didn't even let the RESIDENT suture the skin. He did it himself. You'd think a guy who's been practicing for 20, 25 years would want to get the hell out of there after doing his thing and wouldn't even have an interest in closing anymore. There was another day where I went into 3 of his cases and didn't get to do a single thing. I just stood there, scrubbed in, for the first two cases contributing absolutely nothing. I didn't even bother scrubbing in for the last case, I just sat there on a stool watching the case on the screen and then bounced early to go to an afternoon conference. Was the biggest waste of my time.

Would it be insanity if the school set guidelines for what their med students should do on each rotation!? Eg coming out of surgery rotation, the student should has closed x amount of times, x amount of tubes, intubations etc.

 

[libertyyne]

One of the most positive experiences I had was my first time closing. I was having difficulty cocking my wrist the correct way and the fellow on the case came over, put his hand over mine, positioned my hand correctly a few times, and let me continue. I remember feeling super emotional because I had heard so many surgery horror stories and here I was receiving one of the most kind acts of third year. He then worked on suturing with me in the sim lab for the entire afternoon. And then later in the rotation I had a resident slap my hands away when I tried to help remove the drape at the end of the case but you know, win some lose some.

I had a neurosurgery senior say "Imagine this man waking up and walking outside and people saying wow your scar looks wonderful, and at that moment the wind will whisper your name in his ear "libertyyne did this, libertyyne, libertyyne" Now close this scalp, and dont mess up because he could die from infection. " He guided me through closing, walking me through the steps and allowing me to close, and corrected any mistakes i made, easiest one of the best teaching moments in m3 for me.

Would it be insanity if the school set guidelines for what their med students should do on each rotation!? Eg coming out of surgery rotation, the student should has closed x amount of times, x amount of tubes, intubations etc.

My school does this, stuff like must attend x amount of delieveries, have sign off on suture skills etc. These are really just cya from the school, and not extremely effectual, if anything are a headache more than adding any value. The people running the show must want to spend time teaching, and want to give you opportunities.

 

[ciestar]

When I was on the second half of my surgery rotation there was an attending who was notorious for letting his students do little in the OR. Even the residents sometimes didn't get to do much when he was operating. I remember one case, a relatively uncomplicated one, he didn't even let the RESIDENT suture the skin. He did it himself. You'd think a guy who's been practicing for 20, 25 years would want to get the hell out of there after doing his thing and wouldn't even have an interest in closing anymore. There was another day where I went into 3 of his cases and didn't get to do a single thing. I just stood there, scrubbed in, for the first two cases contributing absolutely nothing. I didn't even bother scrubbing in for the last case, I just sat there on a stool watching the case on the screen and then bounced early to go to an afternoon conference. Was the biggest waste of my time.

My last two week of surgery...
Thoracic surgery. Robotic VATS/lung resections. Not much for the resident to do (PA was assisting on the end of the robot) even less for me to do. Still had to sit through the six hour surgery. RIP

 

[ciestar]

Would it be insanity if the school set guidelines for what their med students should do on each rotation!? Eg coming out of surgery rotation, the student should has closed x amount of times, x amount of tubes, intubations etc.

My school does...
Let me just say this is an imperfect system.

Regardless, i put it in my LCME survey thing that i havent even had the chance to start an IV or do a blood draw. I got the chance to close, but it was a “fail once and youre done” situation...

 

[libertyyne]

I sincerely doubt flexner had envisioned the current standard as education when he proposed the model. Considering that residencies were not standardized I think he probably meant that the clinical education would be adequate for a generalist going out into the world. I dont think that model is working the way it was designed or had worked for a long time. Probably time for a new flexner report with changes that make sense under the current climate. Maybe cut medical school down to three, everyone does an intern year and then applies to further pgy training.
Or make switching specialties easier after pgy 1.
Or make a 12 month preclinical , step 1, then two years of rotations with applications going out in the third.

Considering financial/economic interests do not allow for medical students to do any real clinical work , better to shove them into spending more time training in residency.

 

[Dantrolene FC]

My school does...
Let me just say this is an imperfect system.

Regardless, i put it in my LCME survey thing that i havent even had the chance to start an IV or do a blood draw. I got the chance to close, but it was a “fail once and youre done” situation...

I’ve never been witnessed doing a history or physical exam on a patient on at least half my rotations. Yet my evaluators somehow justify giving me a 2/4 on my history and physical exam skills.

