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I hate residents

Discussion in 'Clinical Rotations' started by Acherona, May 12, 2008.

  1. Acherona

    Acherona Senior Member
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    The residents at my school never try to help the med students do well. I am so nice to them and offer to do their scut and give them information so they don't look bad in front of the attending, or mention on rounds that "resident X did this or that " but they *never* return the favor. It has happened so many times where I suggested a diagnosis or plan and they took my advice but rarely gave me credit always using "I I I". Is it so hard to be nice or acknowledge someone??? Ahhhh.
     
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  3. Top Gun

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    Welcome to third year. Compliments and other forms of recognition from residents will be few and far between. If you are working really hard, you will be rewarded for it in your evals. So be patient.
     
  4. muscles

    muscles student of the month
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    I know what top gun is trying to say, but I disagree with part of it- don't count on being rewarded for hard work in your evals. At my school, at least, the surgery and OBGYN residents/attendings were extremely tough evaluators. I worked very very hard on these rotations, but you'd never know it from the evals. A lot of people I've talked to about this have had similar stories...

    I always wonder, at what point do residents and attendings forget what it's like to be a med student? I just want to know so I don't forget when I become a resident in a couple months...
     
  5. lankysudanese

    lankysudanese antibiotics fetish
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    i know that it is easy for someone else to say, but as long as your hard work and "help" is potentially positively-affecting patient outcomes (by broadening differentials, not missing key info etc) then you should feel good about yourself. they are too busy to remember to give you credit, but they will remember how an awesome student you were, when the time for evaluations comes. i would suggest going easy on the scut work though, since learning is your other objective (besides patient care), and people tend to get carried away with scut work.
     
  6. DarthNeurology

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    Just bring the residents down to your level:i.e. they will make you part of the team when they realize that if you are a worm's belly button they are 1/2 inch off the ground:

    1. So why did you "choose" internal medicine, family practice here? (Works if not MGH, i.e. makes residents make up something if their first choice was not your school, also let's them think of place as your school not where they do residency)

    2. So are you able to pay off some of your loans with your resident's salary? (Rubs nose that they aren't valued as an attending and reminds them of how close they are to med school).

    3. Did you survive internship well? (This is fun as it gives 'em flashbacks)

    4. How did you do well on inservice exams? (Makes the so-so resident get red under the collar)

    5. Do you think you would get fellowship x? (Makes em' happy that you "care" about their career and also reminds them their trial of fire is not over).

    6. Ask chief resident if they would do a chief year over again. (Most can't answer intelligently and you become their life guru).

    When they are vulnerable, then you ask to see more patients, do more stuff and you can but them out of conversations between you and attending without a problem. Face it, residents compete with us students for 'face time' with the attending, I guess what I did was relatively mean to residents, but at least I got my face time and when having a conversation with attending the little ole' resident can just sit there watch like a mouse and even be ignored if they are not on their game. Residents are not your friends they are like bishops or knights in chess, i.e. people to appease, learn from their mistakes, and steal patients from them and humiliate inocently when they are not on their game, other students are pawns to steal patients from, you are a queen/king and the other king/queen of the other color is the attending, you win when more people agree with your management plan and support you, end of story, when you can check-mate the attending you are recognized as an equal of sorts and get an honor. Really, I didn't care what residents think of me (or at least not nearly as much as attendings) as they are just something to be maneuvered to 1. take great care of patients 2. help me learn a little 3. to maneuver away from sucking my time with pointless social conversation and to maneuver away from attendings so I get more face time

    Best Rotation:

    1. Resident One (Knight) is put in their place by Darth's good knowledge and listens sans interupting Darth during rounds and likes Darth's presentations he offers to do. Neutralized, and ally to box in the attending.

    2. Resident Two, doesn't like or really dislike Darth, but is marginalized from conversations with attendings by Darth and respect Darth extra work and humiliated by Darth who knew x about their patient so leaves Darth alone

    3. Three students pawns all like Darth because he looks outs for them, gives pointers to third years and in exchange Darth gets more patients.

    End Game - Resident one here, resident two there, a couple pawns over here and check-mate

    I started out being nice like a little daisy flower, but you get trampled, third year is about harassment, abuse and intimidation, and if you complain it looks like you want to close the NFL and have everybody play volleyball. Time spent being nice is wasted, you have to be admired like a flower, but have thorns as well that stick in resident's sides, like a rose, better to be admired and feared.
     
