Fed up with 3rd year...

[Sharkfan]

---

Members do not see this ad.

You should get honors in what you like; I don't see why I should fight for honors in ob-gyn when they ought to go to someone who is actually interested in that specialty.

Try telling this to the people openly obsessed with getting high pass/honors in as many rotations as possible (if not all). 😡

 

[im do 08]

I really enjoy teaching, and love having students around. And I'm not very far removed from being one, so I remember vividly what it was like.

Hey TommyGunn, what hospital are you at!? I'll be there in a sec! 😉

If you look at it from an attending/resident/intern's perspective, where every month they're working with different students, they clearly do have a better view of how well we're doing... so start thinking from their point of view, therefore 1. do NOT be a nuisance, 2. be a team player... nobody likes to work with selfish people, 3. study for your own knowledge, not for pimping sessions, shelfs or boards. study for your patients.

In any case, like stated elsewhere, honors aren't the only thing that's important. The way I do things is to just think about your fund of knowledge as what's going to save your a$$ when you're an intern on call... so I learn mostly to be a competent physician... if you work hard, show initiative and are not concerned purely by what your attendings etc. are thinking about you, you might just do better than you were... its been working for me so far...

 

[71263]

Jeez. You guys are crushing my dream here! 🙁

First year was hell for me, and the only thing that got me through was thinking that in only 2 years, Id be away from the classroom and seeing patients in the hospital. I started hearing the horror stories this summer, when my friends who had just finished boards were starting up in the wards.

The hard part doesnt end after step 1, huh? Great. Here I am, way over my head just thinking about boards. Guess I got nothing to look forward to till 4th year...

 

[kito]

Third year is more difficult than second year cause you need to learn as much while working up to 80 hours per week. That being said it is a hell of a lot more interesting, and most (though not on this thread) would argue that it is more fun too. I am one of them.

NOTHING is worse than Step 1, and it is not likely that you will ever see anything as miserable as that ever again, ever when it comes to board certification.

 

[nutcancer]

my third year experience hasn't been stellar so far either. and i can find plenty of things to bitch and moan about. but in retrospect, all those bad things have been valuable lessons for me that will hopefully be formative in who i am as a professional. 3rd year is more about learning how to be a coworker and a professional than anything else. if you have good people skills, you will automatically excel. fund of knowledge has very very very little to do with it. my recommendation to 2nd and 1st years is to work on your people skills more than anything

'its not about who u know, its about who u blow'

a little dramatic but more or less true in the real world, not the 2nd floor of the library you've been working at the past year

 

[chocomorsel]

my third year experience hasn't been stellar so far either. and i can find plenty of things to bitch and moan about. but in retrospect, all those bad things have been valuable lessons for me that will hopefully be formative in who i am as a professional. 3rd year is more about learning how to be a coworker and a professional than anything else. if you have good people skills, you will automatically excel. fund of knowledge has very very very little to do with it. my recommendation to 2nd and 1st years is to work on your people skills more than anything

'its not about who u know, its about who u blow'

a little dramatic but more or less true in the real world, not the 2nd floor of the library you've been working at the past year

I completely disagree with this. I have great people skills, and work with my fellow students and residents quite well. But I failed IM for other reasons, not lack of people skills. And alot of it had to do with fundamental knowledge. So with that said, I think the different factors count their fair share, but I bet people skills count a lot less. How often are the attendings there to see your people skills anyway? They mostly see your fundamental knowledge and presentation skills whereas the residents see the other stuff. Too bad resident evals don't count as much, otherwhise I wouldn't be retaking 3months of IM.

 

[nutcancer]

very sorry to hear about IM. i agree in IM attendings evals count and they don't evaluate your people skills. but in other rotations, expect to be working with residents primarily and that's when what i said really matters. attendings tend to look at things objectively. but with residents, they have to like you as much as they like your fund of knowledge.

i know someone who had to repeat IM as well. you can feel sorry for yourself or go in there with and take heads next time around. stay confident and work on your weaknesses.