I would like to devise a study somehow, not sure exactly how I’d measure the outcomes. But I’d like to have my experimental group be attendings filling out medical students evaluations like normal. And my control group would be some random attending who filled out a generic evaluation which would be photocopied multiple times and sent to the schools as the students official grading.

I expect the conclusions would find no difference between the two study groups.

 

[Giovanotto]

My last two week of surgery...
Thoracic surgery. Robotic VATS/lung resections. Not much for the resident to do (PA was assisting on the end of the robot) even less for me to do. Still had to sit through the six hour surgery. RIP

I've had to sit through 9-10 hours surgery. In the corner, doing nothing. I wanted to rip my eyeballs out.

 

[ciestar]

I’ve never been witnessed doing a history or physical exam on a patient on at least half my rotations. Yet my evaluators somehow justify giving me a 2/4 on my history and physical exam skills.

I would like to devise a study somehow, not sure exactly how I’d measure the outcomes. But I’d like to have my experimental group be attendings filling out medical students evaluations like normal. And my control group would be some random attending who filled out a generic evaluation which would be photocopied multiple times and sent to the schools as the students official grading.

I expect the conclusions would find no difference between the two study groups.

I was with a resident once who was filling out an eval on their phone over breakfast.. they legit said “i dont even remember this person” 5/5 in everything. Timely evals are also a problem. Took 3 months for my one.. (granted, my school lost a lot of staff members and duties were reshuffled, but timeliness was an issue before)

 

[ciestar]

I've had to sit through 9-10 hours surgery. In the corner, doing nothing. I wanted to rip my eyeballs out.

Yep, that was me. Sometimes back to back cases. Thankfully i was usually told to go home after the first one.

 

[Frazier]

It gets better. We all go through it. You do have control in what matters most.

Chose your specialty wisely.
Base decisions on passion instead of money, lifestyle, prestige, etc.

Ultimately, the latter are not under your control, they change with the wind -- yet no one can take the former from you.

 

[hallowmann]

Your point is valid. But there isn't a grand conspiracy -- the system we have has created this. Several major factors:

A. Nothing medical students do "counts" for anything. I need to write a whole note, I need to cosign and check any orders, etc. (Note: new Medicare guidelines may change the role of student notes for billing, maybe).
B. Seeing patients with students slows me down.
C. I get no credit of any sort for working with students. My schedule / patient load remains the same. My RVU targets are the same. It doesn't count for promotion in any way. Etc.

Together, these create the system we have now. Students can't carry a large load of patients because the inefficiencies it would cause for me would eb enormous, and my day is already full. You want to close an OR case? Sure, but remember that surgeons are evaluated on total time of the case -- you closing slowly = they get penalized. In the past students did "scut work" currently done by techs or solved with technology -- drawing blood, getting CXR's to review. So students are left doing, well, not much.

It's a problem. The rule changes for student notes might help, at least a bit.

The change in Medicare documentation has already had a big impact on med student charting at my institution. Med students are doing a lot more, seeing more patients, and in general feeling more involved. The problem is there are all these med students that see interviewing a patient and writing notes as scut. It's weird. It's like they got used to doing nothing and cramming Anki, then when we have them do something doctor-like they complain.

That said, I agree with everything else you've said. Heck there are points in time where as a senior I struggled to get through watching my intern interview a patient, because it was taking a while and they weren't focusing on meaningful things. I was tempted repeatedly to just jump in.

The learning curve in residency is steep. You get used to doing a lot of work in a little amount of time, because that's what's expected and if you don't, you risk probation, dismissal, and the loss of your career.

That said, I try my best to give students a good experience, give them some leeway to actually be involved in patient care, and when they can pend orders on a patient I try to let them do it (although as you described it's always more work, often done wrong, and more or less is simply a way to make them feel like part of a team). When there's nothing I can reasonably have them do, then I send them home, its pointless for them to just stand there when they could be doing something with family, friends, or even just studying for the shelf.

I was with a resident once who was filling out an eval on their phone over breakfast.. they legit said “i dont even remember this person” 5/5 in everything. Timely evals are also a problem. Took 3 months for my one.. (granted, my school lost a lot of staff members and duties were reshuffled, but timeliness was an issue before)

That doesn't end in med school.

