Help me help you

[the fat man]

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Hey all,

I was one of you guys once. Now I'm head and shoulders above as I grab my long coat and get to toy with you as would a cat to a ball of yarn...

Seriously, though, I want your input into things I can do to be a good intern to you. It's too much work for everybody to be really generic here, so I'm going to present you a case and you tell me what I should do.

Patient in for, say, pneumonia, has a drop in HCT. No visible source of bleeding, not hemodilutional. Has history of OA and has been taking lots of ibuprofen for a number of months. Nurse thinks stools may have been dark and tarry but wasn't already ordered to sample for blood so didn't. We want to make sure it's not an upper GI bleed so we want do a rectal and guaiac the stool. (Actually if you're worried about a true bleed you won't bother guaiacing because you don't care about occult blood but that's neither here nor there for now.) At this point I can:

a) Do the rectal myself. You, however, as an eager student want to be involved and are more than willing to do it. I would be more than happy to let you do it because I don't enjoy doing them anyway but don't ask you because I'm afraid you'll feel pressured to say yes so I won't ding you on the eval, even though you really want to say no and I'm so busy with other things that I'll never remember that time you refused to do a rectal anyway.

b) Ask you if you want to do it. This time you are someone who is revolted by the idea of rectal exams and feel I am using my power and implied threat of a bad eval to get you to do my most unpleasant work for me. But you say yes so it won't affect your grade. In truth I am sincerely trying to get you involved and will never use it as some kind of way of judging your performance.

c) Ask if you want to do it but emphasize that it won't affect you negatively if you decline. However I was once a student too and would NEVER fall for that line, so effectively this is like option "(b*)" for lack of a better term.

So...what should I do? Or better put, what would you as an M3 prefer I do in a situation like this?

 

[PathMD2010]

I remember my first rectal.

We were going over the pts case - similar scenario, dropping crit and looking for source - and the resident smiled at me and put his index finger in the air and handed me the lube.

When I told him it was my first one, he explained how to do it and said he would come in if needed. Point being he was calm and assertive - with some collegial humor thrown in.

The best residents for me were the best pack leaders.

Rules, boundaries, and limitations - if you ask a med student if he would rather round for 5 hours or read, guess which he's going to do - and if you gave him/her the choice, you can't be mad at them for it, but the attending/ other residents can. I've never seen this actual scenario but have seen similar ones.

Its best for the med student because they are given clear directives with help as needed, are part of the team, and you know the residents will be straightforward with you when they do tell you to "go read"

Another tactic I had a (surgical) resident use was to tell us how he was going to grade us, what was needed for LORs by the attendings, and what was needed to pass. Awesome!

 

[the fat man]

I remember my first rectal.

We were going over the pts case - similar scenario, dropping crit and looking for source - and the resident smiled at me and put his index finger in the air and handed me the lube.

When I told him it was my first one, he explained how to do it and said he would come in if needed. Point being he was calm and assertive - with some collegial humor thrown in.

The best residents for me were the best pack leaders.

Rules, boundaries, and limitations - if you ask a med student if he would rather round for 5 hours or read, guess which he's going to do - and if you gave him/her the choice, you can't be mad at them for it, but the attending/ other residents can. I've never seen this actual scenario but have seen similar ones.

Its best for the med student because they are given clear directives with help as needed, are part of the team, and you know the residents will be straightforward with you when they do tell you to "go read"

Another tactic I had a (surgical) resident use was to tell us how he was going to grade us, what was needed for LORs by the attendings, and what was needed to pass. Awesome!

Awesome indeed. I had surgical residents who complained behind my back to the clerkship director that I "asked if I could go home." I know that's technically a dumb move on my part, but that was after the previous day where the residents signed out to the on-call person and left the hospital without telling me...I was simply busy doing post-op checks for them so they could round faster on the other patients. I waited around for them to come back, paged their signed-out pagers with no response, and finally tracked down the on-call resident who told me they signed out to him almost 2 hours prior. Not that I was bitter or anything, after I had to sit down with the clerkship director for a lesson on "medical student expectations." A couple days later my residents pulled the same trick...I kept my mouth shut and stayed until the on-call resident told me to go home. It was too bad that my grade in the rotation was already destroyed by that point.

Sorry for going off topic. In the end I guess things were for the better, since I was actually crazy enough before the clerkship to think I wanted to go into surgery.

 

[PathMD2010]

Awesome indeed. I had surgical residents who complained behind my back to the clerkship director that I "asked if I could go home." I know that's technically a dumb move on my part, but that was after the previous day where the residents signed out to the on-call person and left the hospital without telling me...I was simply busy doing post-op checks for them so they could round faster on the other patients. I waited around for them to come back, paged their signed-out pagers with no response, and finally tracked down the on-call resident who told me they signed out to him almost 2 hours prior. Not that I was bitter or anything, after I had to sit down with the clerkship director for a lesson on "medical student expectations." A couple days later my residents pulled the same trick...I kept my mouth shut and stayed until the on-call resident told me to go home. It was too bad that my grade in the rotation was already destroyed by that point.

Sorry for going off topic. In the end I guess things were for the better, since I was actually crazy enough before the clerkship to think I wanted to go into surgery.

Similar thing happened to me on OB - we finished all our work but they told us to "hang out" in the event that the attending wanted to round later, and said they would page us when we could leave. Never heard from them. Went by the residents room (because no one was returning pages) approx 4 hours later to find out they left 3 hours ago. 😕

 

[the fat man]

OK, this reinforces part of being a good intern/resident--don't go home without telling your students that you're leaving or giving them another person to check in with!

In my case, part of the problem was the surgery department was super cheap and gave the students numeric pagers. So residents didn't ever page us for anything whatsoever since it involved waiting for us to call back--couldn't send us a quick text telling us what to do next. Rather, it was our job to never let them out of our sight or we might not find them for the rest of the day. Even going to the bathroom was risky unless we knew they weren't going anywhere for 5 minutes. Once I got yelled at for being seen sitting at a cafeteria table eating a quick snack while reading one of those pocket surgery guides. Of course they only saw me because...wait for it...they were sitting at another table eating lunch!

 

[MattD]

OK, this reinforces part of being a good intern/resident--don't go home without telling your students that you're leaving or giving them another person to check in with!

In my case, part of the problem was the surgery department was super cheap and gave the students numeric pagers. So residents didn't ever page us for anything whatsoever since it involved waiting for us to call back--couldn't send us a quick text telling us what to do next. Rather, it was our job to never let them out of our sight or we might not find them for the rest of the day. Even going to the bathroom was risky unless we knew they weren't going anywhere for 5 minutes. Once I got yelled at for being seen sitting at a cafeteria table eating a quick snack while reading one of those pocket surgery guides. Of course they only saw me because...wait for it...they were sitting at another table eating lunch!

sounds like your surgery dept. is full of d-bags. that's about all I'd take away from the experience. Sorry you were soured to surgery by them though :-( Where is this group of d-bags located, if you don't mind me asking? PM is fine 🙂

 

[Perrotfish]

sounds like your surgery dept. is full of d-bags. that's about all I'd take away from the experience. Sorry you were soured to surgery by them though :-( Where is this group of d-bags located, if you don't mind me asking? PM is fine 🙂

Yes, where is this utterly unique surgery department where the people are rude?

 

[MattD]

Yes, where is this utterly unique surgery department where the people are rude?

Precisely!

 

[bigDinLV]

Hey all,

I was one of you guys once. Now I'm head and shoulders above as I grab my long coat and get to toy with you as would a cat to a ball of yarn...

Seriously, though, I want your input into things I can do to be a good intern to you. It's too much work for everybody to be really generic here, so I'm going to present you a case and you tell me what I should do.

