Gross/Mildly Dangerous Things In Medical School?

[Neurotic98]

I will be starting medical school in a year (I'm a senior in a BS/MD program), and I had a few questions about medical school that I'd rather not ask profs/other students because I don't want to look unprofessional/stupid/like I'd be a bad doctor. So I thought I'd post here!

I have been leaning more details about medical school from seniors/profs, and I'm a bit worried. What are some gross/mildly dangerous things that people have to do in med school? I have a few examples of things I think fall under that category:

• DREs: Are they gross? Do you have to do a lot? Do you get used to them?
• Physical exams on classmates during MS1/MS2 (not gross, but out of my comfort zone...): What do we practice on each other, and what do we do on standardized patients?
• Needlesticks: I read a study that said ~60% of residents at Hopkins got a needlestick injury while in medical school. How hard would it be to avoid this?
• TB and other infectious disease exposure: Is this something I should be concerned about?
• What procedures do third and fourth years get to do on patients? (I'm assuming very very few).
• Am I missing anything else that I seem like I would be concerned about in the future?

I know that these concerns will only amplify in residency, but for now I only want to know about med school I understand I'm being neurotic and admittedly a total wimp, but please please bear with me! I just want to prepare myself.

---

Members don't see this ad.

 

[Tenk]

DREs are nothing. Unless you don’t wear a glove for some reason.

We never did exams on classmates unless you set it up outside of any instruction time and I think that has pretty much become the norm at most schools but I’m sure there are some that still do.

Needle sticks happen. My only needle stick was putting in an art line on a critical patient. I had the catheter with needle in the patient’s arm and an alarm went off (patient was intubated and critical) so I looked up at the monitor and when I did I accidently pulled the cath needle out and grazed my finger. I then regloved and washed my hand. It sucks but luckily the odds are in your favor. Even patients with HIV or hep c, the transmission rate on needle sticks is very very low. Just need to always watch your needles.

Wear a mask if you’re concerned.

I got to do much suturing, a few LPs, paracentesis, several deliveries and a central line or two in med school. Results will vary.

The smells are worse than all this.

 

[ciestar]

I will be starting medical school in a year (I'm a senior in a BS/MD program), and I had a few questions about medical school that I'd rather not ask profs/other students because I don't want to look unprofessional/stupid/like I'd be a bad doctor. So I thought I'd post here!

I have been leaning more details about medical school from seniors/profs, and I'm a bit worried. What are some gross/mildly dangerous things that people have to do in med school? I have a few examples of things I think fall under that category:

• DREs: Are they gross? Do you have to do a lot? Do you get used to them?
• Physical exams on classmates during MS1/MS2 (not gross, but out of my comfort zone...): What do we practice on each other, and what do we do on standardized patients?
• Needlesticks: I read a study that said ~60% of residents at Hopkins got a needlestick injury while in medical school. How hard would it be to avoid this?
• TB and other infectious disease exposure: Is this something I should be concerned about?
• What procedures do third and fourth years get to do on patients? (I'm assuming very very few).
• Am I missing anything else that I seem like I would be concerned about in the future?

I know that these concerns will only amplify in residency, but for now I only want to know about med school I understand I'm being neurotic and admittedly a total wimp, but please please bear with me! I just want to prepare myself.

1. DREs are what they are. Theyre more uncomfortable for the patient than you.

2. We learned everything for PE on SPs. Only thing we ever practiced on each other was BP and the fundoscopic exam.

3. I’ve never even come close.

4. Eh, not really. Just use the universal precautions given to you.

5. It varies based on where you are and how willing residents/attendings are to teach you procedural stuff. Im 21 weeks into third year and I’ve only done an ABG and a few suture removals.

Only things I would say to be concerned about is working on your time management skills sooner rather than later. Can’t do the clinical stuff if you can’t make it through MS1/2 and boards.

 

[RNtoMD87]

I will be starting medical school in a year (I'm a senior in a BS/MD program), and I had a few questions about medical school that I'd rather not ask profs/other students because I don't want to look unprofessional/stupid/like I'd be a bad doctor. So I thought I'd post here!

I have been leaning more details about medical school from seniors/profs, and I'm a bit worried. What are some gross/mildly dangerous things that people have to do in med school? I have a few examples of things I think fall under that category:

• DREs: Are they gross? Do you have to do a lot? Do you get used to them?
• Physical exams on classmates during MS1/MS2 (not gross, but out of my comfort zone...): What do we practice on each other, and what do we do on standardized patients?
• Needlesticks: I read a study that said ~60% of residents at Hopkins got a needlestick injury while in medical school. How hard would it be to avoid this?
• TB and other infectious disease exposure: Is this something I should be concerned about?
• What procedures do third and fourth years get to do on patients? (I'm assuming very very few).
• Am I missing anything else that I seem like I would be concerned about in the future?

I know that these concerns will only amplify in residency, but for now I only want to know about med school I understand I'm being neurotic and admittedly a total wimp, but please please bear with me! I just want to prepare myself.

