Failing an AI, is it possible?

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Meh, no one truly relies on the med students to do anything. The fact that your senior did makes me think it's the partial source of his consternation. My guess is the attending responsible for determining whether you pass or not will be far less moved by this event than the senior's stressed-out piss fest.

If I'm wrong, I hear Best Buy is hiring.
 
If your senior was like "Oh, ok, I get it now" they aren't going to fail you. If you are stressed out about it, you could ask the senior how you are doing and if you can do anything to improve.
 
Wow you need to chill the f out; how'd you survive med school with this level of neuroticism? You'll be just fine.
 
I think OP should take some propanolol. Or beer.
 
Dd you match last week? If so, does all this really matter? You should be going home after didactics anyway! Come on people, this is fourth year!
 
No, you won't fail. You told the RT to page the team if it was urgent, and the RT didn't do that. The senior was taking her frustrations out on you because the mom yelled at her. Its not like you committed a major error anyway.
 
Holy god, I can't believe the answers in this thread.

Let's be incredibly clear about something: (At least at my institution) As a SubI, your primary responsibility is to the care of your patients. That trumps everything: didactics, going home on time, your dinner date, your research project.

Telling the RT that you're too busy to address the problem, and that they should "call the intern" is unacceptable IMHO. As the SubI these are YOUR patients, and YOU should be caring for them. Sure, everyone signs out their patients to an on call / night float cover at night, and on days off. That's fine. But when you're in house, these patients belong to you. They are your responsibility.

You claim that you didn't know it was urgent. Of course you didn't. You didn't go see the patient to sort it out. It might not have been urgent had you actually went to see the patient and sort out the problem.

Now, I realize that institutions may be different. Where I am, SubI's don't have didactics. They take care of patients. They go to intern conferences. But they are always covering their pager, and they understand that when it rings, the problem is yours to deal with. Not to pass off to someone else. However, if in your institution your SubI is graded on your attendence at conference, then that's a different model that I honestly find hard to support.

Perhaps I'm a hard ass, but SubI's simply skating by (usually those rotating late in the schedule, already matched, and not really caring) drive me crazy. I fail them after I warn them to change their work ethic (if they don't)
 
Yeah that's sort of interesting that there's didactics on a sub-I. I feel like there are very different sub-I experiences at different institutions. At some med schools they simply schedule one less intern to a service and the sub-I replaces them completely and has the ability to write orders, etc. At mine, at least on the service I was on (heme) it's a totally different experience; there was another intern on the team and I didn't get paged about anything, ever. It was actually a really similar experience to 3rd year medicine except the patients were totally different. I do think the OP would benefit from talking to their residents about what they could do better rather than post on SDN about it.
 
aProgDirector said:
Holy god, I can't believe the answers in this thread.

Let's be incredibly clear about something: (At least at my institution) As a SubI, your primary responsibility is to the care of your patients. That trumps everything: didactics, going home on time, your dinner date, your research project.

Telling the RT that you're too busy to address the problem, and that they should "call the intern" is unacceptable IMHO. As the SubI these are YOUR patients, and YOU should be caring for them. Sure, everyone signs out their patients to an on call / night float cover at night, and on days off. That's fine. But when you're in house, these patients belong to you. They are your responsibility.

You claim that you didn't know it was urgent. Of course you didn't. You didn't go see the patient to sort it out. It might not have been urgent had you actually went to see the patient and sort out the problem.

Now, I realize that institutions may be different. Where I am, SubI's don't have didactics. They take care of patients. They go to intern conferences. But they are always covering their pager, and they understand that when it rings, the problem is yours to deal with. Not to pass off to someone else. However, if in your institution your SubI is graded on your attendence at conference, then that's a different model that I honestly find hard to support.

Perhaps I'm a hard ass, but SubI's simply skating by (usually those rotating late in the schedule, already matched, and not really caring) drive me crazy. I fail them after I warn them to change their work ethic (if they don't)
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I think this was just miscommunication, not a question of poor work ethic.
 
