How many patients are med students generally responsible for...

[CBG23]

...for the core rotations like medicine, OB/GYN, etc.? Are there both inpatient and outpatient/clinic duties?

---

Members don't see this ad.

 

[Doctor4Life1769]

...for the core rotations like medicine, OB/GYN, etc.? Are there both inpatient and outpatient/clinic duties?

Depends on service.

I wasn't directly responsible for any patient until I hit 4th year.

As a 4th year, I was responsible for the entire census, except on medicine sub-I, where I was responsible for anywhere b/w 5 and 7 pts.

 

[BigRedBeta]

I'm a pediatric resident and our program expects 3rd year students to carry 4 patients during their time on inpatient services. That means they're seeing those patients each morning, writing notes and presenting them on rounds. As a resident, I encourage students to really work on coming up with their own management plans, but interns are obviously following along behind the students and helping them along.

Our sub-I's are treated as interns - the upper level resident will follow along on their patients but they (the subI's) carry the same number of patients as the interns and if the sub-I proves themselves, the upper level is there to merely sign off on their notes/orders to make everything legal.

There is data out there that the more patients students carry on their inpatient rotations, the better they do on shelf exams.

 

[mordounhas]

Most rotations I've carried 3 at a time, while occasionally having 2 or 4. I've only ever really carried one patient if the census was tiny or it was the first day of a rotation.

 

[2012mdc]

...for the core rotations like medicine, OB/GYN, etc.? Are there both inpatient and outpatient/clinic duties?

Surg depended on the census. At times I had zero patients (3 on the census, 4 students in my group) to as many as 6 (12 on the census, 2 students coming in on the weekend). Usually it was 3 or 4

Medicine was usually 2 or 3. We admitted 2 patients a student each call q4. If you ended up with rocks you could end up with 4 patients (they capped us at 4).

On Peds inpatient they capped us at 3 patients, regardless of the total census.

Haven't done sub-I's yet but I've generally heard you are responsible for 5-6 patients like the previous poster mentioned

 

[vicinihil]

As many or as few as you are comfortable taking. It's better to do a good job on a few patients than to do a piss poor job on a lot. My peds max was 7 but half of them had RSV. ICU takes longer obviously because of the FENGUI management plans. Some service have such fast turn arounds that the residents may not even expect you to carry any since its faster if they just round and discharge.

 

[MilkmanAl]

I can't recall having more than 6, but I'm sure it happened when I was on plastic surgery, the craziest damn rotation ever.

 

[Perrotfish]

All the MS3 rotations I've had considered either 3 or 4 patients a maximum for medical students. So as a student you either see (census size/# of students) or the maximum number of patients they want you to see, whichever is less.

 

[cpants]

Responsible for....zero. Usually required to round on/know about at least 3-4. You have to play it by ear. Don't gun out your classmates and try to pick up way more patients than them. There is plenty to learn about even if you are only carrying one patient. Just follow what the resident tells you on the first day.

 

[turkeyjerky]

Responsible for....zero. Usually required to round on/know about at least 3-4. You have to play it by ear. Don't gun out your classmates and try to pick up way more patients than them. There is plenty to learn about even if you are only carrying one patient. Just follow what the resident tells you on the first day.

agreed, and some might argue that there's even a benefit in in only carrying one or two patients--less time copying down vital signs means more time for learning.

 

[Doctor4Life1769]

agreed, and some might argue that there's even a benefit in in only carrying one or two patients--less time copying down vital signs means more time for learning.

There's important info to be had with attaining vitals, too 😉

 

[turkeyjerky]

There's important info to be had with attaining vitals, too 😉

I wonder if everyone going into peds has a hard-on for age-specific heart rates and urine output in ml per kg per hour.

 

[cpants]

agreed, and some might argue that there's even a benefit in in only carrying one or two patients--less time copying down vital signs means more time for learning.

Amen. I think you'd often be better served with following around 1-2 patients at a time. It's better for your learning and also your performance. You look a hell of a lot better knowing all the PORT criteria and the proper antibiotics for your one pneumonia patient than you do knowing the vitals for 6 patients. Also, good to try to pick up different pathology with each new patient. That is, if you followed 3 PNA patients last week, volunteer for the CHF patient this time.

 

[2012mdc]

Amen. I think you'd often be better served with following around 1-2 patients at a time. It's better for your learning and also your performance. You look a hell of a lot better knowing all the PORT criteria and the proper antibiotics for your one pneumonia patient than you do knowing the vitals for 6 patients. Also, good to try to pick up different pathology with each new patient. That is, if you followed 3 PNA patients last week, volunteer for the CHF patient this time.[/QUOTE]

+1, throughout this year residents have been pretty good about letting the students choose which student is admitting a particular patient as well as sometimes switching patients post-admission to get a broader experience

 

[CBG23]

does it look bad if you take on less patients (with the goal of trying to learn more about each individual patient)? Especially if other med students on the rotation volunteer for more?

 

[cpants]

does it look bad if you take on less patients (with the goal of trying to learn more about each individual patient)? Especially if other med students on the rotation volunteer for more?