I am not in medical school but I can address some of these

DRES: I haven't done these but I do digital feces removal and it isn't that bad.
I never found physical exams to be that bad, personally.
Only had one needlestick. Not from nursing, but when I was sewing up a head after an autopsy (non clinical volunteering for premed). Got a little overzealous with the stitching. Thank god we wear thick gloves and it happened to be on a thick callous (thank deadlifting!)
Disease exposure: This is something that worries me. Can't tell you how many times I go in a patients room to have them cough on me, and then come back the next day to see that they're now on droplet precaution.

 

[ciestar]

I am not in medical school but I can address some of these

DRES: I haven't done these but I do digital feces removal and it isn't that bad.
I never found physical exams to be that bad, personally.
Only had one needlestick. Not from nursing, but when I was sewing up a head after an autopsy (non clinical volunteering for premed). Got a little overzealous with the stitching. Thank god we wear thick gloves and it happened to be on a thick callous (thank deadlifting!)
Disease exposure: This is something that worries me. Can't tell you how many times I go in a patients room to have them cough on me, and then come back the next day to see that they're now on droplet precaution.

Literally happened with my patient a few weeks ago. They were worried about flu after I’d been in her room multiple times.

 

[RNtoMD87]

TB is rare these days (If not for HIV I'm sure it would probably be virtually non existent in the US). I've never had a TB patient. On the floor I work at currently we don't have any negative pressure rooms so I won't get any.

 

[AllBleedingStops]

DREs: Are they gross? Do you have to do a lot? Do you get used to them?

I can't answer this one for medical school but for practice it just depends what specialty you are in. More common in surgery, GI, EM, maybe some others. I think the bigger thing you are missing is the fact you will likely have to disimpact at least 1 person at some point.

Physical exams on classmates during MS1/MS2 (not gross, but out of my comfort zone...): What do we practice on each other, and what do we do on standardized patients?

My school does not do this. The closest we come is having each other act as pseudo-standardized patients for history taking practice. More common for DO students to have to practice manipulation on other students.

Needlesticks: I read a study that said ~60% of residents at Hopkins got a needlestick injury while in medical school. How hard would it be to avoid this?

Most physicians I know have had a scare for infection at some point in their careers. Again, if proper precautions are followed, risk is minimal. Some specialties would likely carry higher theoretical risk (EM/Psych for combative/very "out of it" patients, ID for many patients with HIV/other infectious agents [however most are very well controlled and very little reason to have needles out while seeing them as the physician])

TB and other infectious disease exposure: Is this something I should be concerned about?

We get fitted for masks. And we have regular TB tests. And there are drugs. And tons of precautions for confirmed/suspected patient encounters.

What procedures do third and fourth years get to do on patients? (I'm assuming very very few).

Really depends on attending/resident willingness and school policy. Suturing, IV access, Foley insertion, disimpaction are all common. Compressions/bagging during a code, LP, ABG, central line placement, I&D are all also reasonable according to 3rd and 4th year students I have interacted with. You may also help deliver a baby. You may get to try ultrasound to do exams depending on resources and faculty expertise/time. There may be more depending on your skills and attending comfort level.

Am I missing anything else that I seem like I would be concerned about in the future?

Clinically - other disease exposure. Patients are bad at hygiene and will likely give you a cold or the flu or some random virus at least each year no matter your hand washing and mask wearing. Patients throw up and cough and things at inopportune times. Patients also stink. Diabetic wounds are an interesting smell. You also don't really forget the smells of C. difficile and melena.

Coming from a student perspective - anatomy lab is a big one you missed mentioning. You are cutting open bodies with other, often inexperienced students. There are scalpels and scissors and bone saws. Most students in my class have found their glove has been torn or cut at some point during lab. One or two suffered a graze with a scalpel. I regularly get liquid/fat above my gloves on my arms - just wash your hands well after lab. Your hair/clothes can smell like the lab but this is something you get used to since there are often times we have something mandatory after lab so you can't shower. You just might want to get used to that idea. There is often fecal matter and other GI related substances present that you would need to remove. Sometimes brains are not properly preserved due to timing and difficulty in perfusing the body. Bone has a particular smell when being sawed. Again, there are masks and eye protection among other gear you can wear.

Can't seem to think of anything else off hand. You get used to a lot of things pretty quickly.

 

[curbsideconsult]

DREs: Are they gross? Do you have to do a lot? Do you get used to them?

Haven't done many, but it's NBD. You get used to it.

Physical exams on classmates during MS1/MS2 (not gross, but out of my comfort zone...): What do we practice on each other, and what do we do on standardized patients?

On SPs you practice just about everything. On each other, you do what you're comfortable with. My friends and I have done every PE on each other except for the obviously invasive ones.

Needlesticks: I read a study that said ~60% of residents at Hopkins got a needlestick injury while in medical school. How hard would it be to avoid this?

I haven't had a needlestick yet (*knock on wood*)

TB and other infectious disease exposure: Is this something I should be concerned about?

Yes, but not overly so. Take the necessary precautions and you'll be fine.

What procedures do third and fourth years get to do on patients? (I'm assuming very very few)

It depends on you and your preceptors. If you're viewed as an incompetent and/or extremely uncaring medical student, your preceptors will not let you near patients except to do H&Ps.

Am I missing anything else that I seem like I would be concerned about in the future?

