How much of your rotation is pure scut?

[Dr McSteamy]

If you've done internal medicine, how much (as %age) of your work is/was just scut?
I'm halfway through IM, and most of what I've done is pure crap. I'm the doc's little errand boy.
I only learn from my own review books and the internet. I do ask questions, but most of the time, I get half-assed answers from the attending.


If you've done other rotations, which rotation? and how much scut?

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[jdh71]

If you've done internal medicine, how much (as %age) of your work is/was just scut?
I'm halfway through IM, and most of what I've done is pure crap. I'm the doc's little errand boy.
I only learn from my own review books and the internet. I do ask questions, but most of the time, I get half-assed answers from the attending.


If you've done other rotations, which rotation? and how much scut?

Define "scut" - if you mean running to radiology to check on a CT, or calling the cards resident to make sure the consult is done today, or filling out medicine reconcilliation forms, etc. That's NOT scut. That's being a doctor and good experience.

So . . . are you doing "scut"?

 

[angel80]

Yeah, everyone defines "scut" differently. I don't consider things like filling out paperwork, calling consultants, calling pt's family members, speaking to radiologists about pt's films, etc, as scut. That's all part of a doctor's job. Even though it's not "medicine" you still need to learn how to do it. That's pretty much 90% of the job of an intern. When I started internship, there were interns who had never done a single dictation, never filled out discharge forms, and didn't know how to write basic orders, because that was "scut" and they didn't do it as a student. To me, scut is getting your residents/attendings coffee, going to the library to pull articles for your resident's presentation tomorrow because he/she is too lazy, running around doing favors for your residents that don't pertain to patient's care, etc. If that's the case, I would definately say something on my eval. Even though it won't help you out too much, it may benefit the next person who comes along after you. It sucks, but some rotations will be like that and you will just have to take initiative and read on your own as much as possible.

 

[Dr McSteamy]

i define scut as doing stuff that requires no skill. e.g. copying stuff into the charts, fetching charts. A monkey can do this mindless crap.

that fits the definition of scut- menial trivial unskilled activity.

a student should learn the how/when/why of treatment that goes into the paperwork.

looking up & copying vitals and lab tests so that the lazy attending doesn't have to.... is scut work. I learn nothing from it.


everyone should know how to write a progress note and orders, but coming up with an appropriate plan and assessment requires some guidance from the attending, and should be practiced.

 

[superoxide]

I'm half way through my surgery rotation, which is 90% scut work. The students are responsible for following up on any labs/Xrays/CTs/consults that were done. The students also get info on ins(IVs, TPN/PPN etc) and outs(foley output,JP drains etc) and report it to the resident on call. We have to make sure that all labs are drawn before 6AM rounds with the attending (which involves chasing after some nurses all night which usually involves getting yelled at because for most of them the students are just a pain in the a$$)

While in the OR, you are basically invisible. The attending barely even acknowledges your presence. There is only one attending that actually teaches/pimps in the OR. So far my only job in the OR is to suction and retract. Actually on my last OR day, I did my first staple, after I asked the attending if I could try😀

We also have an assigned wound care day, where we are either on our own or we assist the PA with wound dressings/VAC placements or changes.

I have absolutely no interest in surgery, so I'm not complaining. I'm just waiting for this rotation to be done with, but it would be nice if I actually learn SOMETHING considering I'm paying a lot of money for this "learning experience"🙄

 

[domer621]

looking up & copying vitals and lab tests so that the lazy attending doesn't have to.... is scut work. I learn nothing from it.

everyone should know how to write a progress note and orders, but coming up with an appropriate plan and assessment requires some guidance from the attending, and should be practiced.

I do all of the above, and don't feel like any of it is "scut". Sure, coming up with a plan is the most important and contains the most amount of thinking and learning, but the other stuff has to get done, too. Usually I'll write down all the newest vitals/labs/overnight events and tell them to the residents/attending, then the attending will ask me for my plan, then give his/her opinions on the plan.