 

[Allosteopath]

I think the rationale behind what roles a medical student can/should take comes down to the watch, do, and teach method. However, when lives are on the line, you don't want to be making mistakes, so it gets taken to the extreme.

Watch 100, Do 100, Teach 100. (or more, can't really say, haven't done it yet)

 

[CherryRedDracul]

That doesn't end in med school.

There are too many ****ing evaluations. This 360 evaluation stuff is a pain in the ass.

I still have like 60 to complete.

 

[Dantrolene FC]

There are too many ****ing evaluations. This 360 evaluation stuff is a pain in the ass.

I still have like 60 to complete.

Just give them all 100%. Problem solved!

 

[CherryRedDracul]

Just give them all 100%. Problem solved!

I've created a macro that automates my evaluations. Everyone gets straight 5/5 evals and it takes a second per evaluation. Even then, I was exhausted by the time I got down to 60.

*Radiology co-residents who know me IRL through this little factoid, keep me anonymous!

 

[efle]

Base decisions on passion

What would you advise to a student for whom no beam of light from heaven ever shined down onto any particular specialty? Largely as a byproduct of being a glorified shadow most of the time, I feel like no matter what rotation I've been on, all I'm ever thinking about is when I'll get sent home. When everything feels so meh, it's hard not to just default to the best hours and pay, even though I'd value loving my work more.

 

[Frazier]

What would you advise to a student for whom no beam of light from heaven ever shined down onto any particular specialty? Largely as a byproduct of being a glorified shadow most of the time, I feel like no matter what rotation I've been on, all I'm ever thinking about is when I'll get sent home. When everything feels so meh, it's hard not to just default to the best hours and pay, even though I'd value loving my work more.

The range of specialties, subspecialties, and sub-subspecialties is so broad, immense, that I feel with near certainty your match is out there... the 2 of you just haven't crossed paths yet.

From addiction, to aerospace, to pain, to GI, to child psych, to CT surgery, to sports med, to informatics, to EM, to palliative, to neonatology, to geriatrics, to admin, to policy, to general IM, to gyn onc path... there is a field out there for everyone.

You aren't defective! I didn't personally find mine until already into residency.

 

[Ho0v-man]

What would you advise to a student for whom no beam of light from heaven ever shined down onto any particular specialty? Largely as a byproduct of being a glorified shadow most of the time, I feel like no matter what rotation I've been on, all I'm ever thinking about is when I'll get sent home. When everything feels so meh, it's hard not to just default to the best hours and pay, even though I'd value loving my work more.

I felt this...so much

 

[Chemist0157]

I think it's okay to look around and vent about the negatives periodically. However, I would not confound that with what is for the most part appropriate, ie medical students being a lower priority in the hospital. They are not the patients who need care, and they are not the staff who are equipped to provide the care. I would temper expectations. There should be efforts made to involve students and to not make them feel like they are wasting their time or time of others. At the same time, students should not expect to be the focus of the day. It seems like even small interactions have been extremely meaningful to some of you.

With that said, do not expect M3-M4 to prepare you for the whirlwind that is intern year. You can get a taste of it on an M4 AI/subAI/away rotation, but for the most part, that is a toe dip in the water. That does not mean you will be unprepared to take on the challenge of residency, just that the learning curve will be steep.

 

[Chemist0157]

I would also add that perspective is important. Medical education is not the only field where students/trainees feel like they are low on the totem pole. Not by a mile.

 

[Dantrolene FC]

I think it's okay to look around and vent about the negatives periodically. However, I would not confound that with what is for the most part appropriate, ie medical students being a lower priority in the hospital. They are not the patients who need care, and they are not the staff who are equipped to provide the care. I would temper expectations. There should be efforts made to involve students and to not make them feel like they are wasting their time or time of others. At the same time, students should not expect to be the focus of the day. It seems like even small interactions have been extremely meaningful to some of you.

With that said, do not expect M3-M4 to prepare you for the whirlwind that is intern year. You can get a taste of it on an M4 AI/subAI/away rotation, but for the most part, that is a toe dip in the water. That does not mean you will be unprepared to take on the challenge of residency, just that the learning curve will be steep.

I guess saying we’re at the bottom of the totem pole doesn’t precisely describe what I mean. I mean medical students feel like we are neglected in the hospital for most rotations.

IM is the best rotation for medical students learning.