General concerns, not necessarily medical mishaps:

• Not being nice to nurses and support staff - these are the people in the hospitals and clinics everyday. They were there before you were and will be there after you leave. They will move heaven and earth for you if you're a normal human being and treat them with kindness and respect. Be a jerk and you'll quickly feel their wrath.
• Babies peeing on you when you open their diapers
• Toddlers running around and screaming when you're trying to talk to parents
• Patients who are verbally abusive
• Other medical students
• Your own neuroticism - yes, be cautious and prepared, but there's a fine line you shouldn't cross. At the end of the day, you are your own worst enemy and your medical school experience largely depends on you.

 

[deleted480308]

MDs don’t do a lot of practice on each other, DOs get much more hands on

 

[RNtoMD87]

Haven't done many, but it's NBD. You get used to it.


On SPs you practice just about everything. On each other, you do what you're comfortable with. My friends and I have done every PE on each other except for the obviously invasive ones.


I haven't had a needlestick yet (*knock on wood*)


Yes, but not overly so. Take the necessary precautions and you'll be fine.


It depends on you and your preceptors. If you're viewed as an incompetent and/or extremely uncaring medical student, your preceptors will not let you near patients except to do H&Ps.


General concerns, not necessarily medical mishaps:

• Not being nice to nurses and support staff - these are the people in the hospitals and clinics everyday. They were there before you were and will be there after you leave. They will move heaven and earth for you if you're a normal human being and treat them with kindness and respect. Be a jerk and you'll quickly feel their wrath.
• Babies peeing on you when you open their diapers
• Toddlers running around and screaming when you're trying to talk to parents
• Patients who are verbally abusive
• Other medical students
• Your own neuroticism - yes, be cautious and prepared, but there's a fine line you shouldn't cross. At the end of the day, you are your own worst enemy and your medical school experience largely depends on you.

Kids are fine. Its the parents that will annoy the hell out of you.


Wow... slightly OT, but tonight must have been a full moon. Had one resident ask me "Is she on nasal cannula?" while looking DEAD at a woman who was intubated, and had a second resident ask an obviously vegetative pt if she checks her blood sugar at home :S

Its time for me to head back to the house.

 

[AliBabaMD]

I once injected a patient with anesthetic to remove a mole (that had a big fat hole at the top) and blood splashed onto me. Lesson learned. Be careful. In this case, it was an older Persian lady with almost no medical hx but remember, the white coat does not make you immune. You still need to be careful!

 

[Goro]

I suspect the biggest thing you have to worry about is getting burnt out, depressed or anxious due to the stress of medical school.

 

[Catalystik]

What are some gross . . . things that people have to do in med school?I just want to prepare myself.

If you aren't fast on your feet, you might get a shower of vomited, activated charcoal (a fine, particulate substance) all over your white coat, pants, and shoes. On the positive side, you gain very fast reflexes and it only happens once.

 

[stayathomemom]

TB is rare these days (If not for HIV I'm sure it would probably be virtually non existent in the US). I've never had a TB patient. On the floor I work at currently we don't have any negative pressure rooms so I won't get any.

And yet I am TB+ somehow. Life is surprising.

You are cutting open bodies with other, often inexperienced students.

I misread this as "You are cutting open the bodies of other, often inexperienced students." I was like, HOLY COW is that how they motivate you to study hard?

OP, may I present you with That Smelly Smell that Smells Smelly as a little glimpse into your future (if you are lucky).

As for me, I'm most worried about pus. I hate pus. I hate abcesses, they make me want to gag. Dr. Pimple Popper? NO THANK YOU.

 

[deleted938090]

Let's turn this question around a bit - what are some dangerous accidents that may happen that you absolutely should seek help if you're exposed?
Signs to look out for?

 

[ciestar]

I almost got peed on today, so watch out for newborn baby boys lol

 

[MyOdyssey]

And yet I am TB+ somehow. Life is surprising.


I misread this as "You are cutting open the bodies of other, often inexperienced students." I was like, HOLY COW is that how they motivate you to study hard?

OP, may I present you with That Smelly Smell that Smells Smelly as a little glimpse into your future (if you are lucky).

As for me, I'm most worried about pus. I hate pus. I hate abcesses, they make me want to gag. Dr. Pimple Popper? NO THANK YOU.

Any idea how you contracted TB?

 

[MyOdyssey]

TB is rare these days (If not for HIV I'm sure it would probably be virtually non existent in the US). I've never had a TB patient. On the floor I work at currently we don't have any negative pressure rooms so I won't get any.

What’s a negative pressure room?

 

[Catalystik]

What’s a negative pressure room?

One with a ventilation system that generates negative pressure to allow air to flow into the isolation room but not escape from the room, as air will naturally flow from areas with higher pressure to areas with lower pressure, thereby preventing contaminated air from escaping.

 

[stayathomemom]

Any idea how you contracted TB?

Nope. I was tested in the early 2000's and was negative then. I was next tested earlier this year and two tests came back positive. Clear chest x-ray. Who knows? I don't have any risk factors.

What’s a negative pressure room?

There is a HVAC unit that sucks air from inside the room at a certain pressure, so if the door is opened, the air flows from outside of the room to the inside. This prevents the spread of airborne disease like TB.