  7. Mayhem

    Mayhem Scut Bear
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    Well you'll find out as you go along in medical school that people rarely notice the good things and are even less likely to ackowledge it. But if there's anything bad you better believe it will be headline news on CNN for the rest of your life. My advice is learn to deal with it or: ...do not offer to do their scut and give them information so they do look bad in front of the attending, or do not mention on rounds that "resident X did this or that " since they *never* return the favor. Are you getting the idea?

    BTW, Darth whoa...just whoa.
     
  8. Tired

    Tired Fading away
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    This is excellent advice.

    Any resident that needs medical student support to do their job is, by definition, a weak resident who deserves what's coming to them.
     
  9. lankysudanese

    lankysudanese antibiotics fetish
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    where do you go to school, DarthNeurology? b/c this strategy wont go well if you attend an institution with strong residency programs. not well at all!
     
  10. getunconcsious

    getunconcsious Very tired PGY1
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    Good grief! I don't think it needs to be this Machiavellian. Sure there is a bit of politics involved in the process, but doesn't this basically just make you a terrible human being to act like this?

    Anyways I don't think the majority of residents are mean or out to deprive us of credit for stuff, I think they are just very busy. And face it there's only so much help we can give them. We mainly only can traffic in information. We can't do anything really useful like write orders. I suppose scut work is useful to the residents as well, but of variable yield for the evaluation...sometimes the attendings rely very heavily on housestaff impressions for writing evals, and sometimes they really couldn't care less what the residents have to say about you.

    And call me naive, but for what it's worth I really do believe that being a NICE, PLEASANT person who can carry on a conversation with interns and residents and is generally nice to be around is worth a lot. I had one attending tell me when she was going over my evaluation, "I noticed that you smiled more than anyone else on the team. You're a very pleasant person and I think that patients noticed that and it also made the team feel better." And this was on internal medicine, not one of the more touchy-feely services. I wholeheartedly disagree with this notion that "Time spent being nice is time wasted." There are a LOT of malignant residents on OB and surgery, but on the other services it is relatively easy to make friends with the residents and this makes life a LOT easier, I have found. Remember that residents (NOT attendings) determine your day-to-day quality of life on any rotation. Also, attendings frequently rely quite a bit on residents for evals. Manipulating them in general and especially "humiliating" them at rounds, etc, is not only mean and wrong and unethical...it's something that you do at grave risk to your own evals.
     
  11. oompaloompa

    oompaloompa 0.20 Blood Caffiene level
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    Agreed. Of course I went to UT-Houston for med school and the med students there definitely have a more laid-back culture. I'm more aware of it now after dealing with the students at my residency program. I think the quality of both is quite high, but there's definitely a different approach.

    As for Darth, I think based on several of your postings that you must be in a very malignant environment or are easily offended. I know its hard to have perspective in med school, but try to remember that unless path or rads is in your future, a good chunk of your day as a resident is "people management". When you think about it, it's really quite unfair. For some people(like myself), you may have been in school for 21 years with little or no managerial experience, and then all of a sudden someone slaps 2 letters at the end of your name and you're the coordinator of a dozen different services. Like getunconscious said, basic people skills can go a long way, especially when you're dealing with someone twice your age who likely resents you at baseline.

    Also, I'll share something that wouldn't have occurred to me as the narrow-focused med student that I was. As a resident, I spend 0.009% of my day thinking about the med students, if that much. It's not that we don't like you, I've thought most of the students I've come across are perfectly affable people. I think it's great if you offer help, but neither will I dock you if you just want to do whats expected and go home. I know you have to study, or maybe you don't like peds, whatever. I understand, I actively hid from the fem-nazis during Ob-Gyn. You may not get this offer from other residents, but I'll never figure out why people are offended when the student doesn't profess a love for your particular specialty.

    Anyway, maybe there's a few residents out there that are mean to the students out of some form of displaced aggression, but I think the worst crime most of us could be accused of is just some mild neglect. Try to forgive us, you'll understand soon enough. ;)
     
  12. vtucci

    vtucci Attending in Emergency Medicine
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    Maybe my experience has been unusual or it is just a policy from the top down at my institutions, however, I have found most of my residents and attendings appreciate hard work and value when students state that the faculty or staff have done something well. It is a rare time when I do not see reciprocation if a student brings something to the attention of an attending that a resident did well. The residents generally return the favor as is human nature to do (ok- maybe not when the team is post call but eventually).

