How to do well without being really mean

[Cantal]

I'm interested in going into a competitive specialty like derm. I see all this posts here saying how people have to be jerks (ie obvious brownosing, make others look bad).

Do any of you guys who are getting tons of Honors this yr or last have tips for us? Most importantly, if you could give rank-ordered list of what will earn you a good grade without being really mean, that'd be perfect (ie #1 way is to give good presentations, #2 is to develop a good report with your attending, etc).

Or, in fact, do you have to do some of the stuff I listed above like brownosing and telling your Peds resident that you want to go into Peds when you really don't?

This seems like a great post (if it is active enough) to keep for future years!

Cantal

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[Shodddy18]

Sexual favors cant hurt in securing your spot on the top...

J/K, I couldnt resist...

 

[DrMom]

I'm interested in going into a competitive specialty like derm. I see all this posts here saying how people have to be jerks (ie obvious brownosing, make others look bad).

Do any of you guys who are getting tons of Honors this yr or last have tips for us? Most importantly, if you could give rank-ordered list of what will earn you a good grade without being really mean, that'd be perfect (ie #1 way is to give good presentations, #2 is to develop a good report with your attending, etc).

Or, in fact, do you have to do some of the stuff I listed above like brownosing and telling your Peds resident that you want to go into Peds when you really don't?

This seems like a great post (if it is active enough) to keep for future years!

Cantal

I have honored every one of my rotations. I go in & work hard, do my readings, am friendly, and I've been honest about wanting to go into EM. If you do your work & get along, it really increases your chances of honors.

 

[Samoa]

We haven't gotten any grades back so far, so maybe I'm not the best person to reply here. But the things that seem to make a uniformly favorable impression are the following:

1) Knowing your patients well enough to answer random questions about their medical history and the history of their hospitalization, studies done, etc. (esp. if they were admitted before you were on service).

2) Helping out other students on your team. Even if it's behind the scenes, which it should be if you don't want to alienate your teammates, an astute attending will pick up on it (and most of them are pretty astute, although they may act oblivious).

3) Taking responsibility for following complicated and/or high-maintenance patients.

4) Reading, and getting mileage out of it. It's the proverbial tree falling the forest. If you read about a topic, or about a particular problem your patient has, then bring up the topic and preface it with, "I was reading last night about X, and I read that we should do Y and Z. We're doing Y but not Z, and I was wondering if Z would be an appropriate thing to do with this patient." (or alternatively, "I understand the rationale for Z, but this whole Y thing doesn't make sense to me.") This is particularly effective when you're with people who aren't taking time to teach you anything.

Aside from that, be aware of the specific things your resident or intern wants you to do (or not do), and modify your activities accordingly. If there's a conflict between what two of them want, whoever's higher in the heirarchy gets it their way. Just apologize to the lower person on the totem pole and explain that their resident/fellow/attending told you to do it the other way.

That about sums it up.

 

[Cantal]

Thanks for the responses!

Here are two specific questions regarding the responses:
Do you think that doing all those things you listed (specifically helping other people with their work) will require staying later than you are asked to? Should you offer to stay later every day? How much later? (this is specifically aimed at rotations that don't really require tons of hours)

Also, you both mentioned reading. Does this mean reading your textbook or do you go a step further and read journals? Is it worthwhile to read JAMA and the main journal for each specialty while you are on a particular specialty?

 

[DrMom]

Thanks for the responses!

Here are two specific questions regarding the responses:
Do you think that doing all those things you listed (specifically helping other people with their work) will require staying later than you are asked to? Should you offer to stay later every day? How much later? (this is specifically aimed at rotations that don't really require tons of hours)

I have a family & I have never *volunteered* to stay late, but I stay until my work is done. I leave when the attending or resident tells me I can go.

Also, you both mentioned reading. Does this mean reading your textbook or do you go a step further and read journals? Is it worthwhile to read JAMA and the main journal for each specialty while you are on a particular specialty?

I do required readings & also read up on anything I feel that I need to work on. If I have a patient with a specific condition that I don't feel well-versed on, I read on that. If I was being pimped on something that I couldn't answer, I read on that.

 

[Samoa]

I have a family & I have never *volunteered* to stay late, but I stay until my work is done. I leave when the attending or resident tells me I can go.



I do required readings & also read up on anything I feel that I need to work on. If I have a patient with a specific condition that I don't feel well-versed on, I read on that. If I was being pimped on something that I couldn't answer, I read on that.

Ditto above. And I meant help when you'd otherwise be standing around doing nothing. Don't stay if you're told you can go. If one person always has to stay late, take turns. The key is to share the work. Don't hog it to try and look good, and don't slack off so that someone else has to do yours as well as theirs.

 

[PickyBicky]

Thanks for the responses!

Here are two specific questions regarding the responses:
Do you think that doing all those things you listed (specifically helping other people with their work) will require staying later than you are asked to? Should you offer to stay later every day? How much later? (this is specifically aimed at rotations that don't really require tons of hours)

Also, you both mentioned reading. Does this mean reading your textbook or do you go a step further and read journals? Is it worthwhile to read JAMA and the main journal for each specialty while you are on a particular specialty?

