How competent are fourth year med students supposed to be?

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samuelp said:
no. that's still useful to crank you over the head with it when you can't provide any studies to support your argument of refuting someone else's. :nod: :diebanana:
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The onus is on YOU to prove that the USMLE Step 3 accurately predicts residency performance. You have yet to do that and instead find an article that says nowhere close to what you thought it was (or don't understand what the word converse is - besides maybe thinking it's the name brand of a shoe) or were being intentionally deceptive, thinking that no one would actually read the article you posted. On a side note, Dr. Andriole at WashU wrote a great paper.
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DermViser said:
The onus is on YOU to prove that the USMLE Step 3 accurately predicts residency performance. You have yet to do that and instead find an article that says nowhere close to what you thought it was (or don't understand what the word converse is - besides maybe thinking it's the name brand of a shoe) or were being intentionally deceptive, thinking that no one would actually read the article you posted. On a side note, Dr. Andriole at WashU wrote a great paper.
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...It is the name brand of a shoe. Duh.
 
TooMuchResearch said:
...It is the name brand of a shoe. Duh.
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Yes, I know:
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mimelim said:
My experience is that our ICU nurses tend to know what to bug us about. They also just over bug, which is way better than under bugging (from a patient care stand point). Most floor stuff goes to the on-call intern (ie. not me), but I know exactly which nurses you are talking about (can even picture 2 of them in my head right now). I also prefer nurses to call me if I'm not on call if there is an issue than to be stuck without help. I try my hardest to make my service the best in the hospital. Part of that is that we are always reachable, even for the stupid stuff. If the intern isn't calling pages back, that is a problem, especially if they are consults. Our ER docs sometimes text me if they can't get a hold of the on-call resident for 15-20 minutes. If nothing else, it helps me get out earlier because I know about stuff not getting done earlier. It also helps me take better care of our intern, because those texts usually mean that he is getting overwhelmed.
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Any doctor is welcome to my cell phone number. Residents in other specialties, consultants, whatever. I hand that out to all of them. Ditto with our pharmacists. I love our clinical pharmacists and wish they would text me MORE often, not less.

No nurse, PT, SW, dietician, etc gets it. I don't care how competent they are, I get paged for the most ridiculous stuff sometimes and I'm not willing to risk it.
 
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Raryn said:
Any doctor is welcome to my cell phone number. Residents in other specialties, consultants, whatever. I hand that out to all of them. Ditto with our pharmacists. I love our clinical pharmacists and wish they would text me MORE often, not less.

No nurse, PT, SW, dietician, etc gets it. I don't care how competent they are, I get paged for the most ridiculous stuff sometimes and I'm not willing to risk it.
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Some nurses, PTs, SWs, and dieticians can have my number...just...not for work ;)
 
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DermViser said:
Wow, you are much more magnanimous than most (all) interns/residents that I know, excluding of course, chief residents - who will have their own reasons. I find more often, that type of thing tends to get abused by hospital staff which is why people don't do it. So during internship (or for some, categorical residnecy), when one is off, you're off -- thank god for being able to link pagers or people would be getting pages long after they've left the hospital.

Nice of you to realize that an intern who isn't answering pages the moment they get them, might just be overwhelmed at the moment. Too often, I think programs wrongfully assume that the intern is "purposefully" not answer pages (yes, I'm sure this happens sometimes, but I don't believe this to be a majority of the cases).
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My patients are my patients. They don't disappear because I leave the hospital. I'm not sacrificing the care of my patients because the night intern got slammed and didn't get a message. If the call is meant for someone else or would be better handled by someone in the hospital, I let the person in house know. To be honest, it doesn't really happen that often and doesn't cost me a whole lot. But, the benefits are substantial. We have a great relationship with our staff. Our interns should feel like we care about their well being and education just as much as we care about the work getting done because we really do.

Raryn said:
Any doctor is welcome to my cell phone number. Residents in other specialties, consultants, whatever. I hand that out to all of them. Ditto with our pharmacists. I love our clinical pharmacists and wish they would text me MORE often, not less.

No nurse, PT, SW, dietician, etc gets it. I don't care how competent they are, I get paged for the most ridiculous stuff sometimes and I'm not willing to risk it.
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Every once in a while the ridiculous stuff gets through to my pager, but honestly, never from one of the ICUs. When they call, they need help or think that they need help. I certainly can't speak to every hospital's staff, but in my limited experience ICU nurses are the go to people. You want to know what is going on, they are who you want. You want to figure out the best management of a complex patient, absolutely, the intensivist/ICU team is who you want, but, for figuring out the normal stuff, or the urgent stuff, I want the nurse. I also want them to care as much about my patients as I do because, while I can't prove it, I think that it leads to better outcomes. Showing my investment in the patient and the nurse taking care of them goes a long way toward that goal. I also don't know how much of it is the specialty. Most of our issues in Vascular are very acute. What nurses tell me affects my management right then. I'm sure that that is very different in other specialties.
 