    Too often, students will complain when things are not being done well or if they feel slighted, overlooked etc. We forget to write when things go well. I like to have individuals recognized for doing things right-- e.g., when that internal medicine resident goes out of their way to explain a disease process or management plan to the student, or helps you prepare for your weekly quiz. When the surgery intern lets you put in a central line (under supervision) and patiently walks you through step by step asking and teaches you about common complications. Would it be quicker if residents just did this themselves? Absolutely. Do some residents just do it themselves and ignore students? Absolutely. Or how about when a resident bucks against the culture of a particular rotation and is pleasant to work with, enjoys teaching and is not abusive to students. Why not have some positive reinforcement to those residents? And not just to them in person (although everyone likes to have their efforts acknowledged and appreciated). It is about taking that extra step.

    When someone really helps in my education and goes above and beyond, I will e-mail the attending as well as the chair of their department and/or residency program to make sure that they receive the credit that they deserve.
     
  13. Acherona

    Acherona Senior Member
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    At my school the students are just as busy as the residents (we often have more calls and have equal patient loads), that is zero excuse to "neglect" someone that you work closely with 12 hours a day. It's just common courtesy. I don't understand why people think medicine gives them the license to be a**holes. It also takes time to bitch out the student but somehow they fail to neglect that. I just hope I don't perpetuate the cycle of abuse when I'm a resident and can stoop to be nice to students.
     
  14. velo

    velo bottom of the food chain
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    Honestly? So let's say you're on an IM rotation as a 3rd year student, you're picking up 5 patients/call night and carrying a census of 10-15 patients? That sounds fishy...

    I can imagine how it can be very, VERY frustrating to not get credit for the work you do. I think one of the things I really liked about my favorite rotations was how the housestaff looked out for the students. I remember one specific example where, in rounds, the attending brought up a diagnostic possibility I had mentioned in passing the previous day and one of the interns made it a point to point out that I had thought of it earlier.

    What can I say about your residents though...only that they are making life harder on themselves. I always worked harder for residents who had my back and it really made their lives easier. I was aware as a 3rd year that a medical student can be a very difficult resource to utilize well, but when a resident is able to they can really get a lot done.

    I've been thinking about all this as I get ready for intern year...I knew exactly what made a good resident as a 3rd year, but I'm wondering if I'm forgetting as that experience gets more remote. Other than keeping students in the loop about their patients, involved in their care, making sure they get credit for their work, and walking that fine line between keeping them busy and scuting them out...what makes a great resident from a student perspective?
     
  15. Rendar5

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    Different hospitals have different caps. I've worked at 2 different hospitals for my IM rotation and both had a very different setup for patients, caps, call nights, involvement of the attending, etc. In one I had an equivalent patient load to my interns (but not nearly the responsibility or paperwork, of course), in the other, I didn't. Total workload and lectureload was similar though.


     
  16. velo

    velo bottom of the food chain
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    That's true, but by and large programs are more similar than different. Every program where I interviewed had a cap of 5 patients/call night for the interns and the interns seemed to be carrying about the patient load I mentioned if things were moderately busy. I was wondering if that's what that poster was doing as a 3rd year because that's, frankly, insane...and not a good learning experience so early in your clinical training.
     
  17. DarthNeurology

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    Being nice is natural and seemed what was right for me when I first started third year, but really, if you are too nice people think you are brown-nosing them, I don't want to be seen as a hypocrite or a brownoser, so I show little of that "niceness". People in medicine respect you if you are assertive and, I am sorry to say, shove down residents and other students when they are making a mistake or saying something wrong. I got upset when harassed and humiliated by attendings early on, but the greatest reward is learning stuff really well so you can humiliate (maybe to strong a word, maybe just make them look stupid) on rotations. I do scut for people (not the same as smiling) a lot. So if you were my resident I would get you a drink in the cafe in the morning and point out a flaw in your management/thinking in front of the attending in the afternoon. Then again, no one would ever say I am mean as I only whisper up what I think is right and preface it with "I might be wrong, but atelectasis can present with a fever too . . ." so I guess my temperment has molded my machiavelian approach to clinical rotations into something that overides a shy and wanting to please temperment. The trick is that there is nothing unethical with humiliation, harassment, or intellectual intimidation in medicine, mean yes, but OK to do if you do it sneakily. If a third year brings in an article then you ask them some questions to see if they really even understood what they read, makes them think maybe they are not even close to knowing as much as an attending and trying to stand up everybody by bringing in something like we don't read all the time anyhow. Being nice and pleasant and people think it is an open sign to abuse you even more.
     
