How would you deal with this?

[Back34]

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I just started my medicine rotation and was paired with an intern that's been making life diffiicult thus far. Don't get me wrong, her heart's in the right place but I'm learning absolutely nothing from her. Whearas my colleagues are learning the finer points of writing SOAP notes and doing physical exams supervised by their interns, I haven't done 1 H&P thus far and still can't write a progress note worth 2 cents. I get the feeling she doesn't want to be bothered with having to hold my hand for a few weeks until I get the routine down, so I'm usually left having to do the menial things that makes her life easier and mine, hellish.

I'm thinkinig about bringing the situation up to the resident. I don't want the intern to get in trouble, but my clinical education is literally suffering because of her. Any suggestions?

 

[MustafaMond]

Tell the resident that you are not learning from the intern.
Its OK to be open, after all, you are the one paying for this experience.

Get switched over to someone else, or better yet, hang out w/ the senior resident.

I try and teach as much as I can, because interns are usually too damn clueless to teach anything, at this point in their career (4 months into residency)

 

[bigfrank]

Try talking to the Intern. If she doesn't grade you, then you can go over her head without worry. But if she does grade you, then you have to be more diplomatic about it. My $0.02.

 

[Cpt.Hook Hamate]

We discussed this situation during 3rd year orientation and I have also come across this problem myself. In orientation, we were told that the best thing to do is to bring this to the attention of the attending or Senior resident and on one of my rotations, I brought it to the Attending and the next, I brought it to my Senior. They both were very understanding.

My attending had me and the other med student rotate between the two interns and she actually caught the bad intern not teaching me much and told her she shouldn't just tell me what to do but explain why and teach me stuff ( once she started teaching me I found her to be very good at it). On the following rotation, my senior simply offered me the option of following her instead and she was one of the best teachers I have ever had.

 

[Back34]

On the following rotation, my senior simply offered me the option of following her instead and she was one of the best teachers I have ever had.

Thanks for all the suggestions. I was primarily thinking about doing the above as well. The senior is a great teacher and I hope she's willing to get me on board.

 

[carrigallen]

My humble opinion is that in Fall, interns are not suited for preceptorship, because they themselves are still in the steep parts of the learning curve. It is not fair to the student nor the intern.

 

[Jaded Soul]

Hmm...Another case of med students working directly under interns instead of residents, and another example of how it's not a good system (at least early in the year as mentioned above).

To the OP: In what part of the country is your school located?

 

[Back34]

Hmm...Another case of med students working directly under interns instead of residents, and another example of how it's not a good system (at least early in the year as mentioned above).

To the OP: In what part of the country is your school located?

Hi, I'm in the northeast at a really great teaching hospital. I think I just ran into some bad luck with the intern. I should probably mention that this person is new to the country and has been out of medicine for a while, so she's almost as clueless as I am. I don't really blame her for anything because she's going through as big an adjustment as I am and I'm just dead weight. I'm going to bring this up to the R3 today and I'll post how it goes.

 

[lowbudget]

Why are you trying to learn from your intern? At most hospitals, the interns are too busy and too clueless to also be supervising students. That's usually the responsibility of the resident. Your job is to help the intern (help the scut so everyone goes home early and get the census down) and learn from doing, but get your teaching from the upper level resident. Ask the upper level to supervise your H&P's, show them your progress note and ask them how you can make it better ("what do I need to look for in this patient every morning to make sure he's on his way to a discharge or getting worse?"). It's not a knock on your intern. I just can't believe that people expect the intern (basically MS4+3 months) to be teaching.

 

[Jaded Soul]

Why are you trying to learn from your intern? At most hospitals, the interns are too busy and too clueless to also be supervising students. That's usually the responsibility of the resident. Your job is to help the intern (help the scut so everyone goes home early and get the census down) and learn from doing, but get your teaching from the upper level resident. Ask the upper level to supervise your H&P's, show them your progress note and ask them how you can make it better ("what do I need to look for in this patient every morning to make sure he's on his way to a discharge or getting worse?"). It's not a knock on your intern. I just can't believe that people expect the intern (basically MS4+3 months) to be teaching.

This is what I was alluding to. There's a little bit of a discussion in the middle of this thread. I think certain parts of the country follow the strict heirarchy more when it comes to med student supervision (student, intern, junior resident, senior resident, attending).

 

[babyruth]

Just curious, but shouldn't you already know how to do the H&P and SOAP note stuff from your first two years?

 

[Barry Otter]

Just curious, but shouldn't you already know how to do the H&P and SOAP note stuff from your first two years?

I had experience doing H&P during my 2nd year, but certainly didn't feel comfortable with it at the end of my 2nd year. Never had to write a SOAP during the first 2 years.

 

[Back34]

I had experience doing H&P during my 2nd year, but certainly didn't feel comfortable with it at the end of my 2nd year. Never had to write a SOAP during the first 2 years.

Basically what Barry Otter said.

 

[babyruth]

Really? They make it a point to have us fully prepared to do all of that stuff, and I am only an MSII and I have written several SOAP notes. Didn't you have mock patients or anything?

 

[Jaded Soul]

Really? They make it a point to have us fully prepared to do all of that stuff, and I am only an MSII and I have written several SOAP notes. Didn't you have mock patients or anything?

I thought the same thing because I wrote a couple dozen H&Ps (on real patients) and learned how to write SOAP notes in the first two years. The only parts that were helpful when beginning rotations was knowing the format and structure of each.

In the first two years when learning how to write H&Ps, we are taught to be thorough. That usually leads to confusing histories that are difficult to follow and redundancies. You can definitely tell when you are reading an H&P from someone with little experience because it doesn't tell a story in the way you'd expect for a patient with a given chief complaint. There's usually just too much information and none of it is arranged well.

In the clinical years, we learn how to refine the H&P. It should get other people thinking along the same lines as you are, without having to ask additional questions. Your diagnosis or differential should be in the person's head before you even get to it based on the way you tell the story. Also, the history becomes more succinct while not sacrificing any important information. Being able to do this well happens if you get good feedback from someone else who knows the patient well, like your resident.