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mimelim said:
My patients are my patients. They don't disappear because I leave the hospital. I'm not sacrificing the care of my patients because the night intern got slammed and didn't get a message. If the call is meant for someone else or would be better handled by someone in the hospital, I let the person in house know. To be honest, it doesn't really happen that often and doesn't cost me a whole lot. But, the benefits are substantial. We have a great relationship with our staff. Our interns should feel like we care about their well being and education just as much as we care about the work getting done because we really do.
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Like I said, you're definitely in the minority (definitely not a bad thing, as I don't think strength in numbers is what you should use to dictate how to be) as far as your dedication to patients. The interns/residents that don't do what you do, do it more for burn out purposes, not bc they don't inherently care about people. I realize also this is very much institutional culture specific (i.e. UCSF vs. Cook County) although one can choose to do so, regardless of the institution they are at.
 
DermViser said:
Like I said, you're definitely in the minority (definitely not a bad thing, as I don't think strength in numbers is what you should use to dictate how to be) as far as your dedication to patients. The interns/residents that don't do what you do, do it more for burn out purposes, not bc they don't inherently care about people. I realize also this is very much institutional culture specific (i.e. UCSF vs. Cook County) although one can choose to do so, regardless of the institution they are at.
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Haven't worked at cook county, but rest assured. If I was at the VA, I would NOT do this. ;) I agree. It is mostly institution specific. But, if you do have the opportunity, working at a hospital with a good support structure, investing in people is really key.
 
mimelim said:
Haven't worked at cook county, but rest assured. If I was at the VA, I would NOT do this. ;) I agree. It is mostly institution specific. But, if you do have the opportunity, working at a hospital with a good support structure, investing in people is really key.
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Yes, I think you'll be hardpressed to find anyone at the VA like that. It's a vicious cycle, employees who feel used and abused, no good support structure, managers promoted based on seniority and not actual ability, will have a culture in which people don't feel the hospital is invested in them, and so they either don't do a great job or they leave. Just see Glassdoor.com there are tons of hospitals like that. The ones who feel everything is going right are those in administrator roles.
 
Simply, to answer the OP, at mid 4th year you should be a functioning intern. That is based on no data, no RCT. If you can function as an intern mid-4th year, you can only get better and your transition to intern may be less painful. If you are not performing at intern level, you need to work harder. Your journey toward and through internship may be difficult. My opinion only.
 
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samuelp said:
o'rly.... what do you think is going to happen when we plot that on a graph and calculate an r^2 value? huh? what do you think... is there going to be a correlation? what says you can't reverse extrapolate it to get a predicted PD performance evaluation prior to entering pgy1. I almost want to do a study now just to prove you wrong.
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why? This has ZERO impact in your life. AS you know, you need four years of med school, apply to residency, and train to be a doctor. Tests means nothing. Why do you care?
 
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KnuxNole said:
why? This has ZERO impact in your life. AS you know, you need four years of med school, apply to residency, and train to be a doctor. Tests means nothing. Why do you care?
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Bc he's using USMLE test scores as the reason he should get a residency. He has a dog in this fight and directly benefits from it.
 
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DermViser said:
Bc he's using USMLE test scores as the reason he should get a residency. He has a dog in this fight and directly benefits from it.
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He sounds like those people who say "OMG I GOT A 99 PERCENT ON STEP1. I DESERVE TO BE IN XXX RESIDENCY". Boy please, get out of here with that bull.
 
KnuxNole said:
He sounds like those people who say "OMG I GOT A 99 PERCENT ON STEP1. I DESERVE TO BE IN XXX RESIDENCY". Boy please, get out of here with that bull.
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Pretty much. That's the metric (sole metric) he is using regarding whether one deserves a residency and how well they will do in residency. Who cares where they did their clinical clerkships. Nope - just a score.
 
it's not a percent you misinformed fool. or a percentile for that matter. I'm using the fact that I passed all three to say I should be starting training now. not my numerical scores.

IF YOU CAN'T GET SOMETHING RIGHT WHEN THE ANSWER IS RIGHT IN FRONT OF YOU, THEN THERE'S SOMETHING WRONG WITH YOU.
 
samuelp said:
it's not a percent you misinformed fool. or a percentile for that matter. I'm using the fact that I passed all three to say I should be starting training now. not my numerical scores.

IF YOU CAN'T GET SOMETHING RIGHT WHEN THE ANSWER IS RIGHT IN FRONT OF YOU, THEN THERE'S SOMETHING WRONG WITH YOU.
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So then you're even more wrong, if you believe that you deserve a residency simple bc you accomplished the feat of passing the Steps - something every medical graduate has to do.
 
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samuelp said:
it's not a percent you misinformed fool. or a percentile for that matter. I'm using the fact that I passed all three to say I should be starting training now. not my numerical scores.