Patient in for, say, pneumonia, has a drop in HCT. No visible source of bleeding, not hemodilutional. Has history of OA and has been taking lots of ibuprofen for a number of months. Nurse thinks stools may have been dark and tarry but wasn't already ordered to sample for blood so didn't. We want to make sure it's not an upper GI bleed so we want do a rectal and guaiac the stool. (Actually if you're worried about a true bleed you won't bother guaiacing because you don't care about occult blood but that's neither here nor there for now.) At this point I can:

a) Do the rectal myself. You, however, as an eager student want to be involved and are more than willing to do it. I would be more than happy to let you do it because I don't enjoy doing them anyway but don't ask you because I'm afraid you'll feel pressured to say yes so I won't ding you on the eval, even though you really want to say no and I'm so busy with other things that I'll never remember that time you refused to do a rectal anyway.

b) Ask you if you want to do it. This time you are someone who is revolted by the idea of rectal exams and feel I am using my power and implied threat of a bad eval to get you to do my most unpleasant work for me. But you say yes so it won't affect your grade. In truth I am sincerely trying to get you involved and will never use it as some kind of way of judging your performance.

c) Ask if you want to do it but emphasize that it won't affect you negatively if you decline. However I was once a student too and would NEVER fall for that line, so effectively this is like option "(b*)" for lack of a better term.

So...what should I do? Or better put, what would you as an M3 prefer I do in a situation like this?

Don't ask them to do it. Ask how many they have done (no matter what they say it isn't enough!). Tell them there is one to do and ask if they have any questions or anything. Then you go with and help.

Then proceed to make fun of them after they do it

 

[Rendar5]

Don't ask them to do it. Ask how many they have done (no matter what they say it isn't enough!). Tell them there is one to do and ask if they have any questions or anything. Then you go with and help.

Then proceed to make fun of them after they do it

I agree. I came to my program and was shocked that they didn't have formal training on rectal exams like they do pelvic exams =p Now in retrospect I realize that this may be the norm. I try to teach my students rectal exams when I can

 

[the fat man]

I agree. I came to my program and was shocked that they didn't have formal training on rectal exams like they do pelvic exams =p Now in retrospect I realize that this may be the norm. I try to teach my students rectal exams when I can

The rectal exams I generally did were for checking for melena or BRB. Those are easy, just get in there enough to grab a sample. As for prostates, I have no fricking idea.

 

[the fat man]

sounds like your surgery dept. is full of d-bags. that's about all I'd take away from the experience. Sorry you were soured to surgery by them though :-( Where is this group of d-bags located, if you don't mind me asking? PM is fine 🙂

That might blow any semblance of my anonymity. Nowhere near you or TPC, however. Also, they weren't ALL like that, just that the ones that I was assigned to were. That being said on average the d-bag quotient for the dept. was pretty high.

 

[Richspiders07]

I wish the residents I spent weeks working with would take more than 2 seconds to fill out my evaluation... assuming they even fill out my evaluation. Nothing's worse than working your rear off for your team and only the attending evaluates you.

 

[cartoondoc]

Hey all,

I was one of you guys once. Now I'm head and shoulders above as I grab my long coat and get to toy with you as would a cat to a ball of yarn...

Seriously, though, I want your input into things I can do to be a good intern to you. It's too much work for everybody to be really generic here, so I'm going to present you a case and you tell me what I should do.

Patient in for, say, pneumonia, has a drop in HCT. No visible source of bleeding, not hemodilutional. Has history of OA and has been taking lots of ibuprofen for a number of months. Nurse thinks stools may have been dark and tarry but wasn't already ordered to sample for blood so didn't. We want to make sure it's not an upper GI bleed so we want do a rectal and guaiac the stool. (Actually if you're worried about a true bleed you won't bother guaiacing because you don't care about occult blood but that's neither here nor there for now.) At this point I can:

a) Do the rectal myself. You, however, as an eager student want to be involved and are more than willing to do it. I would be more than happy to let you do it because I don't enjoy doing them anyway but don't ask you because I'm afraid you'll feel pressured to say yes so I won't ding you on the eval, even though you really want to say no and I'm so busy with other things that I'll never remember that time you refused to do a rectal anyway.

b) Ask you if you want to do it. This time you are someone who is revolted by the idea of rectal exams and feel I am using my power and implied threat of a bad eval to get you to do my most unpleasant work for me. But you say yes so it won't affect your grade. In truth I am sincerely trying to get you involved and will never use it as some kind of way of judging your performance.

c) Ask if you want to do it but emphasize that it won't affect you negatively if you decline. However I was once a student too and would NEVER fall for that line, so effectively this is like option "(b*)" for lack of a better term.

So...what should I do? Or better put, what would you as an M3 prefer I do in a situation like this?

In my residency program, there were residents who would ask med students to pick up their laundry.

Stop being such a little girl and just make the med student do the rectal. 😛

 

[spicedmanna]

In my mind, there's no question about it: give the medical student the opportunity to do it. How else are we going to learn? My best and most enjoyable learning experiences have been when residents put me on the spot and made me try something. Push us to our learning edge. Depending on the complexity of the procedure, either do the first one as you explain what you are doing as you are doing it and what you are looking for, or walk us through it as we try it, or if the situation is right, just have me do it. Few things are more frustrating than standing there, basically shadowing, and not being able to play an active role. Push me to try it and then pimp the **** out of me as I'm doing it. Teach me to do what you would do and then let me practice it. Make me step up one level above where I'm at.

I watched a quinton catheter placement today as my resident and intern explained it. At the end, my resident said, basically, "you think you can do the next one?" Hell, yeah. I still remember the time when I was on ICU call and my resident gave me the chance to try an art line on an extremely difficult stick. I love it when my resident and attending gave me the chance to close half of the fourteen some incisions on a vascular case. Today, my intern put me on the spot by asking me to write all the post-op orders and notes (it wasn't even my case, but I was more than happy to practice). I feel like I'm being a productive member of the team and learning some of the things I need for internship. I'm always ready to do stuff, even if I'm just watching, and I try to be proactive and anticipate what's needed.

Seriously, I have some friends who did absolutely nothing during a rotation. What's the point? I'd be frustrated.

 

[SeminoleFan3]

Maybe everyone should just remember what it was like to be the medical student, and act accordingly.

 

[Jolie South]

Seriously, I have some friends who did absolutely nothing during a rotation. What's the point? I'd be frustrated.

I'd rather be held responsible for everything than nothing. Your thought processes are not going to improve without dealing with patients on your own and being forced to think.

 

[spicedmanna]

I'd rather be held responsible for everything than nothing. Your thought processes are not going to improve without dealing with patients on your own and being forced to think.

Absolutely. I couldn't agree more. Not only just thinking processes, but also it takes a heck of a lot of practice. I'm not going to be able to pick up abnormal physical findings, if I don't get a chance to examine a lot of patients. I'm not going to be able to write good orders, if I don't do it a lot. I'm not going to be able to put in a central line just by watching it. I'm not going to be able to manage patients, if I weren't given the opportunity to get involved. Etc, etc... Let me do it...when there there is the chance and then critique and guide me.

 

[Rendar5]

Absolutely. I couldn't agree more. Not only just thinking processes, but also it takes a heck of a lot of practice. I'm not going to be able to pick up abnormal physical findings, if I don't get a chance to examine a lot of patients. I'm not going to be able to write good orders, if I don't do it a lot. I'm not going to be able to put in a central line just by watching it. I'm not going to be able to manage patients, if I weren't given the opportunity to get involved. Etc, etc... Let me do it...when there there is the chance and then critique and guide me.

Good judgment comes from experience. Experience comes from bad judgment.

🙂

 

[Jolie South]

Good judgment comes from experience. Experience comes from bad judgment.

🙂

. . . and that's the downside.