OB and surgery are the worst. I honestly could have done a 1 hour suturing session, saw patients on the floor for 1 hour per day, and just watched the rest of the surgeries online without alternating my education one bit.

 

[AnatomyGrey12]

I had a neurosurgery senior say "Imagine this man waking up and walking outside and people saying wow your scar looks wonderful, and at that moment the wind will whisper your name in his ear "libertyyne did this, libertyyne, libertyyne" Now close this scalp, and dont mess up because he could die from infection. " He guided me through closing, walking me through the steps and allowing me to close, and corrected any mistakes i made, easiest one of the best teaching moments in m3 for me.

I had a similar experience except with an attending on like my 3rd day of my ortho rotation. One of the residents was out on fellowship interviews so it was just me, a pgy2, and a fellow on a really busy trauma service. I was scrubbed in with the fellow and resident when the attending had to go do a case that had been put on the board last second, and the resident wanted to see the approach for the acetabulum case the fellow was doing so they sent me over to do this other case with the attending. I had only met this attending that morning when I introduced myself and yet he literally sat there and taught me every step of the case as he was doing it, why he was using certain retractors, how aberrant anatomy could make it more difficult, benefits of different approaches, things to consider in the post-operative period, etc. He was super patient with me as I'm sure I made his life harder because I wasn't first assisting as smoothly as a resident would have. At the end he walked me through closing and pointed out some things that would make suturing easier. I learned more with that attending on that one case than I had on entire previous rotations combined. I found out later the residents love the guy because the dude just loves to teach.

The problem is there are all these med students that see interviewing a patient and writing notes as scut. It's weird. It's like they got used to doing nothing and cramming Anki, then when we have them do something doctor-like they complain.

I don't think that's a result of the pre-clinical pathway. I have seen the same thing and, in my experience, it typically comes from the students who obviously had glorified expectations of what clinical medicine actually is. As if they thought they'd be cracking chests and saving lives on a minute by minute basis.

 

[Chemist0157]

I guess saying we’re at the bottom of the totem pole doesn’t precisely describe what I mean. I mean medical students feel like we are neglected in the hospital for most rotations.

IM is the best rotation for medical students learning.

OB and surgery are the worst. I honestly could have done a 1 hour suturing session, saw patients on the floor for 1 hour per day, and just watched the rest of the surgeries online without alternating my education one bit.

OB was by far my worst rotation. Terrible residents/attending nearly across the board. Off service residents/interns were better. Still, there were expectations that I would participate in x number of deliveries, catch a couple babies myself, go to see C sections, go to GYN surgeries, retracting (ugh), rounding, etc.

Surgery was pretty good. I did optho so I only observed in the surgeries but learned a lot during the procedures and saw patients in clinic. I also did colorectal surgery and got to participate. (Slow) surturing. Retracting. I remember using some of the other instruments to cut bowel, etc just to get a feel for it.

I do not know if all programs are the same. I suspect some are better than others. That's a failure of specific programs, staff, etc, not necessarily "medical education."

Enough people complained that the OB rotations apparently got better after my time.

 

[Aleaz]

I agree with some of this. As a retired surgeon who trudged uphill for years as a female, made to run upstairs all day to 'keep up with the (male)gang' as they 'hazed me' (I was a surfer girl and kept up easy😉...Having any other students in a rotation would be very hard to swallow. But it is not the 'totem pole'--it is MONEY. The school is making money from the government to rtrain PAs and NPs as well as govt kick backs. My old med school TRIED in vain to push EVERYONE into FP because of the same govt's kick backs due to shortages in that field.

If I was in your shoes--I would speak directly with the RESIDENT on the rotation with you and tell them you do not wish to get 'left behind in the crowd' and will do ANYTHING to have them take you under their wing. IF you find a really smart Resident--LEARN from them everything you can but also do for them--which might be scut but so what?

One more caveat: MANY med students will say "Oh yeah, I hear it" or such when an Attending or Res. is showing you something-a murmur, crackles, etc. IF YOU DON'T HEAR IT OR GET IT--SAY SO! I used to be the ONLY one to say I didn't hear a murmur etc...and then the rest of the team would come up and ASK me what I heard (but they tsk tsk'd me at the time I said so!!!)--because they were to chicken to admit it. You guys are LEARNING--so do the time, find a good Attending or Res mentor and work HARD...and learn.