  18. vtucci

    vtucci Attending in Emergency Medicine
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    Darth- I am not sure what it is like at your institution but at mine, people definitely do not respect you for showing up your colleagues or putting them down- be it another student or resident or attending. Those few souls who do as you suggest are considered tools/trolls (fill-in-the-blank negative descriptive term). There is a difference between respect and fear or loathing.

    Medicine is a team sport and no matter how smart we are, someone always knows more about something at some point in time. The person you make look bad today can return the favor tomorrow (and will be more inclined to do so if you do it to them first).

    I will agree that being assertive can earn respect if done appropriately and with a good knowledgebase (arguing a point when you do not have the information to back it up just demonstrates that the person is an a**).
     
  19. Tired

    Tired Fading away
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    :laugh:

    Residents eat students like you for breakfast.
     
  20. vtucci

    vtucci Attending in Emergency Medicine
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    I can stand my ground with the best of them Tired and I do not take abuse from anyone. I am fortunate in that I had a career before I went to medical school and had the opportunity to work with a wide range of personalities (some of which were even pathologic- I was a lawyer who practiced in NYC after all :smuggrin:).

    My rule has always been-- be nice until it is time to not be nice. This works for the vast majority of people. You do not need to be a b**ch or a** to get things done and have people recognize your worth and respect you. Geez.... you guys sound like you had too many toys stolen from you in the playground during kindergarten.:laugh::laugh::laugh:

    Also, it does not hurt that I generally know what I am talking about and if I do not know the answer to a question, I admit it and look it up. I do not feel the need to make my classmates or residents look bad in front of anyone. It is only insecure individuals who feel the need to do so. I will grant you that there are alot of such individuals out there. I would submit though that if you are really that good (or that bad), you do not need anyone's help- it will show. It also helps if the person's whose opinion you are concerned with most is your own. We know when we need to improve and while evaluations from superiors are important, the one that we need to live with is our own self-assessment. Our attendings and residents do not come home with us and will not live with our mistakes.
     
  21. Acherona

    Acherona Senior Member
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    Our call system is a little different but we would never get more than 3 admissions/night. Maybe internal if you had it early in the year they would try to give you a few fewer patients than the intern but the patients could easily accumulate if you admitted a lot the night you were on call and had no discharges. In surg we didn't follow any patients specifically, had to know about everyone on the floor and make sure all scutwork taken care of with the interns. All our notes stand alone and for surg only the med students wrote notes. Yes it is a brutal way to learn.
     
  22. getunconcsious

    getunconcsious Very tired PGY1
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    Ugh...I spent the whole year trying to be nice. And these kinds of quotes are what makes me SO GLAD I'm going into Path :)

    You might eat me for breakfast, but I'll NEVER EVER again take in-house call after medical school. I'll probably work half the time you will.

    So enjoy being a petty tyrant, and enjoy your miserable life. :cool:
     
  23. MrBurns10

    MrBurns10 Excellent, Smithers
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    Man, have I wanted to say that to a few surgery residents on my rotation (only insert rads for path, at least hopefully). :) Residents have very short-term memories when it comes to remembering what it felt like to be a med student.

    Though I don't think Tired necessarily meant it the way it sounded. I thought you made great points, vtucci.
     
  24. colbgw02

    colbgw02 Delightfully Tacky
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    This particular nugget isn't getting nearly enough attention, because it is so incredibly true.

    It's true that there are plenty of residents out there who are just jerks, but now that I've had the benefit of being on both sides of this relationship, I realize that many residents just don't think about the medical students.

    It's strange how this occurs so quickly, but I can only assume that it's human nature since it happens so naturally and so commonly. I remember thinking as a medical student that it was part of the resident's job to teach me. From the other side - at least at my program - that's not really the case at all.

    I've read my program's handbook and ACGME requirements, and no where does it talk about my obligation to teach medical students. In all of my evaluations, there has never been any mention of medical students, and in my own yearly self-assessment I made no mention of the time that I did spend with students. So, at least in every "official" sense, it's technically not my job to teach medical students. Of course, I can only speak for my own program.

    It's really a shame too, because often times students go through a lot of trouble to put their best foot forward.

    Anyway, I'm not trying to be an apologist for all the a$$hole residents out there. Just remember the next time that a resident does something you don't like, it may not be because they don't care. It may be because they're busy as hell and they haven't thought about it.
     
