How competent are fourth year med students supposed to be?

[medstudent7860]

Depends. March of your M4 year? Subspecialists will be amazed you're around past 1 pm.

I'm assuming you're asking about early M4 year, when you're doing sub-I's. The general idea is to try to function as close to an intern level as possible, with the caveat that you'll make more mistakes and there will be a resident paired with you to guide you through the process. By M4 year you should be able to do more than gather info and give strong presentations, you should be able to make higher-level decisions at this point. Your A/P may need some refining from your senior, but for the most common medical problems, you should be on the right track. You're expected to function at close to an intern level, just with less patients.

E.g. you should know the concept of rate control when you get a patient with atrial fibrillation w/RVR. You should know what immediate steps to take when you get an ascites patient and what antibiotics empirically cover for SBP. CAP vs HCAP. Complicated vs uncomplicated UTIs. How to work up AKI. Basic bread-and-butter medicine.

The higher-level stuff that a good sub-I will pick up on includes putting in admission orders, watching how your resident handles cross-cover calls, etc.

The key for me on a sub-I was coming in early enough so that I had time to read for 5-10 minutes on each patient's condition, so that I had as accurate a plan as possible.

Um... what ARE the steps to take when you get an ascites pt? Labs, paracentesis, Lasix? And what antibiotics empirically cover for SBP? (Not an M4 yet...)

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[tiedyeddog]

I would guess the knowledge base expected is VERY different depending on the field you are going into. A surgical internship vs a medical one would not expect the same things, I would assume.

 

[cbrons]

Um... what ARE the steps to take when you get an ascites pt? Labs, paracentesis, Lasix? And what antibiotics empirically cover for SBP? (Not an M4 yet...)

Probably combo loop plus spirinolactone for most situations, i think it really depends and maybe some can clarify.

For empiric treatment of SBP im thinking 3rd gen cephalosporin such as Cefotaxime or Rocephin (not sure which is technically better in this case). Maybe FQ but im Not sure which one has sufficient fluid penetration

+ Albumin (if renal parameters acceptable)

 

[Mass Effect]

Probably combo loop plus spirinolactone for most situations, i think it really depends and maybe some can clarify

Labs, including LFTs. Ultrasound. Lasix is usually given without spironolactone in an inpatient setting, unless the patient is on spironolactone outpatient and/or comes in with hypokalemia. This is assuming you'll be checking daily labs.

 

[Chemistry>Physics]

To resurrect a partially dead thread, I also hate when attendings interrupt you every other sentence. Not to add something useful, but to correct your presentation. Amazingly, most of the time this happens, it's to ask or tell you to add some bit of information that you are about to say. I'm screaming in my head please just wait one d%#! second and I'll tell you the differential. Today just sucked the life out of me. Wish I had chosen a different career. Nothing is worth this bs. Summary of the day:
1) Attending makes me look like an idiot
2) Resident yells at me for wanting to pick up a patient
3) Patient family member yells at me for a stupid decision made by residents
4) Wrote notes no one will read
5) Worked my ass off to have another attending not bother to write an evaluation
6) Nurse yells at me for writing a note at the only open station because she doesn't want to stand.

Dude just wait till you're an attending and you'll be the one who gets to be top dog!

 

[oldanddone]

To resurrect a partially dead thread, I also hate when attendings interrupt you every other sentence. Not to add something useful, but to correct your presentation. Amazingly, most of the time this happens, it's to ask or tell you to add some bit of information that you are about to say. I'm screaming in my head please just wait one d%#! second and I'll tell you the differential. Today just sucked the life out of me. Wish I had chosen a different career. Nothing is worth this bs. Summary of the day:
1) Attending makes me look like an idiot
2) Resident yells at me for wanting to pick up a patient
3) Patient family member yells at me for a stupid decision made by residents
4) Wrote notes no one will read
5) Worked my ass off to have another attending not bother to write an evaluation
6) Nurse yells at me for writing a note at the only open station because she doesn't want to stand.

on bad days of med ed, you need:

this The Art of Pimping
and this How to Survive a Case Presentation

 

[Kahreek]

As a med student, you wish you could put in orders and do notes.

Then as an intern, you feel like a note/order monkey. I wish I could do more tubes and tonsils and septums.

Next year, I'll feel sick of tubes and tonsils, and wish I was doing more thyroids and neck dissections.

It doesn't stop, not until you the bossman.

Ohh no it doesnt.

 

[Kahreek]

on bad days of med ed, you need:

this The Art of Pimping
and this How to Survive a Case Presentation

Very good

 

[Trefoil]

Believe it or not your notes get read a lot more than you'd think. Whenever myself or any of the other RTs or RNs really needed a thorough history on a patient, we'd dig up the medical student note. They would often have things that the resident or attending completely neglected that would sometimes turn out to be critical pieces of information.

Thank you. That is nice to hear. I think as 3rd year went on I found more ways to be useful to the team. For some reason, I felt especially useless on IM, but now that I am in my sub specialty elective, I've found that my presence has been very much appreciated. The ophthalmology techs actually asked me to be in the same clinic as them because I can work patients up independently which means their day moves faster, and they get to go home sooner. It certainly is nice to hear that our notes are used though. Often, I felt like my days in IM were an exercise in futility.
Best wishes.

 

[notbobtrustme]

Probably combo loop plus spirinolactone for most situations, i think it really depends and maybe some can clarify.

For empiric treatment of SBP im thinking 3rd gen cephalosporin such as Cefotaxime or Rocephin (not sure which is technically better in this case). Maybe FQ but im Not sure which one has sufficient fluid penetration

+ Albumin (if renal parameters acceptable)

pretty sure you need gram negative, positive and anaerobic coverage, so ceftriaxone/cefoxitime, vanc, metronidazole until you get culture/sensitivity data back.

 

[Raryn]

pretty sure you need gram negative, positive and anaerobic coverage, so ceftriaxone/cefoxitime, vanc, metronidazole until you get culture/sensitivity data back.

Way to randomly reply to this thread. Exactly what gram positives are you covering with vancomycin that aren't covered by cefotaxime or ceftriaxone? You don't get MRSA peritonitis. Similarly, those cephalosporins have excellent anaerobic coverage as well. You really only need the one drug.

 

[notbobtrustme]

Way to randomly reply to this thread. Exactly what gram positives are you covering with vancomycin that aren't covered by cefotaxime or ceftriaxone? You don't get MRSA peritonitis. Similarly, those cephalosporins have excellent anaerobic coverage as well. You really only need the one drug.

ah, sweet thanks for clearing me up on that.