I define scut as doing completely unimportant things like fetching the residents coffee, etc (none of which I've had to do, yet).

 

[DrMom]

looking up & copying vitals and lab tests so that the lazy attending doesn't have to.... is scut work. I learn nothing from it.

If you pay attention to the labs & vitals you should be getting something from it. You need this information to help you determine the plan for your patients. In other words, this is integral to functioning as a physician.

The students are responsible for following up on any labs/Xrays/CTs/consults that were done. The students also get info on ins(IVs, TPN/PPN etc) and outs(foley output,JP drains etc) and report it to the resident on call. We have to make sure that all labs are drawn before 6AM rounds with the attending (which involves chasing after some nurses all night which usually involves getting yelled at because for most of them the students are just a pain in the a$$)

While in the OR, you are basically invisible. The attending barely even acknowledges your presence. There is only one attending that actually teaches/pimps in the OR. So far my only job in the OR is to suction and retract. Actually on my last OR day, I did my first staple, after I asked the attending if I could try😀

We also have an assigned wound care day, where we are either on our own or we assist the PA with wound dressings/VAC placements or changes.

I know that being in the OR as an MS3 (doing virtually nothing) sucks, but the rest of what you listed is important to patient care and definitely part of the routine of being a physician.


I think that there are a few things that lead MS3s to assume they're being scutted out. If you're just doing work and not being actively taught in some manner by the attendings and residents, then the work is definitely going to feel useless. You are paying for the education and should be getting some, whether it be pimping, discussions about patient & their care, or more formal lectures and reading assignments. Also, I think some students are a bit disillusioned by the routine of day to day work in medicine. Some of it definitely isn't intellectually stimulating.

 

[arthrodisiac]

I think to overcome this feeling of scut in 3rd and 4th years, tuition should be decreased to reflect the work that is being done as opposed to simply learning. During these years, i think it is fair for schools to charge us for lectures, etc...but as far as doing this file fetching, calling for consults, etc....this should be viewed as work equal to intern work. I felt many times that I was doing more labor than the resident was. i came in earlier, left later, saw their patients for them on top of my own, dictated their h&p's even though students at our school are not allowed to...and i would be happy to do this scut if my tuition was halved. but that will never happen, because of all of you future beaurocrats out there that will be responding to this post....you know who you are 😉

 

[PeepshowJohnny]

I think the problem with "scut" is that the better you are at it, the more you'll get, not less.

(Just FYI, I don't consider many of the things I'm describing below as pure scut. Sure it's not the most exciting stuff, but its stuff you have to do as a doctor and you might as well know how to do it well).

The other day my senior gave me a to do list: Write up a discharge summary for this patient, see what cardiology's plan with that patient is, find out why patient 3 didn't get their MRI done and what we need to do, etc.

Anyway, by the time of check out I'd knocked off my list. It actually ended up being pretty easy, I knew the patient being discharged and he was a simple case. I saw the cardiologist in the hallway and had a nice talk with him (he's a friendly guy who's always trying to recuit students for his field). When I called Radiology, the scheduler knew the exact situation with the patient...

So, I come to check out and I've got everything on my list done. He compliments me on being a hard worker, etc. However, ever since then he's used me as his own little problem solver guy. I'm sure it'll look good on my evalutaiton, but still annoying.

 

[SoCuteMD]

We were told in our orientation that participating in patient care is not "scut." Retrieving a chart, following up on labs, writing down I&Os - not scut.

Fetching our resident's dinner, drycleaning, or child from daycare = scut

 

[Dr JPH]

Scutwork is defined as tasks that are nonmedical in nature which hold no educational value.

Copying labs, retrieving studies, calling consultants, discharge order sets. All NOT scutwork.

The educational value may not be apparent now,ie: "Im not learning anything from looking up labs" or "discharge instructions are just busy work."

BUT when youre an intern you will be glad you did all that "menial" work as it makes you much more efficient when the responsibility is on YOU.

I think medical students have a different idea of what scutwork is.

In fact, by most medical students definition of scutwork 80% of what I do an an intern is "scut".