  25. vtucci

    vtucci Attending in Emergency Medicine
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    I understand that with all residents need to think about medical students do not rank at the top of the list.

    I would submit though that students can make the job easier for residents and many students are more inclined to work hard for residents who take the time to help them and who are pleasant people to be around. Just my $0.02 for what it is worth.

    I also think that we become better physicians when we are teaching others. It makes us retain more information. That is true even when 3rd year students are teaching preclinical students.
     
  26. SLUser11

    SLUser11 CRS
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    That comment shows very little insight. Do you really think that your responsibilities on each patient you "carry" are equal to those of the resident?


    This might be true, but it doesn't make it right. One of the resident's main responsibilities is to teach. I feel like once you get through the first few months of adjustment during intern year, it's only the weak/marginal residents who can't find space in their brains for the med students. These are the same people who just can't find time to eat/pee/etc. during a 14 hour time period.

    I'm in an extremely busy general surgery program, and I still find time to teach every day. I've said it before, but it's all about learning how to multitask.
     
  27. colbgw02

    colbgw02 Delightfully Tacky
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    My point is that it's not a question of weakness, time, or even ability to multitask. It's a question of emphasis. All of what you said above presupposes that the resident has bothered to even think about the students. And I'm asserting that as a resident, there is a natural tendency to do just that - forget about the students. I think this is especially true when external forces, like your attending or program at large, don't make it a point of emphasis. I am contending that there are many residents who possess all of the qualities of a servicable teacher that don't teach simply because it doesn't occur to them to do so.
     
  28. vtucci

    vtucci Attending in Emergency Medicine
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    Velo- I thought you made some excellent points. I also have been giving a lot of thought to what makes a great resident so I remember to try to incorporate those attributes when I start residency.

    IMHO, I look for the following:

    1. Explain expectations at the beginning of the rotation and giving feedback that extends beyond "fine" and recognizes that evaluation forms are judging students on the skills we have vis-a-vis our peers and not interns, residents or general medical community- I like to know what is expected of me. What do I need to do to exceed those expectations? Med students are all Type A personalities and want to excel. Few things are more annoying than hearing on a scale of 1-5 on an evaluation when a physician says "oh, I never give 5s" and the eval is worth a substantial portion of the grade and a 4 translates to a "B". Everyone looks for different things. How do I compare to my peer group? What am I doing well? While recognizing that we can all improve in certain areas, what areas should I focus on? Also, it is great if the student can explain the attending's expectations if those are not clearly communicated.

    2. In the beginning of the rotation, I appreciate when the residents review my H&Ps and oral presentations prior to my presenting it to a new attending. It is great when the residents point out the areas that need improvement as well as the areas done well. It is also great if the resident has experience with a certain attending and knows that they like to hear a lot on the social hx or medication interactions etc. so the student can really look like they know what they are doing in front of the attending. This will also make the resident look good as they are training the student well.

    3. Looking out for interesting & varied cases and learning experiences and making sure that the student feels comfortable with their patient load. Some patients are more complicated than others and especially in the beginning of the year, a student carrying 2 patients may have a lot more work than their teammate with 4 patients if those 2 patients are very complicated and involved. In the ED and psych, I really appreciated when residents explained that the intoxicated patient and alcohol withdrawal while it is good to have at least one case, it does not need to be the entire experience. It is also nice to ask if there is a particular type of case that the student is interested in seeing or need for their log book.

    4. Taking time to explain and allow students to participate in procedures. This will depend on the time of year as new interns need to get in a certain number of procedures but students can be present and help.

    5. Being aware of student time and obligations. If there is nothing going on, letting the student go home. If the student is on call with the resident and it is slow, let them go home with the understanding that you can call them back in if things start getting crazy.

    6. Having discrete teaching points ready to share with students. Some of the best IM residents in my school were aware that students had a weekly quiz on an organ system. They would prepare questions and reviews for students on their team for those topics (and they repeat every student rotation) with the most important areas when there was some down time. It is the extra mile and we were extremely impressed with these residents.

    7. Being nice to be around. Acknowledging the student's presence, treating them like a member of the team and not just an annoyance. Residents can be friends as well as teachers and mentors. As has been mentioned, students will go the extra yard when their efforts are acknowledged and the residents are cool to be around. Often times, there two or more residents on a team. Depending on the school, students can chose which patients to work on and as a result, which resident's patients they will write notes on. Many students will take full advantage of this and work to reduce the workload of the residents they like.
     