IF YOU CAN'T GET SOMETHING RIGHT WHEN THE ANSWER IS RIGHT IN FRONT OF YOU, THEN THERE'S SOMETHING WRONG WITH YOU.
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I wondered how long it would take
 
southernIM said:
I wondered how long it would take
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I agree he finally came out with it. The problem is it's even worse than first thought. He believes he deserves a residency bc he passed the Steps when it's a numerically graded exam not a Pass/Fail exam like the NBDEs in dental school.
 
actually. I deserve a residency cause I'm a competent physician who will probably only need minimal oversight as long as I'm not dealing with unstable patients.

wait wait... how many students pass all three steps in 3 years?
 
samuelp said:
actually. I deserve a residency cause I'm a competent physician who will probably only need minimal oversight as long as I'm not dealing with unstable patients.

wait wait... how many students pass all three steps in 3 years?
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It's amazing that you consider the bare minimum an accomplishment.
 
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and finally... I deserve a residency because I will be able to increase billing when doing consultations after making diagnoses, plus I'm cost effective.
 
samuelp said:
actually. I deserve a residency cause I'm a competent physician who will probably only need minimal oversight as long as I'm not dealing with unstable patients.

wait wait... how many students pass all three steps in 3 years?
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A competent physician - as determined by you, based on the fact that you fact the Steps, when there is a LOT more than that to establish competency beyond multiple choice exams.

Many medical graduates pass 3 steps in 3 years --- They take Step 1 at the end of MS-2/beginning of MS-3, Step 2s in the Fall of MS-4, and Step 3 sometime during their internship. I don't understand why you think your ability to do so makes you special.
 
I didn't get the bare minimum. we'll leave it at that.

southernIM said:
It's amazing that you consider the bare minimum an accomplishment.
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I'm sure there a good number of 4th year students who are much more competent in medicine than you or I or anyone posting in this thread and are unfortunately deluded into thinking they aren't.
 
samuelp said:
and finally... I deserve a residency because I will be able to increase billing when doing consultations after making diagnoses, plus I'm cost effective.
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1) Residents don't bill, 2) You have no credential to establish that you are cost-effective.
 
does it really kill you guys to see someone else be successful? is it that bad for you right now?
 
samuelp said:
I didn't get the bare minimum. we'll leave it at that.

I'm sure there a good number of 4th year students who are much more competent in medicine than you or I or anyone posting in this thread and are unfortunately deluded into thinking they aren't.
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He means bare minimum as in passing. Not bare minimum as in the actual score.
 
^ I saw that once somewhere else.... I wonder if that's the same place. what's that from?
 
mimelim said:
You guys are getting trolled so hard.
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Depends what you mean.

Is samuelp actually a grad of a third rate offshore school who failed to match -> yes

Does he actually believe he is entitled to a position and have a chip on his shoulder -> yes

Is he intentionally being antagonistic and adopting an intellectually dishonest position -> yes
 
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southernIM said:
Depends what you mean.

Is samuelp actually a grad of a third rate offshore school who failed to match -> yes

Does he actually believe he is entitled to a position and have a chip on his shoulder -> yes

Is he intentionally being antagonistic and adopting an intellectually dishonest position -> yes
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Everything one would want in a resident, amirite?
 
samuelp said:
does it really kill you guys to see someone else be successful? is it that bad for you right now?
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What does that have to do with the discussion at hand? This has nothing to do with not seeing you be successful.
 
DermViser said:
At first I thought his mode of reasoning (genuine) was that he did very well on the Steps (maybe 1 standard deviation if not even higher than the mean) and thus should get a residency. Turns out that's not even the case. He believes he should get a residency bc he passed the Steps.

As confirmed by his avatar, http://www.psychologytoday.com/blog...rolls-are-narcissists-psychopaths-and-sadists
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I read this too last week. No but in all seriousness, the NBME or FSMB says that as long as you pass all three, you're competent. Why they put so much weight on the first one, idk. it's not like it's very correlated with IQ. But yes. You're correct in part of your statement above.
 
colbgw02 said:
it's a quote, attributed to a number of people, to include gore vidal and david merrick.
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I thought it meant like the way the system works. Like him just doing well isn't good enough, they have to set it up so others end up failing.
 
samuelp said:
I read this too last week. No but in all seriousness, the NBME or FSMB says that as long as you pass all three, you're competent. Why they put so much weight on the first one, idk. it's not like it's very correlated with IQ. But yes. You're correct in part of your statement above.
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No they don't. Despite all of your out of context attempts - They actually quite clearly state that the exams are only one component of determining competency.
 
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samuelp said:
I thought it meant like the way the system works. Like him just doing well isn't good enough, they have to set it up so others end up failing.
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It's not referring to the system. He's referring to himself - it's his personal credo.
 
well, you see, I've noticed that there's always a certain percentage failing exams....
 
that it's as if the whole system is rigged. it's like studying your ass off and hoping to god that you learned enough to not be in the bottom 10%
 
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