 

[jdh71]

i define scut as doing stuff that requires no skill. e.g. copying stuff into the charts, fetching charts. A monkey can do this mindless crap.

that fits the definition of scut- menial trivial unskilled activity.

a student should learn the how/when/why of treatment that goes into the paperwork.

looking up & copying vitals and lab tests so that the lazy attending doesn't have to.... is scut work. I learn nothing from it.


everyone should know how to write a progress note and orders, but coming up with an appropriate plan and assessment requires some guidance from the attending, and should be practiced.

Sorry NOT scut

 

[jdh71]

I'm half way through my surgery rotation, which is 90% scut work. The students are responsible for following up on any labs/Xrays/CTs/consults that were done. The students also get info on ins(IVs, TPN/PPN etc) and outs(foley output,JP drains etc) and report it to the resident on call. We have to make sure that all labs are drawn before 6AM rounds with the attending (which involves chasing after some nurses all night which usually involves getting yelled at because for most of them the students are just a pain in the a$$)

While in the OR, you are basically invisible. The attending barely even acknowledges your presence. There is only one attending that actually teaches/pimps in the OR. So far my only job in the OR is to suction and retract. Actually on my last OR day, I did my first staple, after I asked the attending if I could try😀

We also have an assigned wound care day, where we are either on our own or we assist the PA with wound dressings/VAC placements or changes.

I have absolutely no interest in surgery, so I'm not complaining. I'm just waiting for this rotation to be done with, but it would be nice if I actually learn SOMETHING considering I'm paying a lot of money for this "learning experience"🙄

NOT scut

 

[jdh71]

Scutwork is defined as tasks that are nonmedical in nature which hold no educational value.

Copying labs, retrieving studies, calling consultants, discharge order sets. All NOT scutwork.

The educational value may not be apparent now,ie: "Im not learning anything from looking up labs" or "discharge instructions are just busy work."

BUT when youre an intern you will be glad you did all that "menial" work as it makes you much more efficient when the responsibility is on YOU.

I think medical students have a different idea of what scutwork is.

In fact, by most medical students definition of scutwork 80% of what I do an an intern is "scut".

Beat me to it.

 

[MadameLULU]

I'm half way through my surgery rotation, which is 90% scut work. The students are responsible for following up on any labs/Xrays/CTs/consults that were done.
I'm just waiting for this rotation to be done with, but it would be nice if I actually learn SOMETHING considering I'm paying a lot of money for this "learning experience"🙄

That's not scut.

 

[SLUser11]

That's not scut.

You guys have already touched on it, and I've said it before, but I have to, once again, quote a SLU neurology attending (Fenton):

"It's not scut until it's old hat."

If you've never done it, I don't care how menial you think it is. You're not above it. Every little task, from gathering vitals to placing foleys, etc, should be part of a physicians repertoire.

I've also noticed that the more prestigious the med school, the more likely a med student will turn their nose to "scut work," as if it is the resident's priviledge to teach them......

 

[Dr McSteamy]

alright then!
if you say so..... it's not scut.

 

[DebDynamite]

alright then!
if you say so..... it's not scut.

Well...it's not scut IF someone on your team teaches you about the situation with the patient....OR you are not graded down for expecting to lean something, even if it's a simple "why we are checking on this lab". It's certainly not scut if it's a patient you have been following and are learning from. If you're running around the hospital mindlessly checking labs & pulling charts, it's scut.

 

[Dr JPH]

alright then!
if you say so..... it's not scut.

It is not so because we say it is so.

It is so because it is the truth.

 

[superoxide]

Well...it's not scut IF someone on your team teaches you about the situation with the patient....OR you are not graded down for expecting to lean something, even if it's a simple "why we are checking on this lab". It's certainly not scut if it's a patient you have been following and are learning from. If you're running around the hospital mindlessly checking labs & pulling charts, it's scut.