  29. Tired

    Tired Fading away
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    :laugh:

    Don't worry, we'll have forgotten who you are two days after you rotate off service.

    Meanwhile you will be a Path PGY-4 still complaining about those mean ol' surgery residents . . .
     
  30. Acherona

    Acherona Senior Member
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    This is what I'm talking about. If I help the resident do her job well when it is certainly not written anywhere that this is *my job* as a student, then it is just *common courtesy* to reciprocate. The main way for a resident to do this is to mention that she helped with x or y thing to the attending when reviewing a case. Basically I think they don't do this because they are insecure in their knowledge or don't think a med student should have known/done something they didn't do. That's the only explanation I can come up with. I highly doubt it is because they were just "too busy" and didn't notice. Or I've been in the situation where I"m getting bitched out by the attending for missing something, and the resident knows the details of why I might not have been able to get that information, but won't stick up for me. It's frustrating.
     
  31. Acherona

    Acherona Senior Member
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    yes I do actually. they are exactly the same. the residents are just expected to make fewer mistakes.
     
  32. kate0834tkjn

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    Really? I find that hard to believe, since you have to get someone to cosign all your orders, can't give verbal orders, etc...
     
  33. DrButtercup

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    At my school we (the students) get to fill out evalution sheets for the residents just like we do for attendings. Still, there are some residents that are good with students and some who aren't. Third year is all about knowing how to play the game. Attending X likes presentations one way and Attending Y another. You just have to adapt to the hand you are dealt. No need to be mean about it. And learn from the residents to define the kind of resident you want to be. Develop a thick skin. Don't get too worked up. And if someone is intentionally being a jerk never let your emotions show on your face. You can't give those type of people the satisfaction. Most importantly remember 3rd year is only temporary.
     
  34. Ypo.

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    It is 4:00 a.m. and instead of scrubbing in on an exploratory lap or better yet, sleeping, I get scutted out to do an H & P on a guy with massive ascites who smells like fetor hepaticus and who insisted on trying to give me a hug because he thought I looked like some girlfriend he knew. I am now up here waiting for mister second year surgery resident to come up here and see this guy.

    I don't hate residents. I just hate being a student.
     
  35. (1) You're a female?
    (2) Are you from Hawaii?
    (3) The MS-III year is VERY tough. Most painful year of med school. Hang in there!

    :confused:
     
  36. doc20

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    anyone have experience of taking the fire and being blamed for residents fault? uhh
     
  37. sacrament

    sacrament somewhere east
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    You are wrong.

    (Plenty of references. One of the few things I bother doing with the students, as far as formal teaching goes, is to go through a PowerPoint I've made dispelling erroneous medical dogma that they all learned in medical school.)
     
  38. SLUser11

    SLUser11 CRS
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    Ahhh, the voodoo that we do.......

    Still, I tell the patients that their fever is from atelectasis, because I want them to use the spirometer........
     
  39. Rendar5

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    Ah, do share if you don't mind :)
     
  40. soeagerun2or

    soeagerun2or Membership Revoked
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    It is well established that atelectasis causes pulmonary macrophages to release TNF and IL-1 and resultant fever. If you have evidence refuting the molecular characterization of this mechanism I would be interested in seeing it.
     
  41. velo

    velo bottom of the food chain
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    I always loved as a medical student how atelectasis seemed to be a cause for fever in the surgical patients but not in the medical patients...very curious...

    If people want to say that atelectasis causes the release of inflammatory cytokines and pyrogens, well, fine. But surgical patients have other sources for the release of these 'evil humors' (read: their big 'ol incisions) and I'd posit that that is probably the source of their otherwise inexplicable fever. You take those same patients (but sans surgical incision) and put them on a medical floor and suddenly a little atelectasis doesn't seem like a very good explaination for fever...
     
  42. Ypo.

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    Hey. Yes, female. No, not from (but lived there for a number of years).


    Is it normal to sleep from noon Saturday to 8 am Sunday post-call? Cause that's what i did. :hungover:

    Also, regarding residents. The surgery residents are mean to us. They just are. The attendings are so nice compared to them. Part of the reason they are mean is because they have unchecked power over us; the clerkship director is never around, and the residents don't respect him anyways.