 

[differentiating]

I’m a 4th year student at a US MD school:

• DREs honestly aren’t that bad, as a provider. I’ve only done 1-2, but they really weren’t a big deal.
• My school is a little different than those above - we learned all non-sensitive exams (breast/genital) on each other. It’s really not a big deal? You’ll have to be comfortable doing the exam on all your patients, no matter who they are, and it’s a safe learning environment. SPs at my school are only for those other exams mentioned above and for practice OSCEs 2-3x/year.
• Needlesticks are a possibility. I’ve had one while on my surgery rotation, and I saw ones happen to other OR staff. Luckily, it was a new needle and had yet to touch the patient, in my case.
• You’ll have TB ruleout patients who are negative, and less commonly, ones who are positive. Wear your N95 as instructed and follow other precautionary methods.
• Intubation, IV attempts, deliveries, suturing. Possibly more if you’re interested in doing procedures; I was not.
• Abscess drainage is both pretty gross and weirdly satisfying. C. Diff is nasty. Also echoing that MS3 is awful- you’re exhausted, doing rotations you don’t really care about, and there’s little validation to be had. Thankfully, it’s only 1 year, and MS4 is way better.

 

[RNtoMD87]

Nope. I was tested in the early 2000's and was negative then. I was next tested earlier this year and two tests came back positive. Clear chest x-ray. Who knows? I don't have any risk factors.


There is a HVAC unit that sucks air from inside the room at a certain pressure, so if the door is opened, the air flows from outside of the room to the inside. This prevents the spread of airborne disease like TB.

Then you didn’t “contract TB”, you came in contact and have latent TB. NBD.

 

[RNtoMD87]

What’s a negative pressure room?

You’ll typically see something like this outside the room indicating whether it is currently functioning.

 

[RNtoMD87]

Note the difference

 

[RNtoMD87]

I almost got peed on today, so watch out for newborn baby boys lol

Have had that happen several times only with adults. Right when you go to change them “BUT WAIT THERES MORE!”

 

[RNtoMD87]

This is not something where there's like a catch-all algorithm for what to do. First and foremost, 99% of the diseases healthcare providers contract from their patients are like common cold, flu, stomach bug, etc. For the minority of stuff that's actually semi-worrisome, you will not be doing anything by yourself as a medical student without a warning as to what's going on and what precautions to take. For patients with rule-out/actual infectious disease where precautions are required, they will have a sign outside the hospital room stating what precautions are needed with all of that equipment readily available. Just pay attention to the signage on/around the door...I've seen many a resident blow past the cart with the gowns and masks on a c diff patient where it was clearly marked on the room door lol.

And most importantly WASH YOUR HANDS. Seen so many nurses, doctors, everybody just not wash their hands. Nasty asses.

 

[NITRAS]

The students are usually last on the list to let do procedures. MOs of the residents who are “signed off” still lack many basic procedural skills. Frankly, I only do LPs and paras which are pretty low risk, but I still see residents stick themselves.


Stuck myself on a suture needle in ortho as ms3. Not fun. But never been a case of hiv transmission from a suture needle.

 

[PeleHonuaMea]

• Am I missing anything else that I seem like I would be concerned about in the future?

I just want to prepare myself.

Not in medical school yet, but when you're cruising through the hospital/clinics for your clinicals and residency:

Gross? Hhmmm I cant really think of anything aside from what's been listed already by previous posters that I'd truly find disgusting as a med student.

Dangerous? Just dont ever get stuck in a room by yourself with an aggressive pt. And between you and the pt, you should always be the one closest to the door! Always.

And watch out for their fast hands! I've seen way too many people get punched, slapped, kicked, hair pulled, a$$ grabbed, and one was strangled with her own stethoscope by a 90+ demented pt. Dont put yourself in that situation. And it will definitely be helpful for you to start learning how to deescalate a situation . Dont argue with a pt or family. Just dont.

And yes, we still get active TB pts throughout the year in our hospital. N95 masks are a hot commodity here .

 

[bahdahboom]

I will be starting medical school in a year (I'm a senior in a BS/MD program), and I had a few questions about medical school that I'd rather not ask profs/other students because I don't want to look unprofessional/stupid/like I'd be a bad doctor. So I thought I'd post here!

I have been leaning more details about medical school from seniors/profs, and I'm a bit worried. What are some gross/mildly dangerous things that people have to do in med school? I have a few examples of things I think fall under that category:

• DREs: Are they gross? Do you have to do a lot? Do you get used to them?
• Physical exams on classmates during MS1/MS2 (not gross, but out of my comfort zone...): What do we practice on each other, and what do we do on standardized patients?
• Needlesticks: I read a study that said ~60% of residents at Hopkins got a needlestick injury while in medical school. How hard would it be to avoid this?
• TB and other infectious disease exposure: Is this something I should be concerned about?
• What procedures do third and fourth years get to do on patients? (I'm assuming very very few).
• Am I missing anything else that I seem like I would be concerned about in the future?

I know that these concerns will only amplify in residency, but for now I only want to know about med school I understand I'm being neurotic and admittedly a total wimp, but please please bear with me! I just want to prepare myself.