My subI was def like an intern. In fact the intern I rotated with on the team hadnt done liver medicine yet and I had as a third year, so I ended up showing him how to do dx and tx taps for ascites.

I think it is institution dependent though.

To the OP though, Id probably clear up with the clerkship director your order of priorities--i.e. didactics vs patient care.
 
..


aProgDirector said:
Holy god, I can't believe the answers in this thread.

Let's be incredibly clear about something: (At least at my institution) As a SubI, your primary responsibility is to the care of your patients. That trumps everything: didactics, going home on time, your dinner date, your research project.

Telling the RT that you're too busy to address the problem, and that they should "call the intern" is unacceptable IMHO. As the SubI these are YOUR patients, and YOU should be caring for them. Sure, everyone signs out their patients to an on call / night float cover at night, and on days off. That's fine. But when you're in house, these patients belong to you. They are your responsibility.

You claim that you didn't know it was urgent. Of course you didn't. You didn't go see the patient to sort it out. It might not have been urgent had you actually went to see the patient and sort out the problem.

Now, I realize that institutions may be different. Where I am, SubI's don't have didactics. They take care of patients. They go to intern conferences. But they are always covering their pager, and they understand that when it rings, the problem is yours to deal with. Not to pass off to someone else. However, if in your institution your SubI is graded on your attendence at conference, then that's a different model that I honestly find hard to support.

Perhaps I'm a hard ass, but SubI's simply skating by (usually those rotating late in the schedule, already matched, and not really caring) drive me crazy. I fail them after I warn them to change their work ethic (if they don't)
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spinnerette said:
truth be told, the didactic is held by the clerkship director (the one in charge of the AIs) and he told us that the interns and seniors know that I would be doing my didactic once a week for one hour. During that period, we can just sign out to the team and a fellow intern can take care of anything urgent.
Of course I answer pages even during didactics. I would act on it if it's urgent.

Besides.... bad work ethic is going for lunch and not seeing your patients.
Knowing that your didactic is "protected time" and you have "signed out" to another intern for 1 hr is not bad work ethic.
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If you had signed out to your intern, then you should've forwarded the page to your intern.
 
spinnerette said:
Just wondering.
I am quite stressed right now.
I posted here a couple days ago about me leaving work for lunch for an hr to grab my stuff. I talked to the clerkship director today and he said it was fine, "you learned your lesson, sure the senior was looking for you but no harm was done. It was not morally wrong for you to do. you checked up on your pts before you left, you brought your pager, it's fine"


Guess what.
I got yelled by the senior again today.
I was going to my didactic at 1230 today. I signed out to the interns and I got a page from the respiratory team at 1235. "Mom's just wondering if the pt can go home today. Can you come listen to her?"
"No, can't at the moment. I have didactics and I will be back in an hr. If it's urgent, you can page the team, the interns can go listen"
"Sure"

An hr later, got another page, "Mom said she's leavning. Can you come now?"
"Sure, will be there in 10min"
When I walked in, I saw the senior getting yelled at by the mom who was threatening to leave with her daughter.
The senior took me to an empty room and asked, "how come you didn't page us?"
"I told the RT to page the team if it's urgent"
"you should've paged us if u knew it was urgent"
"I'm sorry, I had no idea that it was urgent"

Well, later that afternoon, senior came back saying that she has talked to the RT and realized that RT didn't tell me that it was urgent,so it wasn't really my fault.
Seriously, "I'm taking my daughter out of this hospital" is VERY different from "Mom is wondering if the daughter can go home today"


I dunno, I am still quite depressed now.
I have 3 weeks left to impress the senior and all I want is to just pass...............

Can you actually fail an AI at your home institution if you show up everyday on time and you do what you are told?
I am not gunning for an honor right now, clearly.
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I would not worry about it *too* much. I think that it's lack of experience/not knowing how to deal with the situation mostly, not a deliberate attempt at not doing what you are supposed to do really. With that said, keep in mind that patient care *always* comes first-no matter if you have didactics, a meeting, a presentation, etc. Unless it's something you can quickly resolve over the phone, health and safety of patients is always #1. I have had to miss morning reports, meetings, conference, etc a ton of times due to codes, ICU transfers, meetings with patients, attendings wanting/needing to round, etc. You can always explain to whoever that you were taking care of a patient, no one will fault you for that.