Yes, it will probably look bad. Generally, you should all be carrying the same amount of patients. If everyone else has 4 and you have 2, you look lazy. If everyone else has 3 and you have 5, you look like a gunner.

 

[buckeye12]

3rd year core:
Medicine: 3-4
Peds: 2-6
Surgery: 2-6
Ob/Gyn: 1-3
Neuro: 2-4
Psych: 3

 

[ShyRem]

does it look bad if you take on less patients (with the goal of trying to learn more about each individual patient)? Especially if other med students on the rotation volunteer for more?

Depends on the patient. If you have a very complicated patient, then perhaps not. If you have fewer simple patients, then yes.

For example, on wards: if you have only one DKA and one pneumonia patient, then you should be able to take on more.

If you are managing a patient with no known previous medical problems who comes in with thyrotoxicosis, is found to be hepatitis positive who then develops total pituitary failure and has now developed pneumonia, MRSA, thrombocytopenia, delirium, and liver failure on top of it all, then I think fewer patients is more than ok and in fact just this one patient might be more than enough in the acute phases. Or perhaps with a simple pneumonia patient.

It all depends on complexity. No one expects you to take the same number of complicated patients as another student with only simple patients.

 

[deleted263296]

I'm guessing by responsible for you mean having to know every nitpicky detail about them (even though no one tells you anything) and having to present them on rounds and write notes that no one will read. If that's the case, the patient load will depend on the service. Sometimes I didn't have to follow any and others up to 4. But in reality, you are not responsible for any patient. Nothing you do will affect their care. You are redundant.

 

[2012mdc]

I'm guessing by responsible for you mean having to know every nitpicky detail about them (even though no one tells you anything) and having to present them on rounds and write notes that no one will read. If that's the case, the patient load will depend on the service. Sometimes I didn't have to follow any and others up to 4. But in reality, you are not responsible for any patient. Nothing you do will affect their care. You are redundant.

There have been times where the resident either out of laziness or being really busy missed something pretty important and what I told them (which they later confirmed) did change management

 

[deleted263296]

There have been times where the resident either out of laziness or being really busy missed something pretty important and what I told them (which they later confirmed) did change management

Wish I could have that feeling just once. lol

 

[Bacchus]

I wouldn't say I'm really in charge of anyone on surgery. I follow my patients until they are signed off our service for the most part, but there's always a resident closely behind me on rounds to make sure I'm documenting and finding appropriate things.

I've only had one patient where I've requested the resident to do something and that was just to increase a vicodin dose.

 

[KnuxNole]

I don't get why residents make it a big deal to carry lots of patients. Is it just a learning thing? The only thing you do when following patients is interview them, present them in rounds, and that's it. I dunno, I guess I get confused when residents say students should "carry" patients, like we are residents ourselves. We can "follow" patients and read about conditions/interview them, but that's all we can do.

 

[2012mdc]

I don't get why residents make it a big deal to carry lots of patients. Is it just a learning thing? The only thing you do when following patients is interview them, present them in rounds, and that's it. I dunno, I guess I get confused when residents say students should "carry" patients, like we are residents ourselves. We can "follow" patients and read about conditions/interview them, but that's all we can do.

What I've heard from attendings is that they want us to practice getting more efficient.

If you carry less patients you can be slow and still get there at a decent time. By carrying more patients you become more efficient as a means of survival because by the end of third year you do not want to be getting to hospital as early as you did at the beginning

 

[OveractiveBrain]

3rd year core:
Medicine: 3-4
Peds: 2-6
Surgery: 2-6
Ob/Gyn: 1-3
Neuro: 2-4
Psych: 3

Medicine: 3-4
Peds: 0-1
Surgery: 23 (not 2-3, piece of **** *******s)
OB/GYN: 0-2
Neuro: 17 (it was me an attending)
Psych: 1
Family: 20 a day (it was only clinic)
Sub-I: 5

 

[dienekes88]

Medicine: 4
Surgery: 4-6
Peds: 2
Psych: 3

 

[Orbo]

I'm a pediatric resident and our program expects 3rd year students to carry 4 patients during their time on inpatient services. That means they're seeing those patients each morning, writing notes and presenting them on rounds. As a resident, I encourage students to really work on coming up with their own management plans, but interns are obviously following along behind the students and helping them along.

Our sub-I's are treated as interns - the upper level resident will follow along on their patients but they (the subI's) carry the same number of patients as the interns and if the sub-I proves themselves, the upper level is there to merely sign off on their notes/orders to make everything legal.

There is data out there that the more patients students carry on their inpatient rotations, the better they do on shelf exams.

Correlation != Causality

 

[ArcGurren]

Medicine: 3-4
Peds: 0-1
Surgery: 23 (not 2-3, piece of **** *******s)
OB/GYN: 0-2
Neuro: 17 (it was me an attending)
Psych: 1
Family: 20 a day (it was only clinic)
Sub-I: 5

what... the... hell? wow I'mma stay the heck away from wherever hospital that is 😵

 

[speedyk]

I got 3 on my 1st day. Needless to say it took me forever to do pre-rounds and I was comically bad at rounds.