In medical school you get used to some things that would gross the normal person out. As an M3, I personally am still not comfortable with DREs but it’s a much less deal than you think. No one really cares. It’s just one of those things you do.
We weren’t forced to practice much on each other and when we did, we were allowed to choose partners. So naturally we chose friends. Not a big deal.
TB and other infectious diseases..oh god this does happen. Countless times where I was taking care of a patient and they were later placed on TB/Mrsa/Cdiff isolation. So there’s a great chance that I was exposed to all of these, but again..who cares. I’ve gotten sick a few times but God knows what I’ve caught.
Procdecures we get to do on patients...quite a bit. Especially in surgery and OB, attendings will let you jump in and get your hands VERY dirty. We’ve done Pap smears, liposuction, help run codes, delivered babies, catheter placement, suturing, I mean the list goes on. If you’re interested in a procedure, just ask and most attendings will let you do something. Actually most docs like that you’re interested enough to try. Residents and interns are more cautious with that but it depends who you work with. 3rd and 4th year students are not shadowing, they really are a part of the team.

 

[TelemarketingEnigma]

At my school we practice physical exam skills with fellow students, but we skip anything sensitive/that really requires undressing. It's honestly pretty chill, I don't find it that weird. We learn the exams in small groups, practice what we can reasonably and talk through the rest. Then we get do the real practice with SPs once we have a sense of what we should be doing. We haven't learned any of the more sensitive exams yet (DREs, breast, pelvic, etc) but from what I understand we do all of those with SPs and not on fellow students.

 

[The Knife & Gun Club]

Dangerous:
I’ve had a couple close calls with needle sticks from HIV, HepB & C patients which was terrifying

Patient tried to punch me Once, but missed because he was drunk

Psych patient bit me

Been exposed to TB 5 times now, and counting

Gross:
Poop. So. Much. Poop.
That Smelly Smell that Smells Smelly

Edit: also at our inner city hospital we had an active shooter on my floor recently, and multiple people have been stabbed or shot on our campus (they weren’t medical professionals) - that said I’ve never felt unsafe on the campus. Just keep your wits about you.

 

[The Knife & Gun Club]

Also saw my SO do the Penis and testicle dissection in anatomy, which really killed the romance for a bit.

Nothing like watching someone take a scalpel to a scrotum to make you rethink your life decisions.

 

[Neurotic98]

Thank you so much for all of your responses, it's given me more of an accurate picture of med school! I've noticed that some people have had a seemingly smooth sailing while others haven't. I have a few more questions:

• @differentiating said that they weren't interested in procedures so they didn't have to do many. I'm not interested either, could I avoid most procedures just by being relatively passive/disinterested? Could you decline to do a procedure you were offered?
• Would it be socially acceptable to wear an N95 even when not instructed to do so (like if you have a patient that's coughing a lot)? I've see people in Chinese/Indian cities wear them on the streets due to pollution...
• @The Knife & Gun Club, wow, I think you've had the most dangerous experiences out of this bunch. When you were exposed to TB, did you take the proper precautions before seeing the patients, or did you find out after that they had TB? How many HIV or hep patients have you gotten in total approximately?
• Do med students see a lot of patients with HIV or hep C?
• Do you go on call as a third and fourth year? I feel like being careful with needles will be harder if I'm sleep-deprived.
• I would think that very very few med students contract diseases from patients, is that right? Female residents are even pregnant in the hospital sometimes...so is it really that big of a worry?

 

[The Knife & Gun Club]

Thank you so much for all of your responses, it's given me more of an accurate picture of med school! I've noticed that some people have had a seemingly smooth sailing while others haven't. I have a few more questions:

• @differentiating said that they weren't interested in procedures so they didn't have to do many. I'm not interested either, could I avoid most procedures just by being relatively passive/disinterested? Could you decline to do a procedure you were offered?
• Would it be socially acceptable to wear an N95 even when not instructed to do so (like if you have a patient that's coughing a lot)? I've see people in Chinese/Indian cities wear them on the streets due to pollution...
• @The Knife & Gun Club, wow, I think you've had the most dangerous experiences out of this bunch. When you were exposed to TB, did you take the proper precautions before seeing the patients, or did you find out after that they had TB? How many HIV or hep patients have you gotten in total approximately?
• Do med students see a lot of patients with HIV or hep C?
• Do you go on call as a third and fourth year? I feel like being careful with needles will be harder if I'm sleep-deprived.
• I would think that very very few med students contract diseases from patients, is that right? Female residents are even pregnant in the hospital sometimes...so is it really that big of a worry?

Thanks for the shout out - I like these threads, and you ask some great questions. They’re really one of the most valuable parts of SDN imo. Students should know what they’re getting into when they start school, and should know what’s out there so they know what to avoid and what to look for.

Just as an aside, I intentionally chose a school that is the quintessential county experience. I love the the “work with what you’ve got” mentality and caring for the people that the rest of society has given up on. It’s exciting and profoundly rewarding, even when the patients are...difficult.

Procedures: at least where I am they’re pretty lax about not making you do much. You’ve gotta be able to do venipuncture, place a Foley, change would dressings, and suture but that’s pretty much it. You will have to scrub for surgery but don’t have to assist if you don’t want.