With that said, I always thought I would be a hard ass with students given that most of my residents were kind of hard asses, but I ended up being a softie. 😳 I think that being a student, you should be exactly that-a student. If I was ever in a position as a patient where my care depended on a student-i would start seizing instantaneously. Your intern/senior/attending/whatever should ALWAYS have your back, and should be supervising you-no excuses. Most students don't have a clear conception of the seriousness of patients' conditions, etc. many times and what to you may not seem *urgent* might indeed be very urgent. As such, I think you should never be concerned about paging your senior resident/intern/etc in regards to a patient.

And even though I deviated from your main question, 1-I don't think you will fail, just make sure that you are extra responsible with your patients during the remainder of your rotation, 2-I think your resident is kind of a jerk. Teaching by yelling/intimidation, etc. is always a bad idea in my opinion, and just leads to neurotic states, 3-patients frequently yell/get upset at whoever comes first in the room when they are not happy about something, and it will continue to happen-get used to it 😎

Good luck!
 
officedepot said:
In the case of the OP it was not urgent. Just an annoying patient who wanted to go home 5 minutes earlier.

Also a student is and should be responsible for absolutely NOTHING. A sub-i is still a student and it is not the student's responsibility to take care of the patient. The student can/should/does help but the first priority of the student is to learn. Didatics are more important than typing a note which can be typed later because no one wants to read a student's note. The resident should be the one putting in orders (or at least checking them), making sure things get done, etc since it is ultimately the resident's responsibility. If the resident chooses to trust a student that is their problem. As a resident (well likely I'll only deal with students heavily in a patient care clinical setting for 1 year) I won't make students do **** I can't do myself and will let them go home as soon as I can depending on my upper level. And when I become a fellow resident of these upper levels if I hear of crap going on amongst friends I will speak up.


Again, OP, you likely just overreacted to the whole situation because you're (like pretty much every student out there including myself) overly sensitive to criticism since we generally have never been criticized before. Also your resident is probably just an a-hole. But you know sometimes they're not and they're just having a bad day. I swear there was this one obgyn intern I hated with a passion for 2 days and then by the 3rd and 4th day I thought she was pretty cool (turns out she's pretty nice and will insist on getting you coffee and even starting up some small talk on her own - though she was still kind of a douche when I first met her regardless). Point being you will be fine. Suck it up. Move on. A high pass won't kill you anyway so who cares.

lol I like how the OP always deletes her posts. lol. Hopefully she sees this.
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I couldn't agree more. We are paying for this. We are paying to learn. While you should help with the patient, your first priority should always be to learn.

Also, I can't believe an attending would fail a fourth year for anything. That would have to be the most malignant program ever. Our dean calls our fourth year students YO YO's whenever the residents or the interns lean on us too hard. Your On Your Own.
 
officedepot said:
In the case of the OP it was not urgent. Just an annoying patient who wanted to go home 5 minutes earlier.

Also a student is and should be responsible for absolutely NOTHING. A sub-i is still a student and it is not the student's responsibility to take care of the patient. The student can/should/does help but the first priority of the student is to learn. Didatics are more important than typing a note which can be typed later because no one wants to read a student's note. The resident should be the one putting in orders (or at least checking them), making sure things get done, etc since it is ultimately the resident's responsibility. If the resident chooses to trust a student that is their problem. As a resident (well likely I'll only deal with students heavily in a patient care clinical setting for 1 year) I won't make students do **** I can't do myself and will let them go home as soon as I can depending on my upper level. And when I become a fellow resident of these upper levels if I hear of crap going on amongst friends I will speak up.


lol I like how the OP always deletes her posts. lol. Hopefully she sees this.
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1). It was a parent who was about to take a patient out AMA. That needed to be addressed. although it could've been addressed by anyone on the team which is why the OP should have alerted someone on the team instead of just leaving the situation be for an hour. Not a horrible mistake, something to learn for next time.