 

[cpants]

Here is a list of stuff I thought of:

1. Mentioned before, but tell don't ask. Students appreciate a little authority. The worst is when you ask "Who wants to do a rectal?" to a group of students. Then we're all worried about what you think, and we also don't want to be overeager and come off as gunners to our friends. So much better to just walk up and assign it.

2. Fight gunnersism. Giving direct assignments will go a long way to accomplish this. But you should also direct questions to specific students. If you notice a student stepping on colleagues toes, pull them aside and tell them to cool it.

3. Teach us. We love being part of the team, and we will work our asses off for you, but we are here to learn. I appreciated when residents assigned a different student a 10 minute presentation on a topic each day. If you have us writing notes, try to at least read a couple of them and give us feedback. Teach us to do procedures. Give a 5-10 minute presentation on something yourself. It doesn't have to be prepared, just pull us aside and say "Let's talk about pneumonia for a while." If there are interesting exam findings in patients, make sure all the students get to check it out.

4. Try to make sure we get lunch. As above, order students to go to lunch. I'm not saying you need to send them if the team is overwhelmed and you need help. But most days, a 15 min break for every med student (and resident for that matter) is very possible. NEVER get lunch without telling the students. They will hate you so much.

5. Give us time to study. If there is nothing for us to do, send us home or to the library for a while. We don't mind staying late if the team is busy, but we hate staying late to sit around while you do stuff.

6. Give us feedback. If we've worked hard for you and you think we did a good job, mention it or shoot an email about it to the attending. Take the time to fill out our evaluations in a meaningful way. If we are lacking in a certain area, please tell us.

7. Get to know us. Learn our names quickly, and use them. It's respectful.

8. Give us pointers. If a certain attending always pimps on something, let us know. If we are off in our procedure technique, note writing, physical exam, we will appreciate the help.

 

[Law2Doc]

...
Stop being such a little girl and just make the med student do the rectal. 😛

This was my gut reaction to the thread as well. Med students are paying thousands of dollars for each rotation, they had better be thrown into the mix and actually get some sort of experience for that money. You don't ask someone "do you want to do a DRE", you say "what else do we need to check on this patient?" and when they say "DRE" you say "Good. Go do one and let me know the results." And so on. You make them a part of the team. You don't worry about whether they think their grade rides on it. You know what? Everything a med student does may or may not affect their grade, and that is really not your issue. If a med student wants to disappear to the library every time work needs to be done, not show up to things on time, not answer their pager, ask to leave before the day is done etc, they can doom their own eval and that has nothing to do with you as an intern. But in terms of exams, procedures and the like, that is something they should be in the thick of. Think of it this way, you are trying to give them some semblance of preparation for residency. Do residents do rectal exams? You bet they do. Will a med student be behind the curve if he's been allowed to politely decline doing them as a student? Absolutely. So you aren't doing them any favors.

The things I don't really agree with in the prior post are "give us time for lunch" and "give us time to study" for the following reasons. With some med students, you give an inch, they take a mile. You tell the med student to grab a quick sandwich and come back to the call room, all too often you see them an hour later, having sat down to eat lunch with their friends in the cafeteria, and they missed whatever task you had in mind for them, which you had to do on your own because it couldn't wait. You tell them they can go study and check back with you in an hour, and some will stretch an hour to two, and instead of coming back, will page you to see if they should come back. Not saying all med students do this, but enough crummy ones do it every rotation to ruin it for the rest. So sure, when there's time for lunch, you let them get lunch, but don't be afraid to put time conditions on it if things are hectic (based on your opinion, not the med student's), and if you are so swamped that you are missing a lunch yourself, don't feel obligated to part with your staff for an hour and compound the problem. And as med students, don't whine about not getting lunch if the resident is being slammed from every direction. You help him/her dig out as best you can, and if there's time for lunch after that, great. If not, then it's a good thing you were prepared with a power bar in your pocket.

OP, I think your perspective on this is going to change very very soon. But the short answer is that med students aren't there to have an easy, shadowing experience. They are there to work and learn by working, and get exposure to the kind of work that residents do. Some teaching on top, and maybe make them come in and present on a topic or two and your job is done. The "can I go home early" and opting out of DREs etc have no business in a med school rotation. That's my two cents.

 

[Jolie South]

Here is a list of stuff I thought of:

1. Mentioned before, but tell don't ask. Students appreciate a little authority. The worst is when you ask "Who wants to do a rectal?" to a group of students. Then we're all worried about what you think, and we also don't want to be overeager and come off as gunners to our friends. So much better to just walk up and assign it.

This also gets rid of polite indecisive syndrome where the 2 students look at each other and try to decide who should do it.

2. Fight gunnersism. Giving direct assignments will go a long way to accomplish this. But you should also direct questions to specific students. If you notice a student stepping on colleagues toes, pull them aside and tell them to cool it.

3. Teach us. We love being part of the team, and we will work our asses off for you, but we are here to learn. I appreciated when residents assigned a different student a 10 minute presentation on a topic each day. If you have us writing notes, try to at least read a couple of them and give us feedback. Teach us to do procedures. Give a 5-10 minute presentation on something yourself. It doesn't have to be prepared, just pull us aside and say "Let's talk about pneumonia for a while." If there are interesting exam findings in patients, make sure all the students get to check it out.

4. Try to make sure we get lunch. As above, order students to go to lunch. I'm not saying you need to send them if the team is overwhelmed and you need help. But most days, a 15 min break for every med student (and resident for that matter) is very possible. NEVER get lunch without telling the students. They will hate you so much.

5. Give us time to study. If there is nothing for us to do, send us home or to the library for a while. We don't mind staying late if the team is busy, but we hate staying late to sit around while you do stuff.

6. Give us feedback. If we've worked hard for you and you think we did a good job, mention it or shoot an email about it to the attending. Take the time to fill out our evaluations in a meaningful way. If we are lacking in a certain area, please tell us.

7. Get to know us. Learn our names quickly, and use them. It's respectful.

8. Give us pointers. If a certain attending always pimps on something, let us know. If we are off in our procedure technique, note writing, physical exam, we will appreciate the help.

I agree with this. 👍

 

[the fat man]

law2doc,

I agree that med students are there to "learn by working." However, I vehemently disagree that they are there to simply "work." There is a huge difference. Doing an H&P for the new admission is learning by working. Calling the outside hospital for medical records is plain old work, and doesn't teach anything. Sure, now that I'm going to be an intern it's a big help to me if those kinds of scut tasks are done by students. But they will complain, and rightfully so in my opinion, that they pay thousands of dollars a year to learn, not to work. The fact is we are paid to work and they pay to be there; if helping with our scut allows us more time to spend teaching them then it's an acceptable tradeoff. If the work we assign them is directly beneficial to their education then there's no issue to even discuss.

You may be right that my opinion will change soon. But I kind of hope it doesn't. Because I don't want to be one of those residents who scuts out their students without actually teaching them anything just so my life is a little easier. I don't want to be one of those who forgets that the power to order med students around comes with the responsibility for making sure we're doing right by them.

 

[kookaiDO]

One night the intern asked me to do the rectal on an admission... I hadn't done one (other than a standardized patient) and there was nothing else going on, so it was an appropriate learning experience.

It was only after she told me "go down to the ER to do ___'s rectal (my fifth DRE of the night), while I go check on this GI Bleed with the dropping hgb"... that's when I started to get bitter.

If there's nothing else going on, ask the student to do it. But if the student has already done their fair share and there's other stuff going on... the DRE can wait.

 

[PathMD2010]

I think Law2Doc's concern about med students taking a mile is quite valid. My classmates had three camps- those that did their work with a smile, gunner d bags, slacker d bags. The slackers would do this. And the gunners would throw you under the bus by not giving you proper times/ locations to try to make you look like a slacker d bag. Luckily, this did not happen to me, but it happens.

