As a senior resident, I work about half my shifts with a 4th year medical student assigned to me. You'd think being a 4th year medical student would have prepared me to do this, but on not one of my three EM rotations as an MSIV did I work with a resident. I can't believe how much it throws off my rhythm. I get the everything from the super-duper gung-ho EM stud type to the "going into peds never done a procedure" type. I see probably 2/3 of the patients I would see on a regular shift. With the very best students it is a draw, they make up for the time I spend teaching them by taking care of the equivalent scut for me (lacs, checking labs, paperwork, taking the review of systems etc.) With a "bad" medical student, it takes me 3 times as long to let them do something (and I'm not just talking procedures) as to do it myself. Truly, medical education occurs only out of the benevolence of its practitioners. Any tips out there on how to work more effectively with studs?