2). This is a sub-I. some schools just have sub-I's really just be rotator's, and if that's the case then you're right. But at my med school and many others, sub-I's are wholly responsible for the patient. Their notes are meaningful, their care is meaningful, they put in their own orders that are cosigned, they prepare the scripts which are then signed off on by the resident. they are the ones doing it. the point of the sub-I in these schools is to teach them how to be an intern and actually take care of their own patients. working on patients is their learning, moreso than didactic sessions. Their didactic sessions have the same level of commitment as didactic sessions for interns and residents. Meaning patient care comes first, but you should also be making sure someone is aware of pt's and in charge of them while you are gone for that session, and in the event of an emergency, you need to excuse yourself to take care of issues. (in this case, paging someone who is free at the moment to take care of the issue.)
 
Rendar5 said:
1). It was a parent who was about to take a patient out AMA. That needed to be addressed. although it could've been addressed by anyone on the team which is why the OP should have alerted someone on the team instead of just leaving the situation be for an hour. Not a horrible mistake, something to learn for next time.

2). This is a sub-I. some schools just have sub-I's really just be rotator's, and if that's the case then you're right. But at my med school and many others, sub-I's are wholly responsible for the patient. Their notes are meaningful, their care is meaningful, they put in their own orders that are cosigned, they prepare the scripts which are then signed off on by the resident. they are the ones doing it. the point of the sub-I in these schools is to teach them how to be an intern and actually take care of their own patients. working on patients is their learning, moreso than didactic sessions. Their didactic sessions have the same level of commitment as didactic sessions for interns and residents. Meaning patient care comes first, but you should also be making sure someone is aware of pt's and in charge of them while you are gone for that session, and in the event of an emergency, you need to excuse yourself to take care of issues. (in this case, paging someone who is free at the moment to take care of the issue.)
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Then again, it was also the nurse's fault for not expressing the urgency of the situation. It's residents like you who can have a huge negative impact on the med students. Students are there to learn about medicine, not how to second guess what residents think in their heads.
If you have other patient duties on hand and the nurse were to page you saying, "the parents want you to come listen to the kid again but I think the kid is fine", would you drop everything you have on hand and go see the kid? What IF the nurse failed to tell you that the parents are angry at the team? Would you still blame yourself?

Personally, I care about my patients but I would not blame anyone on my team if the patients are being unreasonable.
 
bestcoast said:
Then again, it was also the nurse's fault for not expressing the urgency of the situation. It's residents like you who can have a huge negative impact on the med students. Students are there to learn about medicine, not how to second guess what residents think in their heads.
If you have other patient duties on hand and the nurse were to page you saying, "the parents want you to come listen to the kid again but I think the kid is fine", would you drop everything you have on hand and go see the kid? What IF the nurse failed to tell you that the parents are angry at the team? Would you still blame yourself?

Personally, I care about my patients but I would not blame anyone on my team if the patients are being unreasonable.
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Yes, my med students hate me and go home crying every night when I tell them how they should handle certain situations in the future 🙄 It gets even worse when I have them write a note, review it, tell them how to present to the attending while I cosign the note, add a couple remarks on the physical exam and put in orders for them.🙄 I mean, my god, I suggested that the med student take the time to tell the RT to page someone on the team who was free at the moment that there was a social situation requiring some attention or telling them to page them themselves. Holy crap! That takes 30 seconds away from their didactic education! I mean, it's not like you're supposed to learn anything about patient responsibility as a sub-I if it takes even one second away from a lecture.🙄

And those negative feelings are probably even worse because I said 😱. it's a minor mistake that you now know how to handle next time 😱😱😱😱 Quick! get a psych consult, that could cause suicidality or PTSD

You want my non-sarcastic response? actually read my posts, I just said what they should've done in the situation
 
officedepot said:
I see what you mean but ultimately it's still the resident's responsibility because the sub-i is still a student. They are just learning to be a doctor. So as a student it is essentially my opinion that learning comes first (assuming the patient is ok of course). However if the sub-i really is the only one being paged about issues then that could cause some problems. Some students like that. I'd do it if it was necessary as a student but generally I just say page the resident because a student cannot put in orders. Nurses and staff asked me all the time to do stuff but I have to turn them away constantly because as a student you have no power and you're not going to do anything without talking to the resident first. I hope not anyway.
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That's fine and exactly what is appropriate.
 