Again, I think that this can be curbed with some boundaries. ie if you tell me to go to lunch - and I take 30 mins, pls don't be upset with me for not taking 15 unless you tell me to do so. If you tell me 15 and I take 30 (without some good excuse/ apology - or at least checking in), I deserve to be slammed doing every DRE for the next 2 weeks along with a mark on the eval if more than once.

As to work and scut. Work the med students. Not to death, not to where they have NO time to study for the shelves or for their patients, but we are there to WORK. Utilize the med students and the slacker d bags will learn to avoid working with you, and everyone will be happier.

Also, LUNCH IS IMPORTANT - yes we can bring a power bar, but to eat at some point between 11 and 4 is a human right. Not a lunch hour, but a sandwich and a soda. Its not too much to ask. We are not indespensable. Also, we can get YOU food when slammed.

I argue that part of a medical education is to be taken down a few pegs and do some scut that has "no learning value". It teaches you how the hospital works, and what it means to be learning through apprenticeship.

End of soap box. As I end the end of med school, I get reflective and think of the best and worst experiences.

 

[Law2Doc]

...
Also, LUNCH IS IMPORTANT - yes we can bring a power bar, but to eat at some point between 11 and 4 is a human right. Not a lunch hour, but a sandwich and a soda. Its not too much to ask. We are not indispensable. Also, we can get YOU food when slammed. ...

IMHO, while I would love it if there was nothing going on and folks could go and get a breakfast break, lunch break, and where applicable dinner break during rotations, that isn't always realistic. No it's not a human right. There are times when everyone's slammed and the intern is working full tilt through lunch and still needs the help of med students during this time. Not that you are indispensable, but you guys can be the difference between getting stuff done in a timely manner, and missing deadlines, annoying chiefs/attendings for things that didn't get completed, leaving the night float folk with too much on their plate. At programs where things are run lean and mean, the med student, like it or not, has a more important role.

If I'm too slammed to get lunch (which isn't that uncommon, unfortunately) there is nothing that is more frustrating than having a med student ask, can I go take a lunch break. Sometimes there is time for lunch, sometimes there isn't. There will usually be time for food at some point, but if it's not until after 4, then that's the way it plays out. Part of rotations is to give you guys exposure to what a resident's life is like, to "walk the walk" at least in some small way. Well, this is the walk. I certainly won't eat if I didn't let the med students eat, and am always happy to share whatever I can scrounge. But when you start saying, I need to go get some food because it's a "human right", I have to note that as a concern when I do an eval. Residencies and med school rotations are not party to the Geneva Convention. Your rights are whatever your rotation coordinator, and various attendings and seniors tell us they are. Best not to cop an attitude. Put your head down and work with a smile, always showing me that you are interested and engaged in what you are doing, and you will get a good eval. If your focus is on lunch or when you can leave, it's hard for me to be glowing in an eval.

 

[Law2Doc]

law2doc,

I agree that med students are there to "learn by working." However, I vehemently disagree that they are there to simply "work." There is a huge difference. Doing an H&P for the new admission is learning by working. Calling the outside hospital for medical records is plain old work, and doesn't teach anything. Sure, now that I'm going to be an intern it's a big help to me if those kinds of scut tasks are done by students. But they will complain, and rightfully so in my opinion, that they pay thousands of dollars a year to learn, not to work. The fact is we are paid to work and they pay to be there; if helping with our scut allows us more time to spend teaching them then it's an acceptable tradeoff. If the work we assign them is directly beneficial to their education then there's no issue to even discuss.

You may be right that my opinion will change soon. But I kind of hope it doesn't. Because I don't want to be one of those residents who scuts out their students without actually teaching them anything just so my life is a little easier. I don't want to be one of those who forgets that the power to order med students around comes with the responsibility for making sure we're doing right by them.

My view is that a med student is in part paying to get good exposure to what residents do. So to the extent possible, I integrate them as a member of the team. If a task is allowed to be done by a med student, they are going to do it. I don't mete out scut vs non-scut because some portion of every resident's life is scut, and so to the extent this is an exercise to allow med students to "walk the walk" in some small way, they will do some percentage of scut. I certainly wouldn't give them nothing but scut, but there's a lot of stuff a med student simply isn't legally allowed to do on his/her own, and whether you realize it or not, the rotation coordinators frown on interns who send med students to go study for hours at a time, or send them home early. We recently got lectured that we needed to work the med students harder because when the administration went looking for them, they were inevitably in the library while the interns were doing the grunt work. So yeah, at least in some rotation coordinator's eyes, you guys are supposed to be doing whatever tasks you are qualified to do, scut or not, to be part of the team. Not someone hanging out in the library until something "educational" happens, but really being an integral part of the team, with all the negative scut connotations that involves. I tend to agree with this, honestly, because having done a lot of grunt work in med school rotations and sub-Is did lessen the learning curve when intern year started. The folks who were more coddled in med school had a harder time becoming efficient at doing the scut that was associated with every task. So even if you might not agree that it's a good use of your time, you need to concede that you don't always know what you are going to need down the road. That, plus if you aren't around me when I jump from task to task, there is a high likelihood I'm just going to bang out the truly educational tasks, rather than page you and wait for you to call back and then wait for you to walk back from the library -- I could be done already, and so I will be. And you lose out on any on-the-fly teaching that might occur, the whole "why are we doing this", if you aren't sitting in the same room. And you won't be there at the codes when we try to give med students opportunities for chest compressions, etc. If you are off in the library, you miss out. Even if that means you otherwise would have done more scut. Plain and simple.

 

[MattD]

Agreed. I care a lot about education, and will do everything I can to give medical students a great experience. I absolutely think it's wrong to simply assign the studs all the scut work I don't want to do, but I think a lot of studs greatly underestimate the educational value of a lot of the scut that they do. As L2D said above, if a task needs to be done, it is most appropriate for the person who has the least experience in that task (but is qualified to do it) to perform the task under supervision of someone with more experience. As an example, I haven't done nearly enough central lines as a student. I will be doing those at the beginning of next year myself. I will expect the studs to help, and will teach by example, but I'm doing them. Once I'm comfortable, though, they're doing them. All of them. I'll take over if they can't get it, but they're going to try. Same goes for other things students are allowed to do.

That may sound rough, but by doing things this way will actually be more work for me, as I will have to supervise them doing something that I could do faster. It will, however, free some of my time for teaching, which is the whole point. Looking back, yes, there were times I grumbled about busywork, however, the worst rotations were not the ones with the most busywork, they were the ones where I was ignored, and what work I did do was duplicated by the residents and never looked at, and I was bored for 12 hours a day.

 

[PathMD2010]

IMHO, while I would love it if there was nothing going on and folks could go and get a breakfast break, lunch break, and where applicable dinner break during rotations, that isn't always realistic. No it's not a human right. There are times when everyone's slammed and the intern is working full tilt through lunch and still needs the help of med students during this time. Not that you are indispensable, but you guys can be the difference between getting stuff done in a timely manner, and missing deadlines, annoying chiefs/attendings for things that didn't get completed, leaving the night float folk with too much on their plate. At programs where things are run lean and mean, the med student, like it or not, has a more important role.

If I'm too slammed to get lunch (which isn't that uncommon, unfortunately) there is nothing that is more frustrating than having a med student ask, can I go take a lunch break. Sometimes there is time for lunch, sometimes there isn't. There will usually be time for food at some point, but if it's not until after 4, then that's the way it plays out. Part of rotations is to give you guys exposure to what a resident's life is like, to "walk the walk" at least in some small way. Well, this is the walk. I certainly won't eat if I didn't let the med students eat, and am always happy to share whatever I can scrounge. But when you start saying, I need to go get some food because it's a "human right", I have to note that as a concern when I do an eval. Residencies and med school rotations are not party to the Geneva Convention. Your rights are whatever your rotation coordinator, and various attendings and seniors tell us they are. Best not to cop an attitude. Put your head down and work with a smile, always showing me that you are interested and engaged in what you are doing, and you will get a good eval. If your focus is on lunch or when you can leave, it's hard for me to be glowing in an eval.