That's just it. We are not told why a certain lab was ordered, or why a certain procedure is being done. We are just told to look it up/follow it. Some of the residents do try to explain stuff to the students when asked, but they are worked to the bone, and barely have time to bother with anything else.

I guess medical students DO have a different impression as to what scut is, as one of the above posters mentioned. I was under the impression that while on surgery I'd be spending most of my time doing...well... surgery, not looking up vital signs and lab results.

 

[Dr McSteamy]

Well...it's not scut IF someone on your team teaches you about the situation with the patient....OR you are not graded down for expecting to lean something, even if it's a simple "why we are checking on this lab". It's certainly not scut if it's a patient you have been following and are learning from. If you're running around the hospital mindlessly checking labs & pulling charts, it's scut.

ok. i take back my last post.

it is scut!!

Cuz i'm doing mindless monkey work.

Sure, I guess i can make it unscut by asking the attending EVERY SINGLE time "why this why that"....

But right now, it's completely mindless. Sometimes I see something in the labs:
"Oo0o0. hyperkalemia! Let's give him kayexalate...." "....yay...i'm so qualified to be a doctor.."🙄

But that's just a tree in the forest. I don't know crap about treating this patient, and the attending doesn't care to explain either.
There are many pearls that just can't be picked up in books alone.

Isn't that what we're supposed to learn in IM? how to treat the patient?...... The patients come in with a mess of comorbidities. they're not simple cases.

Seriously, what are you supposed to learn by fetching charts for 12 weeks. The only benefit is that you become proficient at using the hospital computers.
But your patient will still die or suffer.

I guess medical students DO have a different impression as to what scut is, as one of the above posters mentioned. I was under the impression that while on surgery I'd be spending most of my time doing...well... surgery, not looking up vital signs and lab results.

yeah!! At least they should talk about why they're doing a certain procedure, precautions, how to do a procedure......

If you're standing on the side, holding the tools, and counting the holes in the ceiling, that's scut!! and a fricking waste of time.
If i want to just stand around, I'd rather sit at home and watch a procedure on tv on my couch.


However, I'm like you though. I don't wanna go into surgery. But at least teach me how to suture properly and minimize scarring.

 

[DebDynamite]

ok. i take back my last post.

it is scut!!



Seriously, what are you supposed to learn by fetching charts for 12 weeks. The only benefit is that you become proficient at using the hospital computers.

This is why third year is one of the least efficient experiences I have ever had.

How many times did I have to check a T Bili, H & H, I & O before I could say, "next rotation, please..." Too many, of that I'm sure.

How could it be MORE efficient? Shorten the amount of time spent in each rotation, slightly increase the amount of time allowed to study for the shelves, and put the time spent lazing around in fourth year towards more "focused & real-world style" electives. I seriously didn't need that second month of chart fetching, skipping meals, listening to some intern moan (they were getting paid and I was PAYING for it!), and "dropping in " on rads to bump the night- float's CT to the top of the list. I assure you I can do all that crap just fine as an intern, WHEN I GET PAID for it.

As a third year, you should have a reasonable patient load and follow your patients. This means chasing down their labs, etc. You also should expect to help out your intern and team while rounding, do "some" extra work to help out and learn to process paperwork, and be sent home. Then when you get home you are expected to study, in order to pass the shelf. But the "some extra work" is what is so often and sadly abused. Which is why I think 2-3 months in a rotation you have no interest in whatsoever is wrong.

 

[Dr JPH]

But right now, it's completely mindless. Sometimes I see something in the labs:
"Oo0o0. hyperkalemia! Let's give him kayexalate...." "....yay...i'm so qualified to be a doctor.."🙄

If you give kayexelate for hyperkalemia you are NOT ready to be a doctor.

 

[arthrodisiac]

If you give kayexelate for hyperkalemia you are NOT ready to be a doctor.

i really hate your posts.

 

[superoxide]

I think to overcome this feeling of scut in 3rd and 4th years, tuition should be decreased to reflect the work that is being done as opposed to simply learning. During these years, i think it is fair for schools to charge us for lectures, etc...but as far as doing this file fetching, calling for consults, etc....this should be viewed as work equal to intern work.