Why is it that every intern/resident/attending/PD will adhere to the statement that medical students are an important part of the team when most medical students will acknowledge that their daily role is marginal at best.

In this case, however, I'd have to side with the resident. The patient is your responsibility when you're a sub-I and it doesn't matter how many people tell you (or don't tell you) whether something was or wasn't done about your patient. At the end of the day, you're responsible even when the nursing staff fails at their job. This happened frequently when I was a sub-I and required me to learn that certain nurses were more reliable than others and for the unreliable ones, I had to personally make sure they followed through with orders. Sucks.

Oh and that bit about the resident being ultimately responsible? That may be true, but the reality is that when it comes to actual patient care, they simply don't know your patients as well as you do (and why should they...they're taking care of 16+ others). Plus when you screw up, your resident screws up, and when he looks bad because of you, he'll make sure you look REALLY bad. So it's in your best interest to take amazing care of your patients so that everyone wins.
 
Phyozo said:
Why is it that every intern/resident/attending/PD will adhere to the statement that medical students are an important part of the team when most medical students will acknowledge that their daily role is marginal at best.

In this case, however, I'd have to side with the resident. The patient is your responsibility when you're a sub-I and it doesn't matter how many people tell you (or don't tell you) whether something was or wasn't done about your patient. At the end of the day, you're responsible even when the nursing staff fails at their job. This happened frequently when I was a sub-I and required me to learn that certain nurses were more reliable than others and for the unreliable ones, I had to personally make sure they followed through with orders. Sucks.

Oh and that bit about the resident being ultimately responsible? That may be true, but the reality is that when it comes to actual patient care, they simply don't know your patients as well as you do (and why should they...they're taking care of 16+ others). Plus when you screw up, your resident screws up, and when he looks bad because of you, he'll make sure you look REALLY bad. So it's in your best interest to take amazing care of your patients so that everyone wins.
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Darn, I had typed a longish well thought out response to one of these posts and then screwed it up and lost it! Lol. Anyways, while I don't agree that the responsibility of taking care of the patient should fall on the shoulders of the student, it is important for the med students to have some responsibility. After all, most sub-I's are months away from starting their internship, so it's a great way to start learning more real medicine with a safety net. The intern/senior/whatever should always be in charge however, and realize that the sub-I is still a student and may not know what they are doing, so their work should ALWAYS be supervised. As I stated, I would immediately check out of a hospital where my care was solely in the hands of a student. That's crazy.
 
DrAwsome said:
Darn, I had typed a longish well thought out response to one of these posts and then screwed it up and lost it! Lol. Anyways, while I don't agree that the responsibility of taking care of the patient should fall on the shoulders of the student, it is important for the med students to have some responsibility. After all, most sub-I's are months away from starting their internship, so it's a great way to start learning more real medicine with a safety net. The intern/senior/whatever should always be in charge however, and realize that the sub-I is still a student and may not know what they are doing, so their work should ALWAYS be supervised. As I stated, I would immediately check out of a hospital where my care was solely in the hands of a student. That's crazy.
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That's the thing tho - that sub-I is gonna be an intern in just a few months and if anything, you probably start intern year less prepared than your sub-I with all that knowledge attrition from the party and drinking you've been doing the last few months...

What's really crazy is agreeing to be admitted to a teaching hospital in July.
 
I would try so hard not to take "hard" rotations after matching...especially rotations where you actually have to put forth effort D:

these few months before being an intern should be spent on awesome booze :meanie:
 
KnuxNole said:
I would try so hard not to take "hard" rotations after matching...especially rotations where you actually have to put forth effort D:

these few months before being an intern should be spent on awesome booze :meanie:
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Ugh I finish with neuro 🙁
 
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