1. My soap box now is a direct result of not saying anything then. I actaully would go to the bathroom to eat a power bar so as to not look weak - aka needing food between 5am and 4pm after being in the OR/ on my feet seeing pts in every waking second between then. A 30 sec lunch break while using the bathroom. I NEVER asked to go eat.

On rotations where we typically were busy all day, I brought a lunch to clinic and would eat it while doing notes- this also counts as a lunch break to me because I was allowed to eat in the open.

2. You misunderstand my position on the importance of lunch. When asked about ideal residents - they allow students to eat (not a long lunch - but enough to function without focusing on hunger - a power bar q7h or a meal q12 h) and they define what they mean by break. If you are slammed and I'm picking up food for everyone because its 3:30pm then that's self explanatory. But if its slow, and you say "we're going for lunch, come back later" - please define later!

3. Human rights may not have been the right phrase. How about biological necessities (eating, sleeping, using the bathroom).

And you are right, they are dictated by the resident - hence why I said on a forum where we are giving residents suggestions from a med students POV, I said in caps, LUNCH IS IMPORTANT - I am not referring to hour long breaks but 10-15 mins would be nice - give one energy, boost, focus for the rest of the day. Even 5 mins with a sack lunch. If we are focused on hypoglycemia, our function decreases and we are less help to you. Same as when working a 30 hr shift. You are not at your peak at hour 30. You like it when you get to go to your callroom because sleep is a biological neccessity! Not that you get it when you want it all the time, but it becomes a focus only when deprived of it. I understand it's not always possible, but its a note.

People with the attitude only the weak need to sleep/ urinate/ eat - are the reason that I am on an anonymous soap box, rather than addressing it on rotation. It wasn't worth my eval. I can jump through all the hoops. I ALWAYs showed (genuine) interest. I was not focused on leaving early, eating, ect. I just PREFER to be treated like a human - or at least a dog.

My take home point to how I liked to be handled by residents is this: Tell me what you want me to do, and I'll do my best to do it. It'd be great if I can do it while functioning properly. Also, instruction would be nice. This is a school after all. And an expensive one at that. I understand that residents are overworked, med students should help and not hinder that flow. In return, they should learn something from a combination of experience and instruction.

 

[Law2Doc]

... As an example, I haven't done nearly enough central lines as a student. I will be doing those at the beginning of next year myself. I will expect the studs to help, and will teach by example, but I'm doing them. Once I'm comfortable, though, they're doing them. All of them. I'll take over if they can't get it, but they're going to try. Same goes for other things students are allowed to do....

Before med students get too excited, at most of the places I have seen, putting in a central line is not actually considered a med student level job, simply because of the high risk of complications and the liability involved when one eg drops a lung, damages a vessel, loses the guide wire, etc. Med student level procedures in my experience tend to be blood draws/IVs, NG tube placement, removing central lines, minor I&Ds, suturing lacerations, foleys. If you are lucky maybe you get to do an arthro/thoro/paracentesis or an LP. Students can certainly assist with central lines and chest tubes, but at many places they won't be allowed to physically put them in.

 

[Law2Doc]

... If we are focused on hypoglycemia, our function decreases and we are less help to you. Same as when working a 30 hr shift. You are not at your peak at hour 30. You like it when you get to go to your callroom because sleep is a biological neccessity! Not that you get it when you want it all the time, but it becomes a focus only when deprived of it. I understand it's not always possible, but its a note. ...

LOL wait until you get to internship and find yourself missing multiple meals ON a 30 hour shift. Happens a lot. You will survive it without as much drop-off as you might think, and you will probably change your tune. Actually you will learn to like being extremely busy like this because it makes time fly faster and the adrenalin rush tends to make you feel less need for food or sleep. Keep power bars in your pocket. The interns will look after you if the timing works, but if they are slammed, they won't be sympathetic to your needs more than their own.

 

[MattD]

Before med students get too excited, at most of the places I have seen, putting in a central line is not actually considered a med student level job, simply because of the high risk of complications and the liability involved when one eg drops a lung, damages a vessel, loses the guide wire, etc. Med student level procedures in my experience tend to be blood draws/IVs, NG tube placement, removing central lines, minor I&Ds, suturing lacerations, foleys. If you are lucky maybe you get to do an arthro/thoro/paracentesis or an LP. Students can certainly assist with central lines and chest tubes, but at many places they won't be allowed to physically put them in.

Eh, true, everything is subject to rules of the institution / dictates of my superiors. However I do firmly believe that if I can put in a line as a first month intern, a 4th year medical student really isn't any less qualified, assuming proper supervision. Third years may not have the technical skills yet, but they can certainly start developing those skills suturing, placing IVs, drawing ABGs, etc.

 

[Rendar5]

Eh, true, everything is subject to rules of the institution / dictates of my superiors. However I do firmly believe that if I can put in a line as a first month intern, a 4th year medical student really isn't any less qualified, assuming proper supervision. Third years may not have the technical skills yet, but they can certainly start developing those skills suturing, placing IVs, drawing ABGs, etc.

I can't really agree with you about central lines. There's enough **** that can go wrong with them that I'm only going to let someone who's legally responsible for the patient to do. Seriously, beyond ptx and bleeding and infection risk, you're dealing with malplacement, lost guidewires (explain to IR that "i let the med student do it, I wasn't watching carefully enough, can you please retrieve the wire from the pt's IVC for me?"), accidentally dilating arteries when you find yourself in a carotid. There are just simply too many steps in the process for a central line where things can go bad.

Lumbar punctures, fem sticks, thoracentesis, pleuracentesis? go for it! sure there are complications, but fewer steps where you won't have control or close direction.

 

[Law2Doc]

I can't really agree with you about central lines. There's enough **** that can go wrong with them that I'm only going to let someone who's legally responsible for the patient to do. Seriously, beyond ptx and bleeding and infection risk, you're dealing with malplacement, lost guidewires (explain to IR that "i let the med student do it, I wasn't watching carefully enough, can you please retrieve the wire from the pt's IVC for me?"), accidentally dilating arteries when you find yourself in a carotid. There are just simply too many steps in the process for a central line where things can go bad.

Lumbar punctures, fem sticks, thoracentesis, pleuracentesis? go for it! sure there are complications, but fewer steps where you won't have control or close direction.

That's definitely the experience I've had at the couple of places I've been. There are some things that med students don't get to do because if a bad consequence happens, you really don't want to be in a position of saying "I let the med student do it". That's true even if we are talking about a last semester 4th year med versus a first month intern. The skill level may be indistringuishable, but your hospital legal department will let you know that there's a world of difference between what they find defensible vs not.

 

[MattD]

Eh, I never said I wouldn't be supervising (ie. sterile with my hands on the field). Perhaps it's just different institutional cultures. I don't know what hospital legal would say about it, but it's not all that uncommon here for med students to do lines, especially toward the end of the year. Not every attending is ok with it, but I've been around plenty who didn't bat an eye about it.

At any rate, regardless of whether you think a stud should or shouldn't do central lines specifically, the point is that they SHOULD be developing technical skills commensurate with their abilities, which I think everyone agrees on.