 

[chocomorsel]

very sorry to hear about IM. i agree in IM attendings evals count and they don't evaluate your people skills. but in other rotations, expect to be working with residents primarily and that's when what i said really matters. attendings tend to look at things objectively. but with residents, they have to like you as much as they like your fund of knowledge.

i know someone who had to repeat IM as well. you can feel sorry for yourself or go in there with and take heads next time around. stay confident and work on your weaknesses.

Thanks man. I sure hope that the other rotations are better than IM when it comes to people skills counting more. So far I've done fine in psych and OB. We'll see what the latter half of 3rd year has to offer and hopefully you are right.

 

[CaptKirk]

The fed-up-ness continues... Ob/gyn sucks, that's all I'm sayin.

 

[terp03]

Completely agree with all the frustrations expressed about 3rd year! I have been feeling burned out and down too... The sucky thing for me is that I am actually interested in my current rotation and clearly expressed it to the attendings I work with, but they just don't care. They are not responsive at all and I will probably need a letter from one of them.

So much of 3rd year is luck when it comes to who you work with. About those who say there is a difference in students, of course there is we come from such different backgrounds, there is age difference, your life experience, how you learn and so forth... so shouldn't your enthusiasm and willingness to work hard and help out count for most of your evaluation. You learn the rest with experience.

Finally, don't you guys think that the whole system is screwed up if our very expensive education experience depends on whether or not your resident or attending is a decent human being and actually cares about your learning vs. someone who could care less and just wants to get through the day(not even mentioning the jerks) What's their incentive?

hope this is not too much venting🙂

 

[SLUser11]

Completely agree with all the frustrations expressed about 3rd year! I have been feeling burned out and down too... The sucky thing for me is that I am actually interested in my current rotation and clearly expressed it to the attendings I work with, but they just don't care. They are not responsive at all and I will probably need a letter from one of them.

I'm not sure which field you're interested in/going into, but feel encouraged by the fact that you don't really need any letters during third year. In fact, I'd recommend waiting until you do sub-Is to get your big letters. When you do get letters as an MS3, they are usually more vague, as the attending usually doesn't know you as good, and dedicates less effort to sizing you up. Also, these letters reflect your performance as a third year, which hopefully is not as good as it will be next year.

My experience is limited to surgery, but I got all my letters in a short time by setting up rotations with the "big names" and getting face time with the chairman.....as a fourth year.

If your attendings are ambivalent towards you, just take a deep breath, try to relax, and start planning next year's rotations with attendings that give out more hugs.

 

[felipe5]

whats the longest you guys have rounded on your services? my IM team rounds for 5-6 hours everyday and, well, i'm just curious if anyone else had this type of super fun experience during their third year.

 

[QuinnB]

Had an attending that rounded from 7 am until about 12 to 12:30 pm each day. It was incredibly inefficient. What sucks is that this is the prime time to really get stuff done for your patients (consults, evals, lab draws, imaging, etc...).

 

[deleted109597]

Had an attending that rounded from 7 am until about 12 to 12:30 pm each day. It was incredibly inefficient. What sucks is that this is the prime time to really get stuff done for your patients (consults, evals, lab draws, imaging, etc...).

Weak. I had one that on a Saturday, started rounding at 8:30am, and didn't finish (ie, hadn't seen all the patients) by 10pm. Rounding for 13.5 hours hasn't been beaten at my school yet.

 

[QuinnB]

can't beat that...i haven't heard anything close to that. You weren't rounding until 10 pm post were you?

 

[deleted109597]

Yes, it was my Saturday call day. I had to round all day. We did have 2 surgeries interspersed in there, but these weren't long cases, both were quick, one appy, one chole, both in under 2 hours.
Which of course meant standing in one place, not even getting to walk for that point.
Thankfully it wasn't a bad night in terms of call.

 

[yl99]

To anyone who wants to reply,,,

 

[Hard24Get]

I always fear that I will be branded as stupid during clinics, which makes me work harder, even when my riginal plan was to be disinterested. I can do things none of the residents thought to do, answer questions they didn't know, but one roperly placed "what am I thinking" pimping question and I am humilated in front of several people and on the verge of tears. 😳

Maybe it's just b/c I am a minority and don't want to be labeled as an AA case? Or do other people fear that their effort/performance on pimping sessions will translate to whether residents and attendings think they are "good enough" to do medicine?