N95: yea totally. I keep one around my upper arm when I’m in the ED now, and pop it on when the patients are homeless/incarcerated. As for exposure, I just keep up with my PPDs every year. I only know one student who’s ever actually gotten it, and they were doing an emergency thoracotomy on a guy who turned out to positive after the fact.

HIV/HepC: we get a bunch where I am. I haven’t bothered to count but we always have at least 1-2 on our service. At one point during my medicine rotation we had 13 out of 20 patients with HIV/HepB/C. But this isn’t the norm - like I said I’m at a county hospital in a big city. You won’t see this at most community hospitals.

Call: we take four 30-hour call shifts during surgery rotation, but that’s it. Really it’s pretty manageable. Either stuff is going on and it’s exciting so you stay awake, or it’s slow so you take a nap in the on call room. As a student night shifts are fun because with no one else in the hospital you get a lot more freedom to get involved in patient care. No one feels like suturing up some drunk drivers arm at 3 AM, so they let us do it.

Getting diseases: yea, we’re always very well protected and it’s very safe. The school will also work with you if you have health concerns to make sure you’re supported. There was a period of time where it looked like I was going to have to go on TNF-inhibitors (increases susceptibility to TB), so the deans helped shuffle around my rotations to minimize chances of exposure.

Great questions, keep em coming if you’ve got em!

 

[AllBleedingStops]

I'm not interested either, could I avoid most procedures just by being relatively passive/disinterested? Could you decline to do a procedure you were offered?

Why are you so disinterested in procedures? Is it fear of contracting a disease? If you are so scared of disease that you don't want to see patients at all, there are some specialties that would be lower risk but even radiologists have some procedures.

Would it be socially acceptable to wear an N95 even when not instructed to do so (like if you have a patient that's coughing a lot)?

Not really. Could you theoretically? Maybe. But it wouldn't be socially acceptable. I wouldn't want to wear masks all day every day. If you want to go to that length in the clinic or hospital, just realize that these people are out on the streets too, both before and after they are in the hospital/clinic. Just food for thought.

so is it really that big of a worry?

No. And if you ask me, you should think very carefully about talking to someone about these fears before a career in medicine because it almost seems like you are crossing the border from cautious to unreasonable.

 

[WinslowPringle]

DREs: Are they gross? Do you have to do a lot? Do you get used to them?

All the students rotating through general surgery panels at my hospital will usually do >10 DREs. They're a routine and necessary part of medical care for patients with rectal medical issues. I'd recommend trying to not think of it as gross/not gross and try a different framework of routine, necessary, etc. You get very used to doing them if you do enough.

Physical exams on classmates during MS1/MS2 (not gross, but out of my comfort zone...): What do we practice on each other, and what do we do on standardized patients?

Depends on the med school. Never did a 'sensitive' exam on a fellow med student. Did have to do an exam session in T-shirt and shorts for basic PE (heart, lungs, head, neck, basic MSK ROM, basic neuro exam). Wasn't bad, you could choose your pair and if you needed any clothing accommodations (headcovering, longsleeves, etc.) it would be worked out. Had to do DRE, breast, testicular, and female pelvic exams on SPs.

Needlesticks: I read a study that said ~60% of residents at Hopkins got a needlestick injury while in medical school. How hard would it be to avoid this?

Four years of med school, four years of surgical residency and I've not had a reportable needlestick injury. Not that hard to avoid if you use appropriate technique for needle handling and keep your hands off the Mayo. (Probably just jinxed myself here...)

What procedures do third and fourth years get to do on patients? (I'm assuming very very few).

Laceration suturing/stapling, lap camera driving, incision closing, 'running' the bowel in an ex-lap, I've let some students try to help w/ art lines, central lines, and chest tubes. You get more exposure the more proactive you are, the more you know, and the more you want to do.

Am I missing anything else that I seem like I would be concerned about in the future?

Well, you didn't mention fecal disimpactions....that can be a really important med student job. Also, peri-rectal abscesses. Any abscesses, really. Surgical dressing changes. Some people are weirded out by eyes. Some people don't like oral secretions - you'll see plenty on your rotations. Probably be exposed to seeing someone vomit or gastric secretions from NGTs during a surgical rotation. Other unpleasant smells in the ED, too; unfortunately, there are persons without access to or motivation for personal hygiene.

What are some gross/mildly dangerous things that people have to do in med school

Probably the most dangerous thing is going to medical school, period. Sleep deprivation, risk of depression and suicidality is probably higher than your risk of death from TB contracted in medical school.


Good luck!

 

[MyOdyssey]

Doctors in training who envision working a lot with immuno-suppressed patients (e.g. cancer patients) are reasonably concerned about exposure to things like TB, which are airborne and have no 100% treatment. Would a medical student who tests positive for TB have to undergo certain prescribed treatments before being allowed to work with cancer patients, for example.

I know that cancer hospitals insist that their premed volunteers undergo TB testing beforehand.

 

[differentiating]

@differentiating said that they weren't interested in procedures so they didn't have to do many. I'm not interested either, could I avoid most procedures just by being relatively passive/disinterested? Could you decline to do a procedure you were offered?