 

[cpants]

My view is that a med student is in part paying to get good exposure to what residents do. So to the extent possible, I integrate them as a member of the team. If a task is allowed to be done by a med student, they are going to do it. I don't mete out scut vs non-scut because some portion of every resident's life is scut, and so to the extent this is an exercise to allow med students to "walk the walk" in some small way, they will do some percentage of scut. I certainly wouldn't give them nothing but scut, but there's a lot of stuff a med student simply isn't legally allowed to do on his/her own, and whether you realize it or not, the rotation coordinators frown on interns who send med students to go study for hours at a time, or send them home early. We recently got lectured that we needed to work the med students harder because when the administration went looking for them, they were inevitably in the library while the interns were doing the grunt work. So yeah, at least in some rotation coordinator's eyes, you guys are supposed to be doing whatever tasks you are qualified to do, scut or not, to be part of the team. Not someone hanging out in the library until something "educational" happens, but really being an integral part of the team, with all the negative scut connotations that involves. I tend to agree with this, honestly, because having done a lot of grunt work in med school rotations and sub-Is did lessen the learning curve when intern year started. The folks who were more coddled in med school had a harder time becoming efficient at doing the scut that was associated with every task. So even if you might not agree that it's a good use of your time, you need to concede that you don't always know what you are going to need down the road. That, plus if you aren't around me when I jump from task to task, there is a high likelihood I'm just going to bang out the truly educational tasks, rather than page you and wait for you to call back and then wait for you to walk back from the library -- I could be done already, and so I will be. And you lose out on any on-the-fly teaching that might occur, the whole "why are we doing this", if you aren't sitting in the same room. And you won't be there at the codes when we try to give med students opportunities for chest compressions, etc. If you are off in the library, you miss out. Even if that means you otherwise would have done more scut. Plain and simple.

I agree that most med students complain way too much about scut. I want to be part of the team, and I want to help with whatever tasks I can. Plus we all get out of there on time when we get the team's work done. That said, I think the educational value of scut is vastly overstated. Yes it's important to learn my way around the hospital, learn how to order various tests, call the pharmacy for med lists, etc., but most of these tasks, while tedious, are extremely simple and require very little brain power (hence the name). I don't think many students would have a problem mastering scut tasks intern year, even with little exposure to them during med school. Most of the things will have to be relearned in a new hospital anyway. I'm not complaining about having to do these tasks, but let's not kid ourselves about how educational they are.

As I said earlier, I want to be a part of the team, and I want to work hard. But if you make me spend all day everyday slipping CT scans, and my reward for the month of effort is 1 blood draw and noon conference once a week (and we've all had those rotations), I'm going to be unhappy. You'll probably also find me trying to slip away to study, because we have a ton to learn on this rotation, and if we're not doing it on the job, we better do it somewhere else. It sounds like you keep students integrated with the team and really make an effort to teach, so I commend you for that. But realize that many of your colleagues don't care as much.

 

[Law2Doc]

I agree that most med students complain way too much about scut. I want to be part of the team, and I want to help with whatever tasks I can. Plus we all get out of there on time when we get the team's work done. That said, I think the educational value of scut is vastly overstated. Yes it's important to learn my way around the hospital, learn how to order various tests, call the pharmacy for med lists, etc., but most of these tasks, while tedious, are extremely simple and require very little brain power (hence the name). I don't think many students would have a problem mastering scut tasks intern year, even with little exposure to them during med school. Most of the things will have to be relearned in a new hospital anyway. I'm not complaining about having to do these tasks, but let's not kid ourselves about how educational they are.

As I said earlier, I want to be a part of the team, and I want to work hard. But if you make me spend all day everyday slipping CT scans, and my reward for the month of effort is 1 blood draw and noon conference once a week (and we've all had those rotations), I'm going to be unhappy. You'll probably also find me trying to slip away to study, because we have a ton to learn on this rotation, and if we're not doing it on the job, we better do it somewhere else. It sounds like you keep students integrated with the team and really make an effort to teach, so I commend you for that. But realize that many of your colleagues don't care as much.

The thing is, the individual tasks may be scut, but the daily management of the patient isn't. And that's really what residency is going to be about, and what your rotation is supposed to give you a taste of. So the goal is really to integrate med students into that daily management, not simply a task by task kind of thing. So if a med student is assigned a patient, the goal should be for that med student to do everything involved in managing that patient, from admission to discharge, scut or not. So yeah, you will do a lot of scut, because that's a lot of what management of a patient involves. But hopefully you will do some interesting stuff too. And learn a lot about the particular disease process along the way. The problem, as I see it, is when med students focus too much on the individual tasks, and feel like they are doing scut. They don't take ownership of the patient as a whole, and as a result take ownership of each task. And if you aren't seeing the forest for the trees, all you see is that you are scutted out to deal with one little tree, when I really want you to get that the forest is your assignment, and each tree that needs tending to, well that's just how it works. I think too many med students show up and say, I want to do X, Y and Z procedure, because I feel it's educational, but if there's none of that going on, I want to be in the library because it's a better use of my time than "slipping CT scans" (or whatever you consider menial), or I don't want to do another DRE because I've already done enough of them. A good resident will get the med student thinking about why the patient needs a CT scan, or DRE, and why the study is being done, but I think med students who try to decide what is an educational task miss the point that managing the whole patient, through scut and all, is really what you are there to learn. Any ***** can put in an IV. How many know every step (scut or not) involved in managing a patient from admission to discharge? That's what you guys really should be focused on. When you say, this "task" is not a good use of my time, you already have missed the boat.

 

[calvinNhobbes]

Best teaching resident I had during M3 was a senior IM resident. Kept me very busy with very little scut. She'd have me do H&Ps on anything interesting that came in to the ER (usually 3-4 a day when on call). I wouldn't have to follow all of them (usually only 1-2 became my patients), but I got alot of practice doing it. She kept a list of interesting physical exam findings she noted on all our patients so I could go around on non-call days to check them out on my own. And she always paged the med students any time there was a procedure so we could at minimum see it (like central lines) and often do them depending on time with supervision (LP, IVs, ABG, etc.). For the first week I was really annoyed because my pager was always going off and I was often there late most days, but then I realized my time in the hospital was being spent very efficiently as far as education.

I think the real key thing is communication. Let the student know what you expect and keep them in the loop. The worse residents were the ones I never saw, never paged me, and never returned my pages.

 

[the fat man]

The thing is, the individual tasks may be scut, but the daily management of the patient isn't. And that's really what residency is going to be about, and what your rotation is supposed to give you a taste of. So the goal is really to integrate med students into that daily management, not simply a task by task kind of thing. So if a med student is assigned a patient, the goal should be for that med student to do everything involved in managing that patient, from admission to discharge, scut or not. So yeah, you will do a lot of scut, because that's a lot of what management of a patient involves. But hopefully you will do some interesting stuff too. And learn a lot about the particular disease process along the way. The problem, as I see it, is when med students focus too much on the individual tasks, and feel like they are doing scut. They don't take ownership of the patient as a whole, and as a result take ownership of each task. And if you aren't seeing the forest for the trees, all you see is that you are scutted out to deal with one little tree, when I really want you to get that the forest is your assignment, and each tree that needs tending to, well that's just how it works. I think too many med students show up and say, I want to do X, Y and Z procedure, because I feel it's educational, but if there's none of that going on, I want to be in the library because it's a better use of my time than "slipping CT scans" (or whatever you consider menial), or I don't want to do another DRE because I've already done enough of them. A good resident will get the med student thinking about why the patient needs a CT scan, or DRE, and why the study is being done, but I think med students who try to decide what is an educational task miss the point that managing the whole patient, through scut and all, is really what you are there to learn. Any ***** can put in an IV. How many know every step (scut or not) involved in managing a patient from admission to discharge? That's what you guys really should be focused on. When you say, this "task" is not a good use of my time, you already have missed the boat.