 

[Tired]

I always fear that I will be branded as stupid during clinics, which makes me work harder, even when my riginal plan was to be disinterested. I can do things none of the residents thought to do, answer questions they didn't know, but one roperly placed "what am I thinking" pimping question and I am humilated in front of several people and on the verge of tears. 😳

That's the whole point of the MS3 years. Your experience is not personal nor an indication of your intelligence or fitness for the profession. The junior clerkships are designed to do exactly what you describe.

Maybe it's just b/c I am a minority and don't want to be labeled as an AA case? Or do other people fear that their effort/performance on pimping sessions will translate to whether residents and attendings think they are "good enough" to do medicine?

Here's the truth: Your effort/performance on pimping sessions will directly translate into whether residents and attendings think you are "good enough" to do their specialty. Their evaluations will reflect this.

 

[Smoke This]

Thank you all! Seriously, what part of being a quiet person = not being interested or = not honors?! Just because I prefer to speak only when I think I have something useful to say or a non-obvious question to ask, rather than just to hear myself talk or get brownie points, I get marked down...

Anybody else getting kind of depressed thinking about dealing with this kind of stuff for the rest of the year (at least)?

I was heavily criticized for that when I was a student. It didn't matter. I still matched. Some people saw through that (i.e. IM, psych, my specialty sub-i's) and gave the evaluations that I deserved. As ridiculous as it is to be graded down based on this aspect of your personality, it happens. You should force yourself to at least ask lots of questions when you do your sub-i's as one way to look interested in learning and to get noticed. Good luck.

 

[MeowMix]

I've been really struggling with the difference between clerkships and any other kind of job I've ever had. In the normal world, I would show up early, work my ass off to do whatever had to be done at work, help out other people with their workload where appropriate, and then leave once the work had been completed. Here, this behavior is counterproductive. I can end up doing piles of busywork that the interns often do not appreciate; right now 2/3 interns that I'm working with are constantly too busy to discuss any pts with me; when I ask how I can help they say I can't, they'll take care of everything. They keep telling me to leave when actually, I want to pick up more patients so I can see and learn more. I am not learning about my pts because everyone is too busy to spend any time discussing the care plan and the day-to-day evolution. Reading about my pts without discussion? I find that I forget most of what I learn this way within a week. I know they are overloaded and doing the best they can. I hate working this way.

The subjectiveness of evaluations: unfortunately it's taken me months to realize that each attending/resident cares about different things. One thinks the most important thing is whether I specifically know the DSM-IV criteria for specific psych disorders and can get through a full inpt psych eval in 40 minutes followed by a 1-min presentation. Another thinks I should do a full 3-hr H&P and extensive exam on each medicine inpt with a long, detailed, written H&P. Another wants a 30-minute inpt medicine H&P and write it up in 10 minutes. I have to do whatever the attending wants me to do if I want a good grade. My opinion is irrelevant.

Right now I want to know how to make the transition from student-speed H&P to intern-speed, and here I feel the education is really lacking. I have to know how to do each step of the physical exam properly, and the only way to know is to practice. But I also have to learn to be "efficient", which basically means knowing which steps to skip or how to speed up the whole thing, and that also requires practice. I think it's unreasonable to expect the average inexperienced MS3 to be efficient (i.e. fast), unless someone is going to help me through that transition - and of course, no one has the time.

 

[Mayhem]

And before some other jerk comes here to say that I should be more proactive about my education, like, instead of aimlessly wandering the wards I should have been down in the ER or something. You can take that line and shove it. I pay 39k a year for this pile of bull and I think that, at the very least, the f'ing residents can page me when something's going on.