I totally agree. That's the way they do it in most European countries. All education there, secondary and post secondary, is free (well, paid through taxes). When they reach the clinical part of their medical education, they are paid!👍

 

[Dr JPH]

i really hate your posts.

Join the club. 😉

 

[Dr McSteamy]

If you give kayexelate for hyperkalemia you are NOT ready to be a doctor.

you think?
I just copied kayexalate off one of the patient's charts.
so you see what i'm saying about scut work.....

 

[elwademd]

perhaps a better question is, how do you see your team functioning as a med student?
are you following your own patient with the resident supervising? do you follow a patient in conjunction with an intern, and then a resident supervising?
or does everyone on the team follow every patient, and everybody's responsible for everything?

when you're looking at the labs, do you know what medications the patient is on? do you know the patient's diseases/illnesses/comorbidities? or, are you just looking at labs for the sake of looking at labs?

checking/fetching random person a's potassium of 5.6 probalby doesn't mean a whole lot.
getting miss jones' potassium of 5.6, with a history of hypertension on lasix, an ace inhibitor, and receivng potassium in her iv fluids might be a little more meaningful.

so, as a med student, perhaps you should ask yourself if you're looking at the whole picture... i.e. are you missing the trees for the forest?

if you're a med student on my team, you function as an intern- i.e. you'll be writing the h&p, you'll be following the patient on a daily basis, you'll be writing a daily progress note, you'll write the discharge plan. of course we'll go over things together, but the patient will be yours. so, if you consider following the potassium on a patient who has potassium in his/her iv to be scut, then i'll have a problem with that. if you consider checking the chest ekg on someone with chest pain to be scut, then i'll have a problem with that. if anyone on the team asks you to go pick up food from the local fast food joint, then i'll have a problem with that, because that is, in my opinion, scut.
but, the med students i have are often on their 4th year sub-i, so i expect more out of them.
as a 3rd year med student, especially at this time of year, people likely don't expect much, and in some ways may think that you're overwhelmed.

but right now, it's completely mindless. Sometimes I see something in the labs:
"Oo0o0. hyperkalemia! Let's give him kayexalate...." "....yay...i'm so qualified to be a doctor.."

If you give kayexelate for hyperkalemia you are NOT ready to be a doctor.

i really hate your posts.

jp hazelton seems ok, and this is, after all, just a message board. i suppose he could have decided to get into a long winded post about hyperkalemia, the potential causes, and the potential treatment. but, short of that, i agree with him that giving kayexalate off the bat for hyperkalemia does not make you ready to be a doctor.

what would be more appropriate would be to ask what the clinical setting/scenario is?
what's the ekg?
is there a potential for lab error?
is the patient npo?
does the patient have cardiac abnormalities?
does the patient have normal renal function?
what med(s) is/are the patient on?

but that would be long winded, and deviate this thread off topic...

 

[fakin' the funk]

i really hate your posts.

I like JP's posts.

 

[Dr McSteamy]

if you're a med student on my team, you function as an intern- i.e.

your plan seems like a good one.
if that plan is for a sub-i, what's a plan for a ms3? what would be cut out if any, for a 1st rotation at the beginning of 3rd year?


ok. so just off topic for a minute-
i opened my book and tried to use my brain. The first drug to use for hyperK+ is a loop diuretic, right?

 

[Dr JPH]

so you see what i'm saying about scut work.....

No I dont.

I think that any task that needs to be done on an intern level should be done at the medical student level without complaint.

Theres no whining in medicine...at least there isnt in surgery. If you like to cry about scutwork I hope you have your heart set on a medical subspecialty.

 

[SoCuteMD]

Theres no whining in medicine...

THERE'S NO CRYING IN BASEBALL!

Ugh...I really need to get this paper done so I can get out!

 

[Dr JPH]

ok. so just off topic for a minute-
i opened my book and tried to use my brain. The first drug to use for hyperK+ is a loop diuretic, right?