To be clear - it was more that I wasn't "proactive" in seeking out procedures that I had no interest in. If I was asked to do something, I did it. In theory, you could decline a procedure if you felt uncomfortable with it - but in practice this is more difficult, as the people asking you to perform it determine your grade in most cases. There are 4th year rotations that are known to give people a lot of procedural exposure - certain anesthesia, IR, surgery ones, etc. - and I avoided those like the plague. There's one procedure I actually would like to get exposure to because it'll be relevant to my eventual practice, but we haven't had any patients requiring one when I was on a primary team, so.

Would it be socially acceptable to wear an N95 even when not instructed to do so (like if you have a patient that's coughing a lot)? I've see people in Chinese/Indian cities wear them on the streets due to pollution...

Definitely not. It'd stand out pretty significantly, wouldn't be of any more use than a droplet mask that you'd probably need to wear anyway (the mask worn in other cities), and you'd probably get pretty light-headed wearing it if you tried to do it all day.

When you were exposed to TB, did you take the proper precautions before seeing the patients, or did you find out after that they had TB? How many HIV or hep patients have you gotten in total approximately? Do med students see a lot of patients with HIV or hep C?

Sometimes, patients are put on TB ruleout after the initial exam as a "just in case" measure, so you may see them without a mask the first time around. That being said, these patients are usually TB negative, so it's fine. If a patient is high risk for TB/has super classic symptoms, then you should use your best judgement and wear an N95 even if they're not on precautions yet (they probably will be, though).

Do med students see a lot of patients with HIV or hep C?

Depends on where you are and what sites you rotate at. I'm in a big city with (unfortunately) high HIV rates, so I've seen more HIV+ and hep C+ patients at our county hospital than I can count. Honestly not a big deal from a provider/risk stand point, if you take the same precautions you should with every patient.

Do you go on call as a third and fourth year? I feel like being careful with needles will be harder if I'm sleep-deprived.

Yes - we did ~5 30h shifts when on surgery as third years, as well as a week of nights on OB/GYN, and late call (to 10/11pm) on most other rotations. 4th year is similar, as weekend/night call is generally expected in some form on sub-Is (the surg sub-I I'm aware of required 30h shifts q4...).

I would think that very very few med students contract diseases from patients, is that right? Female residents are even pregnant in the hospital sometimes...so is it really that big of a worry?

As everyone else has said - it's not. I'm a highly anxious person, and contracting a serious disease from a patient has never really been on my radar, because I'm careful and follow precautions. I mean, you'll get colds and possibly gastroenteritis on peds (it's a rite of passage at our residency program here), but not TB/HIV/Hep C/etc.

 

[differentiating]

Dangerous? Just dont ever get stuck in a room by yourself with an aggressive pt. And between you and the pt, you should always be the one closest to the door! Always.

I also wanted to address this, as this came up on my outpatient psych rotation - ideally, you want to have a clear route to the door for both of you, in that neither one of you is blocking the other's escape. You blocking off the patient's escape route could agitate them further.

It's rare that you'll have to work with an aggressive patient alone as a medical student, though. Usually the senior will scope out the patients first to determine if they're appropriate for student learners.

 

[Mad Jack]

Why are you so disinterested in procedures? Is it fear of contracting a disease? If you are so scared of disease that you don't want to see patients at all, there are some specialties that would be lower risk but even radiologists have some procedures.



Not really. Could you theoretically? Maybe. But it wouldn't be socially acceptable. I wouldn't want to wear masks all day every day. If you want to go to that length in the clinic or hospital, just realize that these people are out on the streets too, both before and after they are in the hospital/clinic. Just food for thought.



No. And if you ask me, you should think very carefully about talking to someone about these fears before a career in medicine because it almost seems like you are crossing the border from cautious to unreasonable.

In psych we have zero procedures that are of any risk. A&I, rheum, neuro, path, and a few other fields are relatively procedure light, and those procedures are low risk

 

[Mad Jack]

I also wanted to address this, as this came up on my outpatient psych rotation - ideally, you want to have a clear route to the door for both of you, in that neither one of you is blocking the other's escape. You blocking off the patient's escape route could agitate them further.

It's rare that you'll have to work with an aggressive patient alone as a medical student, though. Usually the senior will scope out the patients first to determine if they're appropriate for student learners.

Situational awareness is key. Most medical students have a very poor sense of danger though, it's one of those street smart skills they just seem to have missed, and this puts many in situations that are higher risk than a more careful person would land themselves in

 

[differentiating]

Situational awareness is key. Most medical students have a very poor sense of danger though, it's one of those street smart skills they just seem to have missed, and this puts many in situations that are higher risk than a more careful person would land themselves in

I think it's also worth noting that, if you do feel in danger/uncomfortable, this *is* one situation where stepping back and saying you aren't comfortable generally won't be frowned upon. I had one patient on a non-psych rotation ask me to hug/kiss him and then try to grab my arm, and I immediately noped out of there and told my team. But I can see how that pressure to "do a good job" could make someone want to power through an uncomfortable situation.

 

[Mad Jack]

I think it's also worth noting that, if you do feel in danger/uncomfortable, this *is* one situation where stepping back and saying you aren't comfortable generally won't be frowned upon. I had one patient on a non-psych rotation ask me to hug/kiss him and then try to grab my arm, and I immediately noped out of there and told my team. But I can see how that pressure to "do a good job" could make someone want to power through an uncomfortable situation.