Just as background, I'm an MS4 applying for medicine. I go to a school that has several different hospitals that we rotate through, each with a suprisingly different patient demographic, patient volume, and degree of support from anciallary services (like pt transport, social work, etc, etc). I "honored" everything.

#1. Be a team player. Take the initiative to get things done, be it getting a wet read on an imaging study, physically transporting a patient to get studies done, interfacing with social work early and often (esp. when you anticipate placement following the patient's hospital course will be difficult), drawing blood if a follow up lab value is keeping a patient in house (eg. repeat BUN/Cr) or if that lab value may alter the day's management plans for the patient, the list goes on. Never ask to go home (although, you can ask if there is anything else to be done or that you can help with if things are winding down and you're just standing around late in the day).

I really think too few starting MS3s realize how important these kind of things are to the team and how much they can be appreciated...I would say how well you work with the team can be more impressive than knowing answers to most pimp questions.

#2. Know your patients really well and be an advocate for their needs, particularly social needs. In part, this can be lumped into point #1. In particular, finding out about your patient's living situation, work situation, overall family situation can be very helpful, especially in relation to dispo issues. Again, we spent a great deal of time in a large county hospital with very limited resources and a significant indigent care population, so helping with these issues went a very long way.

#3. Offer to teach your team. This is essentially by doing quick presentations. I found these were most productive when they were topics directly related to a patient on service. Good, high quality reviews (from NEJM, for example; not just some shotty throw together paper from a no-name MD at a community hospital) can be helpful, but if you can bring in a relevant, core paper in the field, it will actually benefit you, other students on the team, the interns, maybe even the residents. How to know what is a core paper for a field? I found looking at some of the references in UptoDate reviews, particularly those that were in bigger journals, to be a good clue. Keep your presentations very short, and bring in a copy of the paper for everyone. Often, I would summarize the paper's key points in <1 page and staple it to the front.

#4. Teach yourself. Be aggressive about reading as much as you can about your patients. This is often repeated, and with good reason. You'll be amazed about how much more you'll retain several months and years down the road by making this kind of investment. Read daily, even if you're post call (which will be difficult). If you make this a habit, you'll be way better off when it comes time for pimping sessions, the shelfs, and the rest of your life.

#5. Never ever put down your collegues, the field you're rotating though, an intern, a patient, a nurse, anybody. This can be tough sometimes.

#6. Be honest. Be honest with things that you did not complete, information you do not know, pimp questions you really have no clue about. This is just my two cents, but I would not try to mislead teams that you are interested in a field just to impress them. It will almost certainly backfire. I was always honest and never got burned for it. Now for some of the people in my class who are applying for derm who lied.....those are some sorry souls I hope never to interact with again! GOD THAT IRRITATES ME!

#7. Be enthusiastic. I, for example, really did not care for Ob/Gyn. But that time was the sole period in my life to learn as much about the field as possible. Suck it up and try to find something cool in everything you do. 6-->8 weeks is not too long. Try to be positive under adverse conditions. Everyone on the team with you will appreciate it.

That's about all I can think of. I guess my last piece of advice is be open to specialties. Give everything a fair shake.....you never no.

-PB

 

[DOCTORSAIB]

Just as background, I'm an MS4 applying for medicine. I go to a school that has several different hospitals that we rotate through, each with a suprisingly different patient demographic, patient volume, and degree of support from anciallary services (like pt transport, social work, etc, etc). I "honored" everything.

#1. Be a team player. Take the initiative to get things done, be it getting a wet read on an imaging study, physically transporting a patient to get studies done, interfacing with social work early and often (esp. when you anticipate placement following the patient's hospital course will be difficult), drawing blood if a follow up lab value is keeping a patient in house (eg. repeat BUN/Cr) or if that lab value may alter the day's management plans for the patient, the list goes on. Never ask to go home (although, you can ask if there is anything else to be done or that you can help with if things are winding down and you're just standing around late in the day).

I really think too few starting MS3s realize how important these kind of things are to the team and how much they can be appreciated...I would say how well you work with the team can be more impressive than knowing answers to most pimp questions.

#2. Know your patients really well and be an advocate for their needs, particularly social needs. In part, this can be lumped into point #1. In particular, finding out about your patient's living situation, work situation, overall family situation can be very helpful, especially in relation to dispo issues. Again, we spent a great deal of time in a large county hospital with very limited resources and a significant indigent care population, so helping with these issues went a very long way.

#3. Offer to teach your team. This is essentially by doing quick presentations. I found these were most productive when they were topics directly related to a patient on service. Good, high quality reviews (from NEJM, for example; not just some shotty throw together paper from a no-name MD at a community hospital) can be helpful, but if you can bring in a relevant, core paper in the field, it will actually benefit you, other students on the team, the interns, maybe even the residents. How to know what is a core paper for a field? I found looking at some of the references in UptoDate reviews, particularly those that were in bigger journals, to be a good clue. Keep your presentations very short, and bring in a copy of the paper for everyone. Often, I would summarize the paper's key points in <1 page and staple it to the front.