Ha Ha Ha. If I had a dollar for everytime someone fed me that line. Bullcrap! The ED isn't some magical bastion of knowledge. When I was on medicine I used to sit in the ED every call night with....get this...the SURGEONS. Why?
1. They aren't arrogant, anal know it alls with a stick up their behinds.
2. They acknowledged my existence.
3. They tried to teach me something.

I remember one night sitting right beside my resident when a patient came in. I got up to see what was going on and the guy just said "I don't need you". I wanted to scream. Well, if you don't NEED me then why the hell am I trapped in this hospital all night. I mean these people were draconian about call, we even had electronic time cards.

Anyway, the rage must have been obvious on my face because one of the neurosurgery residents saw it and said to me, "Guess you're not doing much tonight, wanna be my intern?" After that, whenever I had call I'd just "*****" myself out to whichever service would have me. If I had to be there I was damn well going to be learning something. I haven't seen that eval yet but who cares, i wasn't even close to honoring IM anyway.

 

[Tired]

Some thoughts:

I've been really struggling with the difference between clerkships and any other kind of job I've ever had. In the normal world, I would show up early, work my ass off to do whatever had to be done at work, help out other people with their workload where appropriate, and then leave once the work had been completed. Here, this behavior is counterproductive. I can end up doing piles of busywork that the interns often do not appreciate; right now 2/3 interns that I'm working with are constantly too busy to discuss any pts with me; when I ask how I can help they say I can't, they'll take care of everything.

It's no consolation to you right now, but someone is noticing your work, and it will pay off later on. The alternative is to not come in early, work hard, offer to help, etc. Believe me, if you do that, it will definitely be noticed, and you don't want that.

They keep telling me to leave when actually, I want to pick up more patients so I can see and learn more.

Be careful about staying when they tell you to go, this can actually be a black mark against you ("brown-nosing" appeared on one of my evals for doing this). My approach was, when they tell you to go home, tell them you want to stay and help (don't say "learn more" because you sound like a gunner); if they still tell you to go home, clear it with the chief/upper/attending whoever, and go. Make sure you ask each member of the team if there's anything else you can do to help, and if they all say no, then cut out.

I am not learning about my pts because everyone is too busy to spend any time discussing the care plan and the day-to-day evolution. Reading about my pts without discussion? I find that I forget most of what I learn this way within a week. I know they are overloaded and doing the best they can. I hate working this way.

This sucks, but there's nothing you can do about it.

My opinion is irrelevant.

Yes. Just accept it. I'm not being rude, I'm just telling you the score. It is frustrating, but that's the way it is.

Right now I want to know how to make the transition from student-speed H&P to intern-speed, and here I feel the education is really lacking. I have to know how to do each step of the physical exam properly, and the only way to know is to practice. But I also have to learn to be "efficient", which basically means knowing which steps to skip or how to speed up the whole thing, and that also requires practice. I think it's unreasonable to expect the average inexperienced MS3 to be efficient (i.e. fast), unless someone is going to help me through that transition - and of course, no one has the time.

Always do more than you have to at first (more detailed notes, more complete history, thorough physical exam, complete presentations) until they tell you to do less. The residents/staff need to have confidence in your ability to do student H&Ps and presentations before they will want you to abbreviate it. That is how you can convince them that you will not miss anything obvious that will make them look bad.

You are not there to learn to be an intern, that's what next year is for. Right now you are there to learn to be the best MS3 you can. (I had these two sentences, almost word for word, yelled in my face last year as an MS3)

From there, you just have to adjust your style to each person you work with. This can be hard, but you have probably noticed by now that your residents do the same thing with various attendings. Again, it's just a fact of life.

 

[MeowMix]

Always do more than you have to at first (more detailed notes, more complete history, thorough physical exam, complete presentations) until they tell you to do less. The residents/staff need to have confidence in your ability to do student H&Ps and presentations before they will want you to abbreviate it. That is how you can convince them that you will not miss anything obvious that will make them look bad.

You are not there to learn to be an intern, that's what next year is for. Right now you are there to learn to be the best MS3 you can. (I had these two sentences, almost word for word, yelled in my face last year as an MS3)

All of your advice is excellent, especially this. Thanks for taking the time to write it.