Absolutely. If a medical student ever feels unsafe on my ward I do not look down upon them at all for requesting backup or another patient to see

 

[snapjack]

I’m a 4th year student at a US MD school:

• DREs honestly aren’t that bad, as a provider. I’ve only done 1-2, but they really weren’t a big deal.
• My school is a little different than those above - we learned all non-sensitive exams (breast/genital) on each other. It’s really not a big deal? You’ll have to be comfortable doing the exam on all your patients, no matter who they are, and it’s a safe learning environment. SPs at my school are only for those other exams mentioned above and for practice OSCEs 2-3x/year.
• Needlesticks are a possibility. I’ve had one while on my surgery rotation, and I saw ones happen to other OR staff. Luckily, it was a new needle and had yet to touch the patient, in my case.
• You’ll have TB ruleout patients who are negative, and less commonly, ones who are positive. Wear your N95 as instructed and follow other precautionary methods.
• Intubation, IV attempts, deliveries, suturing. Possibly more if you’re interested in doing procedures; I was not.
• Abscess drainage is both pretty gross and weirdly satisfying. C. Diff is nasty. Also echoing that MS3 is awful- you’re exhausted, doing rotations you don’t really care about, and there’s little validation to be had. Thankfully, it’s only 1 year, and MS4 is way better.

Wow I re-read that about 3 times thinking "Wait breast/genital exams are considered nonsensitive?" You did them on each other?? And it's not a big deal? I guess I'm a prude" Finally realized you meant those are the sensitive exams. That makes more sense lol

 

[snapjack]

Not in medical school yet, but when you're cruising through the hospital/clinics for your clinicals and residency:

Gross? Hhmmm I cant really think of anything aside from what's been listed already by previous posters that I'd truly find disgusting as a med student.

Dangerous? Just dont ever get stuck in a room by yourself with an aggressive pt. And between you and the pt, you should always be the one closest to the door! Always.

And watch out for their fast hands! I've seen way too many people get punched, slapped, kicked, hair pulled, a$$ grabbed, and one was strangled with her own stethoscope by a 90+ demented pt. Dont put yourself in that situation. And it will definitely be helpful for you to start learning how to deescalate a situation . Dont argue with a pt or family. Just dont.

And yes, we still get active TB pts throughout the year in our hospital. N95 masks are a hot commodity here .

Learned pretty fast as an EMT when a psych/intoxicated patient starts looking like they're going to escalate, stethoscope and badge comes off my neck and into my pocket, trauma shears go out of sight (although the blunt end isn't going to do much damage, won't stop them from trying...)
Oh and same for CPR, it's a pain to have a badge or stethoscope swinging around while you're doing compressions.

keep your hands off the Mayo

What's that mean, @WinslowPringle?

 

[longhaul3]

What's that mean, @WinslowPringle?

The Mayo stand is the table nearest the surgical field where the instruments being used in the immediate term are organized ("organized" used loosely for many scrub techs). During closing, the tech will have a few loaded needle drivers and maybe some other unsecured sharps on the table. Best to let them pass you sutures.

 

[snapjack]

The Mayo stand is the table nearest the surgical field where the instruments being used in the immediate term are organized ("organized" used loosely for many scrub techs). During closing, the tech will have a few loaded needle drivers and maybe some other unsecured sharps on the table. Best to let them pass you sutures.

Ah, gotcha. Thanks!

 

[chaim123]

I will be starting medical school in a year (I'm a senior in a BS/MD program), and I had a few questions about medical school that I'd rather not ask profs/other students because I don't want to look unprofessional/stupid/like I'd be a bad doctor. So I thought I'd post here!

I have been leaning more details about medical school from seniors/profs, and I'm a bit worried. What are some gross/mildly dangerous things that people have to do in med school? I have a few examples of things I think fall under that category:

• DREs: Are they gross? Do you have to do a lot? Do you get used to them?
• Physical exams on classmates during MS1/MS2 (not gross, but out of my comfort zone...): What do we practice on each other, and what do we do on standardized patients?
• Needlesticks: I read a study that said ~60% of residents at Hopkins got a needlestick injury while in medical school. How hard would it be to avoid this?
• TB and other infectious disease exposure: Is this something I should be concerned about?
• What procedures do third and fourth years get to do on patients? (I'm assuming very very few).
• Am I missing anything else that I seem like I would be concerned about in the future?

I know that these concerns will only amplify in residency, but for now I only want to know about med school I understand I'm being neurotic and admittedly a total wimp, but please please bear with me! I just want to prepare myself.

I'm pretty confused why you even want to be a doctor. Why not go into research? Being a doctor involved being around sick people, and with that there will be risk. You can't get through medical school looking good while trying to get out of doing anything that a doctor is expected to do. You'll need to touch, and poke, and prod patients. It's part of the job.

 

[RNtoMD87]

Yeah.. if a digital rectal exam grosses you out, I’m not sure medicine is for you... it gets MUCH worse

 

[pommes]

Also... wear booties on labor & delivery.