    Most of the rumours I have heard regarding surgery are true. I always thought, it's got to be exaggerated. Understated is more like it. Of course, I only have this program as an example, so maybe they aren't all this bad.

    I love surgery and I hate it at the same time. I mean, I love being in the OR, taking care of patients, and learning. But I hate the culture; how mean people are to each other. The residents do not stick up for each other by and large. My chief resident spends a good hour each day trash talking one of the attendings. And the ER rotation intern. And probably the students the second we walk out the door. There are a few nice residents, but by and large this program is ridiculous.
     
  43. Ypo.

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    Also, all of the sudden since I'm on surgery a fever is defined as greater than 100.8.

    I was told I was being stupid because I was worried about a patient with a fever of 100.7 and persistent tachycardia. Then later that day they took him to the OR and found he had bowel ischemia.
     
  44. sacrament

    sacrament somewhere east
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    One of the more interesting characteristics of human medicine is that what make good theoretical sense, and what is true, often turn out to be very separate things. Which is why we're moving toward "evidence-based" medicine as opposed to the strictly theoretical. Strictly theoretical medicine held that beta-blockade was a horrible idea in the long-term treatment of heart failure.

    Engoren M. Lack of association between atelectasis and fever. Chest 1995;107:81-84

    Roberts J, Barnes W, Pennock M, Browne G. Diagnostic accuracy of fever as a measure of postoperative pulmonary complications. Heart Lung 1998; 17:166-170.

    There are many others (do an Ovid search), but these are the two I reference in my PowerPoint. Whatever molecular mechanisms you want to evoke w/r/t atelectasis, they don't seem to result in the clinical manifestation of fever. Maybe it seems they should, but they don't. (At least not, as velo points out, independently.)
     
  45. sacrament

    sacrament somewhere east
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    Another popular one is the myth that meperidine is less "spasmogenic" than other narcotics when treating pancreatic pain. Just another example of knee-jerk dogma.
     
  46. DarthNeurology

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    Well, I guess I learn something new everyday, . . . I never thought it made much sense the whole cytokines being released and stuff
     
  47. DrDre311

    DrDre311 Makaveli
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    I don't recommend any of this.
     
  48. Top Gun

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    If you are really trying to show up your residents (in front of an attending, no less!), then that makes you a real douchebag. I'm surprised your attendings and residents put up with you, and didn't trash you on your evals. If I had been your resident, I would have given you low marks for professionalism.
     
  49. Tired

    Tired Fading away
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    This is a really interesting question (at least to me). I would suggest you go through the literature on this sometime, because it's fascinating reading.

    FWIW, I have a paper in my files that says 100.8 is the upper limit of a normal temperature in a non-elderly individual. I also have a paper that says 99.0 ought to be considered a fever in the elderly.

    Of course, these are "fevers" for the purpose of determining infection, and I haven't seen data on what consitutes a "fever" for other purposes (ie - mesenteric ischemia, PE, etc).

    You were right (obviously). But the fever was less telling than the tachycardia, especially if the guy had risk factors for mesenteric ischemia.
     
  50. DarthNeurology

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    You mean low marks for having the audacity to read more than my resident who drunk his way through medical school and residency and barely passed his boards type of low mark? If making people look stupid is unprofessional then fire 85% of attending out there. If a student made you feel puny it would make you a better resident probably, MAKES you look bad if you don't know enough to take care of patients and are just scrapping by in residency. Attendings like whoever is on their game, is interested, and who is focused on taking care of the patient, some residents just aren't and they deserved to get their @##@@ handed to them. I seriously don't do it on purpose actually, I had an idiotic resident who would constantly pimp me and I could answer his questions, and HAD to bring up how he was @#$#$## up the care of a patient for the patient's good. Get real if you think anyone acts this way, but it is a load of garbage if you think that residents are so superior to med students they shouldn't be pimped, they should be as many just don't study #$## I don't like pathetic little residents who are like little moldy rotten pieces of cheese filled with rat excrement who harass and piss on med students who care to study and then go out and drink 24/7. We don't have residents grade us at our school because they recognize how residents are generally a low form of life that couldn't evaluate when to change the oil in their car. Residents haven't earned any deference or respect like physicians y'all have little clinical reputation.
     
  51. smq123

    smq123 John William Waterhouse
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    :confused: That's an interesting metaphor....

    No offense, but really - you've got issues.

    Out of curiosity, when you're a 4th year sub-I, is it okay for the MS3 on the team to pimp you? Just wondering.
     

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