HYPERkalemia:

"See Big K"

OR

C-B-I-G-K

Calcium (gluconate or chloride depending on who you read): to stabilize the cardiac membrane
Bicarbonate: for acidosis...not everyone does this, not always necessary
Beta Agonist: uber doses of albuterol...respiratory therapy will often ask you to be present while they administer
Insulin: moves K intracellularly
Glucose: so your insulin doesnt make the person hypoglycemic
Kayexalate: last line...loved by ER docs, despised by most others; can cause nasty irreversible damage to the gut; takes time to work

Watch for EKG changes and then decide on treatment. Remember ESRD patients can have wacky K values and be OK. Its not all about peaked T waves.

OK, thats it. Thats all I know about hyperkalemia...I am a surgeon afterall. 😀

 

[Dr McSteamy]

No I dont.

I think that any task that needs to be done on an intern level should be done at the medical student level without complaint.

Theres no whining in medicine...at least there isnt in surgery. If you like to cry about scutwork I hope you have your heart set on a medical subspecialty.

i'm not crying about scut work. I just think I could learn something more from the attendings. but i'm not. Like i said already, there's a lot you can learn that is not covered in a book.

HYPERkalemia:

"See Big K"

OR

C-B-I-G-K

ah, yes. i saw that in the book. cbigk is for emergency situations.
for nonemergency , it says furosemide.
i've learned something today, finally.

 

[Tired]

I'm confused. What exactly do you think you should have to do on inpatient rotations? You don't want to get films, followup on labs, talk to consultants, pull articles . . . which is what your intern and residents spend all day doing. Would you prefer to have nothing but didactics? Should your team be responsible for explaining the rationale of all diagnostics and treatments performed? Should coming in be strictly optional?

What exactly would be the ideal MS3 rotation?

 

[Dr JPH]

i'm not crying about scut work. I just think I could learn something more from the attendings. but i'm not. Like i said already, there's a lot you can learn that is not covered in a book.

I agree with you.

Should "scut work" (can be more accurately termed "necessary menial tasks") take the place of teaching? NO.

If you are not being taught...lectures, journal club, teaching rounds, conferences, case presentations, morning reports...then I would agree...filling your day with busy work can be frustrating.

HOWEVER, if you are in a good learning environment then you should look at the "scut work" (your word) as necessary things that need to get done so that there is MORE TIME for teaching.

Hows that? That should make everyone happy and bring us all closer together , right?

 

[Dr JPH]

What exactly would be the ideal MS3 rotation?

Im getting the feeling that McSteamy isnt necessarily a complainer per say...but he is frustrated with the lack of teaching.

Now, if there is strong teaching and he is STILL complaining about the "scut", then I say we string him up by his short coat!

 

[elwademd]

HYPERkalemia:

"See Big K"

OR

C-B-I-G-K

Calcium (gluconate or chloride depending on who you read): to stabilize the cardiac membrane
Bicarbonate: for acidosis...not everyone does this, not always necessary
Beta Agonist: uber doses of albuterol...respiratory therapy will often ask you to be present while they administer
Insulin: moves K intracellularly
Glucose: so your insulin doesnt make the person hypoglycemic
Kayexalate: last line...loved by ER docs, despised by most others; can cause nasty irreversible damage to the gut; takes time to work

Watch for EKG changes and then decide on treatment. Remember ESRD patients can have wacky K values and be OK. Its not all about peaked T waves.