The thing that frustrated me most was when certain management tasks, often the ones that students consider most "interesting" or "educational" are taken away from us for reasons such as liability, efficiency, etc. We take care of all the boring trees, arrive at the interesting one, and get told to move on to the next boring tree because the interesting one is too dangerous or important or whatever to let a med student work on it. If I have to play secretary with the lab and pharmacy and radiology for an hour I felt I had some right to the paracentesis or LP or central line or whatever, even if the risks and liabilities objectively put them above my pay grade.

The times I would get most angry was when I was assigned the "scut" on patients not even belonging to me (such as calling for 3 other patients' outside medical records), while the patients who were supposed to be mine had lots of interesting findings to go over or procedures to be done on them but were only for the interns and residents.

 

[Law2Doc]

The thing that frustrated me most was when certain management tasks, often the ones that students consider most "interesting" or "educational" are taken away from us for reasons such as liability, efficiency, etc. We take care of all the boring trees, arrive at the interesting one, and get told to move on to the next boring tree because the interesting one is too dangerous or important or whatever to let a med student work on it. If I have to play secretary with the lab and pharmacy and radiology for an hour I felt I had some right to the paracentesis or LP or central line or whatever, even if the risks and liabilities objectively put them above my pay grade.

The times I would get most angry was when I was assigned the "scut" on patients not even belonging to me (such as calling for 3 other patients' outside medical records), while the patients who were supposed to be mine had lots of interesting findings to go over or procedures to be done on them but were only for the interns and residents.

So as an intern you can share the wealth. But that doesn't mean protect a med student from scut or DREs. It means they do that AND get to do the LP under supervision. (As mentioned above, I think at most hospitals central lines are not considered something a med student ought to be doing for liability reasons, so it's not really the interns problem that med students can stand and watch on these). Basically if there's something to do on a patient that the med student can do, they should do it. If the patient gets sent to be bronched or goes to IR, send the med student with the patient. Lots of educational opportunities on every patient every day. But if what needs to be done is collect labs, call the pharmacy and write discharge papers and scripts, then that's what the med student is going to be doing. You take the bad with the good. You don't look at it as a task by task issue, where I had to do 10 scut tasks. You look at it as a global patient (or teams' patients) management issue, where you do whatever work is needed for the patient/teams' patients, regardless of whether it's scut or not. Some weeks will be cooler than others, but that's the luck of the draw. You don't sit there saying, this is a waste of my time, I could be studying. This is your taste of what it's like to be part of the team -- you are experiencing what patient care is all about in this day and age. Nothing irks me more than a med student who is given an interesting patient, gets to do a cool procedure or two on that patient, and then whines, can I go to the library every time all that's left is scut. You take the bad with the good, and do it with a smile. That's going to be your life as a med student, as a resident, as a fellow, and probably to some extent as an attending (scut is different at each level, but there's always scut). Get used to it.

 

[the fat man]

So as an intern you can share the wealth. But that doesn't mean protect a med student from scut or DREs. It means they do that AND get to do the LP under supervision. (As mentioned above, I think at most hospitals central lines are not considered something a med student ought to be doing for liability reasons, so it's not really the interns problem that med students can stand and watch on these). Basically if there's something to do on a patient that the med student can do, they should do it. If the patient gets sent to be bronched or goes to IR, send the med student with the patient. Lots of educational opportunities on every patient every day. But if what needs to be done is collect labs, call the pharmacy and write discharge papers and scripts, then that's what the med student is going to be doing. You take the bad with the good. You don't look at it as a task by task issue, where I had to do 10 scut tasks. You look at it as a global patient (or teams' patients) management issue, where you do whatever work is needed for the patient/teams' patients, regardless of whether it's scut or not. Some weeks will be cooler than others, but that's the luck of the draw. You don't sit there saying, this is a waste of my time, I could be studying. This is your taste of what it's like to be part of the team -- you are experiencing what patient care is all about in this day and age. Nothing irks me more than a med student who is given an interesting patient, gets to do a cool procedure or two on that patient, and then whines, can I go to the library every time all that's left is scut. You take the bad with the good, and do it with a smile. That's going to be your life as a med student, as a resident, as a fellow, and probably to some extent as an attending (scut is different at each level, but there's always scut). Get used to it.

I'm sorry you've apparently had such rotten students. When you first got them and explained what you wanted from them, did you ever follow up and ask about their expectations? And if so, did you explain why or why not some of those expectations will be met?

Yeah, I might be quick to judge and question my role if I don't agree with the way things are. And that's something I need to work on. But I can be reasoned with, and even if you can't swing me over to your side of things I will appreciate that you took time to listen to my perspective. If I feel like we're having a true dialogue, rather than just being told "Get used to it" as you put it, or more often "Shut up and do what I told you," then I probably will be more willing to be that team player you're looking for.

 

[bigDinLV]

But when you start saying, I need to go get some food because it's a "human right", I have to note that as a concern when I do an eval. Residencies and med school rotations are not party to the Geneva Convention. Your rights are whatever your rotation coordinator, and various attendings and seniors tell us they are. Best not to cop an attitude. Put your head down and work with a smile, always showing me that you are interested and engaged in what you are doing, and you will get a good eval.

I'd say they have the "right" to go eat, they're students not employees. Part of being a resident and a leader is making sure those under you are taken care of, even if you aren't yourself. Go let them eat for pete's sake, even if you don't get to.

 

[Perrotfish]

I'd say they have the "right" to go eat, they're students not employees. Part of being a resident and a leader is making sure those under you are taken care of, even if you aren't yourself. Go let them eat for pete's sake, even if you don't get to.

+1. Officers eat last.

Also it's a pretty horrific sign when you have to explain to people that what you are doing to them is alright, despite the fact it qualifies as a war crime when we do it POWs, because medical schools 'are not party to the Geneva convention'.

 

[Law2Doc]

I'm sorry you've apparently had such rotten students. When you first got them and explained what you wanted from them, did you ever follow up and ask about their expectations? And if so, did you explain why or why not some of those expectations will be met?

Yeah, I might be quick to judge and question my role if I don't agree with the way things are. And that's something I need to work on. But I can be reasoned with, and even if you can't swing me over to your side of things I will appreciate that you took time to listen to my perspective. If I feel like we're having a true dialogue, rather than just being told "Get used to it" as you put it, or more often "Shut up and do what I told you," then I probably will be more willing to be that team player you're looking for.

You will have your share of very good students and very bad -- it's hit or miss throughout the year. You will find that some very quickly decide they aren't interested in the specialty, and maybe don't care as much as they should about the evaluation, so they outright find ways to make themselves scarce. I've worked with some great students who may as well already be interns, who bang out work (scut or not) like machines, get to do a ton of procedures, get great evals, and seemed to have a good time. They grasped the point of the rotation, and were a pleasure to work with and teach. I've also seen folks who didn't give a damn about anything but going home, felt everything they were asked to do was scut (even if it objectively wasn't), didn't read up on their patients, seemed to forget about the procedures we let them do and whined about how they were being exploited with scut, and even on the busiest of days said things like "since there's nothing going on, is it okay if I go to the library -- the shelf is just 3 weeks away".
For the "good" med students, the dialogue approach works fine. For the "I just want to get through this rotation" med students, it's pointless. It's not a question of them not understanding expectations. They just don't give a damn. They want to get through the rotation as effortlessly as possible, in the library as much as possible. You will see.

I get that it seems like if everyone is on the same page as to expectations and there are clear lines of communication and respect, there shouldn't be any issues. In theory I agree with that. In practice, that only works for the better half to 2/3 of med students. You will almost certainly get a block or two of students who don't fit this bill, and that's where you will get jaded and bent out of shape. Happens to all interns. Either the person simply doesn't get it and needs everything spoon fed beyond what other med students required, or the person simply doesn't care, may be a whiner, and if you don't watch them like a hawk, they will find a way to disappear.

 

[Law2Doc]

+1. Officers eat last.