#4. Teach yourself. Be aggressive about reading as much as you can about your patients. This is often repeated, and with good reason. You'll be amazed about how much more you'll retain several months and years down the road by making this kind of investment. Read daily, even if you're post call (which will be difficult). If you make this a habit, you'll be way better off when it comes time for pimping sessions, the shelfs, and the rest of your life.

#5. Never ever put down your collegues, the field you're rotating though, an intern, a patient, a nurse, anybody. This can be tough sometimes.

#6. Be honest. Be honest with things that you did not complete, information you do not know, pimp questions you really have no clue about. This is just my two cents, but I would not try to mislead teams that you are interested in a field just to impress them. It will almost certainly backfire. I was always honest and never got burned for it. Now for some of the people in my class who are applying for derm who lied.....those are some sorry souls I hope never to interact with again! GOD THAT IRRITATES ME!

#7. Be enthusiastic. I, for example, really did not care for Ob/Gyn. But that time was the sole period in my life to learn as much about the field as possible. Suck it up and try to find something cool in everything you do. 6-->8 weeks is not too long. Try to be positive under adverse conditions. Everyone on the team with you will appreciate it.

That's about all I can think of. I guess my last piece of advice is be open to specialties. Give everything a fair shake.....you never no.

-PB

This is great advice to current 2nd years. Keep 'em coming people.

 

[ears]

PB's advice is really strong.

I would add my emphasis to the points about honesty, presentations, and positivity.

You must be honest, all the time, no exceptions. If you lie, people will figure out that you can't be trusted, and then you are screwed. (You'd hope this would go without saying, but you'll be amazed at the BS your classmates try.)

Solid presentations are a good way you can impress (because you can learn something in detail and prepare for it). But the way to make them useful to your team (and therefore make a good impression) is to present useful papers and summarize them. Mostly, the sources you want are recent (less than five years old) reviews in core journals (NEJM and JAMA). If you want to branch out from that, make sure you only do so with guidance. I used a variant on the cover sheet strategy, too. There are at most five points you can pull from a paper, and you should spoon feed them to your audience. Make each point succinct, and do not go over five. (Most papers have about three.) But those at the top half of your cover sheet. Put the main figure from the paper on the bottom half (with its caption). This is actually pretty easy to do, and believe me, it will be appreciated.

Finally, you need to act like you have a good attitude (even when you don't). Some of these rotations suck, and there can be some pretty bad days. But part of being a professional is acting cheerful, pleasant, and being engaged in your work every day, even when you've been up all night, you feel like crap, you hate ob/gyn (or whatever it is), and your resident is an abusive a$$hole. It's one of those "fake it 'til you make it" things, but it makes a big difference in how you're perceived and graded.

Oh, and you need to realize that you can do everything right, and still not get a good grade. It's just the nature of the game, and you have to pick yourself up and carry on with a smile.

 

[tiredmom]

Great advice so far! It's so important to be a team player with a good attitude. I've found that checking with the other students and residents when you are finished to see if you can help them with anything works well. If the team works really well together, everybody ends up with better grades, especially the ones who work hard. Offer to do things, ask to see things. But be upfront about it... don't steal someone else's procedure/case or thunder. Be organized and timely. Anticipate needs, like filling out the forms for the radiology procedures so the residents can sign them when they are talking about it, instead of having to wait until after rounds. The biggest things are: 1. be nice 2. work hard 3. don't goon your classmates - they will notice. Now - take everything with a grain of salt, I'm a MS3 currently, but have all honors so far.... (knocking on wood!) Good luck.

 

[CYP2E1]

PB's advice is excellent, if you follow it you will do an excellent job at "aceing" evaluations.

Also try to remember that if you are rude to ANYONE it may bite you in the bum later. I have seen collegues who where rude to midwives as students and now have work issues because these people remember them from their student days.

Also your collegues may be interviewing you for a job someday. If you were a prick as a student I wouldn't count on a job offer. Never discount the fact that people from your school will travel across the country, you never know when you may *need* a sympathetic ear.

 

[PickyBicky]

These are also key points. The best experiences and evals I had were when all of the students on service synergized with one another and made each other shine.

An example (which I personally love)....

Did Surg onc for one month with two other students for 1/2 of our MS3 surg clerkship. Somedays, cases would be ultra-light or attendings would be away and 1/3 would scrub while the remainder would look on behind the anesthesia curtain. Attending loved to pimp, esp. about tracks off his MP3 player. All classic rock and stuff none of us knew well. We would walk behind the student scrubbed in and feed them answers to his musical pimping and we all shined in the end. THAT'S TEAM WORK!

Take home point: take care of each other along the way.

Work on......rock on.

-PB