OK, thats it. Thats all I know about hyperkalemia...I am a surgeon afterall. 😀

damn impressive for a surgeon!

in all seriousness though, for the med students reading, this is the approach on your tests, steps 2 and 3 of the usmle, and in practice. sometimes this needs to be done rather quickly (symptomatic bradycardia) and others it can be done slowly.

your plan seems like a good one.
if that plan is for a sub-i, what's a plan for a ms3? what would be cut out if any, for a 1st rotation at the beginning of 3rd year?

i'm at a smaller hospital, and 3rd years rotate on ob/gyn and peds, but not medicine. so, i think any 3rd year i get would be at the end of his/her 3rd year, and thus would be, or at least expected to be, at a different level than the beginning of 3rd year.

but to try and answer the question, it would be hard. everything would be so new. but the most important thing, speaking as a medicine resident, would be the history and physical. many say 85% of the diagnoses (plural) can be obtained from it. i'd still want the patient to be "yours", but i would imagine that there would be a lot more guidance (i.e. handholding- figuratively speaking of course).

i try to remember what it was like to be a med student, and chasing random labs and x rays wasn't too fun, and thus i don't make anyone do it. but then again where i'm training, xrays and labs are available on the computer, so there's no need to truly "chase" anything.

 

[Dr JPH]

damn impressive for a surgeon!

I know what A-Fib is too! 😀

 

[Tired]

Calcium (gluconate or chloride depending on who you read): to stabilize the cardiac membrane

Be careful not to make the rookie mistake of administering calcium, then rechecking the potassium and getting scared that it hasn't come down. 😀

 

[Dr McSteamy]

Im getting the feeling that McSteamy isnt necessarily a complainer per say...but he is frustrated with the lack of teaching.

Now, if there is strong teaching and he is STILL complaining about the "scut", then I say we string him up by his short coat!

I'm confused. What exactly do you think you should have to do on inpatient rotations? You don't want to get films, followup on labs, talk to consultants, pull articles . .

What exactly would be the ideal MS3 rotation?

yes.... there's no discussion. i'm missing this part

Tired, we're supposed to practice the algorithm of diagnosis and treatment, are we not? for a complete n00b straight out of basic sciences, this would involve lots of discussion with attending or resident.
So far, my training stops after the monkey work is done. very very very rarely do we even discuss the treatment of patients.

going back to my first post, i just wanted to compare to what others are doing in their clerkships.

 

[Dr JPH]

yes.... there's no discussion. i'm missing this part

Tired, we're supposed to practice the algorithm of diagnosis and treatment, are we not? for a complete n00b straight out of basic sciences, this would involve lots of discussion with attending or resident.
So far, my training stops after the monkey work is done. very very very rarely do we even discuss the treatment of patients.

going back to my first post, i just wanted to compare to what others are doing in their clerkships.

I think you will find a lot of 3rd years doing the same types of tasks that you are.

Unfortunately you arent getting the teaching aspect along with that.

 

[AF_PedsBoy]

80%?? I would say 95% of my time as an intern is spent on monkey work-albeit necessary monkey work:

- Pre-rounding on patients getting labs, rads, current meds, overnight events, consult results
- Writing orders from rounds on the charts of all my patients
- Consulting inpatient services, calling outpatient clinics for records, history if it's a demented nursing home patient, talking to discharge planning for supplies, placement, etc.
- Calling patients back to follow up telephone consults for refills and lab results
- Checking on labs because half of them weren't back by the morning
- Calling various clinics to make patient appointments for discharge follow up because I have so much more time than they do to sit on the phone and wait to make an appointment...
- And finally, FINALLY writing daily notes and then updating sign out so I can get the hell out of the hospital

Sadly none of it glorious, and as med students they're only exposed to tier number one! And while I try to teach my medical students some on rotation, most of the time I'm trying to get all this done before the early afternoon (because have you ever tried to call a consult or a clinic at 3:30 PM...). I've had really incredible med students (like this past rotation) who were pretty much acting sub-interns (as MS-3s), and a few horrible ones who would sit around bombarding you with questions and then shrug helplessly if you asked them to get a lab result.

P.S. As an addendum, keep in mind there's no magic change from med student to intern- most of our learning is picked up some in 15% in lecture, 30% in rounds in pimping and pearls, and 55% reading to try and figure out a plan for your patient (with the corollary once you've seen in a few times you think, "What did I do with that patient...?"). As far as the admin, you'll find that you need to carry more patients as an intern than a med student (I know, I know, duh) which means you need to start figuring how to be more efficient - I say start because I'm still trying to figure that out!