Also it's a pretty horrific sign when you have to explain to people that what you are doing to them is alright, despite the fact it qualifies as a war crime when we do it POWs, because medical schools 'are not party to the Geneva convention'.

Hate to break it to you but virtually everything about residency would be a violation of the Geneva Convention. You are kept without sleep for 30 hours in a row, kept on your feet for 30 hours in a row, not given many days off per month, often miss meals, aren't given regular opportunities to bathe, shave and shower, etc. The dudes at Guantanamo probably had a higher standard of living than you will have during intern year. So yeah, it's horrific. Only difference is, it's voluntary -- you signed on to be a resident. As med student you more than signed on -- you are PAYING to be treated like this. So it's not about human rights -- you can quit any time. It's self imposed -- masochism.

As for officers eating last, I agree. But my point is that if I as "officer" am not going to get to eat a lunch at all, then if you finally get one at 5pm, while I'm finishing up work before the night float shows up, I'm still eating last. Again, I think it's great if there's time for everyone to have a long leisurely lunch. And some days that works. Some days it doesn't. Some days I tell the med students to run and grab a quick snack. Other days, we are being bombarded and by the time I look up, it's well past lunch time. That's just hospital life. You don't plan for it -- it happens. So bring those power bars, sometimes they are needed. Stop focusing on human rights -- you get no points for that because you requested to be here.

 

[Perrotfish]

You will have your share of very good students and very bad -- it's hit or miss throughout the year. You will find that some very quickly decide they aren't interested in the specialty, and maybe don't care as much as they should about the evaluation, so they outright find ways to make themselves scarce. I've worked with some great students who may as well already be interns, who bang out work (scut or not) like machines, get to do a ton of procedures, get great evals, and seemed to have a good time. They grasped the point of the rotation, and were a pleasure to work with and teach. I've also seen folks who didn't give a damn about anything but going home, felt everything they were asked to do was scut (even if it objectively wasn't), didn't read up on their patients, seemed to forget about the procedures we let them do and whined about how they were being exploited with scut, and even on the busiest of days said things like "since there's nothing going on, is it okay if I go to the library -- the shelf is just 3 weeks away".
For the "good" med students, the dialogue approach works fine. For the "I just want to get through this rotation" med students, it's pointless. It's not a question of them not understanding expectations. They just don't give a damn. They want to get through the rotation as effortlessly as possible, in the library as much as possible. You will see.

I get that it seems like if everyone is on the same page as to expectations and there are clear lines of communication and respect, there shouldn't be any issues. In theory I agree with that. In practice, that only works for the better half to 2/3 of med students. You will almost certainly get a block or two of students who don't fit this bill, and that's where you will get jaded and bent out of shape. Happens to all interns. Either the person simply doesn't get it and needs everything spoon fed beyond what other med students required, or the person simply doesn't care, may be a whiner, and if you don't watch them like a hawk, they will find a way to disappear.

It sounds like you're equivilating going to the library to read about the rotation you're on with going home to watch TV. Don't you think that study time is important as well? I think one of the things that medical stdents struggle with is that there comes a point where being a 'good' student is actualy getting in the way of your education. I understand that part of the point of the rotation is to learn how the hospital works, but part of it is also simply to cram an incredibly large amount of information into your head and I don't see anyone acomplishing that if you spend every waking hour (and most of the ones designated for sleeping) doing tasks that only educate you in teamwork.

I know this is getting off topic, but if you were redesigning the cirriculum from the ground up, do you think maybe it would make sense to seperate the two activities? You know, two weeks of reading and classes, then an exam, then two weeks in the hospital followed by a practical grade, then repeat? Just a thought

Hate to break it to you but virtually everything about residency would be a violation of the Geneva Convention. You are kept without sleep for 30 hours in a row, kept on your feet for 30 hours in a row, not given many days off per month, often miss meals, aren't given regular opportunities to bathe, shave and shower, etc. The dudes at Guantanamo probably had a higher standard of living than you will have during intern year. So yeah, it's horrific. Only difference is, it's voluntary -- you signed on to be a resident. As med student you more than signed on -- you are PAYING to be treated like this. So it's not about human rights -- you can quit any time. It's self imposed -- masochism.

I don't see this as masochism, so much as being taken advantage of. The difference is that masochism is when you want to be abused, but we want something else (to be a doctor) and the people holding the keys to the profession are making us suffer unnecessary abuse to get it. It is possible to take advantage of someone who technically has the right to walk away from the situation (which is why we have both labor and hazing laws). You're right, POWs are a bad metaphor, but a sweat shop worker might not be. I see what happens to medical students and Interns as abuse that is designed largely to haze them and, in the cases of Residents (and maybe even medical school students), to increase the profit margins for those in charge by overworking them without proper compensation. I think that the only reason that hospitals can operate this way is that we have given them uncontested control of medical licencure in a way that allows them to circumvent anti-trust laws, and that if medical licecure were seperated from training for medical licencure (like it is in every other profession) these kinds of abuse would be over within a year. In other words I don't see it a necessary part of our profession at all and particularlly I don't think that it makes any sense to extend these abuses to medical students in an effort to get them ready for what's coming next. Abuse isn't something you can train for.

Anyway, I have no illusions about changing the system before I at least finish residency, and I understand that it's not the Intern's fault but rather the system's, but I do still disagree with the whole thing

 

[MattD]

As a corollary, as much as I think students have a right to study, I dont' get the whole 'go to the library' thing. I actually don't think I 'went to the library' a single time in my 3rd and 4th year. It's not like students are going to the library to check out books, they have their books with them. The only reason that I see to go somewhere secluded to study is to avoid the possibility of being asked to help with the work. I read plenty during my rotations, but I was typically reading my materials in or around the resident work area, so as to be available for other things. Is that uncommon???

 

[the fat man]

If there's anything reassuring about all this back-and-forth, it's that (most of) today's generation of physicians aren't willing (at least in the privacy of their own homes, anonymously on the internet) to accept the prevailing system and all the abuse that entails. All this controversy about lunch? Be reasonable, people! Unless you're doing something like trauma surgery where the patient will die if you're not right there right away, you can take 10 minutes out of the day to go grab food! If the thought of sparing 10 frickin' minutes out of an entire day blows up your world, then you have issues!

I'm not saying we have to tear down everything we have. But things can be improved. If some of the powers that be in medicine lived 110 years ago, they probably would have come out against the automobile because the horse worked perfectly fine!

Sorry. I'm done...for now.

 

[bigDinLV]

Hate to break it to you but virtually everything about residency would be a violation of the Geneva Convention. You are kept without sleep for 30 hours in a row, kept on your feet for 30 hours in a row, not given many days off per month, often miss meals, aren't given regular opportunities to bathe, shave and shower, etc. The dudes at Guantanamo probably had a higher standard of living than you will have during intern year. So yeah, it's horrific. Only difference is, it's voluntary -- you signed on to be a resident. As med student you more than signed on -- you are PAYING to be treated like this. So it's not about human rights -- you can quit any time. It's self imposed -- masochism.

As for officers eating last, I agree. But my point is that if I as "officer" am not going to get to eat a lunch at all, then if you finally get one at 5pm, while I'm finishing up work before the night float shows up, I'm still eating last. Again, I think it's great if there's time for everyone to have a long leisurely lunch. And some days that works. Some days it doesn't. Some days I tell the med students to run and grab a quick snack. Other days, we are being bombarded and by the time I look up, it's well past lunch time. That's just hospital life. You don't plan for it -- it happens. So bring those power bars, sometimes they are needed. Stop focusing on human rights -- you get no points for that because you requested to be here.

If you're always that behind on work, you need to work on becoming more efficient.

You should not be dependent on the students to "work", they are there to learn. What about the days they have lecture or something else going on? What do you do on those days?