Integris Health EM Rotation

LChristmas

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Don't do it. Terrible culture. They have a "med student wall" where they make you STAND for your 12 hour shift. Then they openly judge you by how quickly you clean the room after patient discharge.
 
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CajunMedic

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I auditioned there and it's a love it or hate it experience. I was 6 hours into my first shift and officially went "F This". The med student wall is real. I gave up and pulled a stool out of a room and sat down. The interns weren't allowed to sit on shift until '17, pretty sure the attending are still the only ones that can use Dragon. You'll have to fight the other med students as well as interns to see patients. I had charts snatched out of my hands and had to figure out where to stand and catch the patients being roomed. Got no real procedures, wound up doing a lot of EKG's and starting IV's. No Epic access unless you were there during your 3rd year, so don't plan on checking your patients labs, etc. There's a paper sheet to scratch out an H&P, Assessment and Plan on.

On the flip side. I have a classmate and a couple of friends who matched there and love every minute of it. It's busy, the acuity is high, and you're unopposed. So you're running codes in the ICU; doing lines, ETT, Chest tubes, etc. He was allowed to moonlight at the start of 2nd year and had most, if not all of his procedures. You'll see a LOT of patients quickly and learn how to be efficient. The PD and most of the attendings were good to work with and seemed extremely strong. I auditioned at another OK program with attendings that had trained there, and were great clinically.
 
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Don't do it. Terrible culture. They have a "med student wall" where they make you STAND for your 12 hour shift. Then they openly judge you by how quickly you clean the room after patient discharge.

Avoid rotating at old AOA programs. This just seals the deal.
 
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Rekt

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I auditioned there and it's a love it or hate it experience. I was 6 hours into my first shift and officially went "F This". The med student wall is real. I gave up and pulled a stool out of a room and sat down. The interns weren't allowed to sit on shift until '17, pretty sure the attending are still the only ones that can use Dragon. You'll have to fight the other med students as well as interns to see patients. I had charts snatched out of my hands and had to figure out where to stand and catch the patients being roomed. Got no real procedures, wound up doing a lot of EKG's and starting IV's. No Epic access unless you were there during your 3rd year, so don't plan on checking your patients labs, etc. There's a paper sheet to scratch out an H&P, Assessment and Plan on.

On the flip side. I have a classmate and a couple of friends who matched there and love every minute of it. It's busy, the acuity is high, and you're unopposed. So you're running codes in the ICU; doing lines, ETT, Chest tubes, etc. He was allowed to moonlight at the start of 2nd year and had most, if not all of his procedures. You'll see a LOT of patients quickly and learn how to be efficient. The PD and most of the attendings were good to work with and seemed extremely strong. I auditioned at another OK program with attendings that had trained there, and were great clinically.

Or you can do this all at many other normal programs in a more desirable location without the malignancy, pretty much anywhere else. Surprised they can get away with it since OKC is a trash can.
 
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Fox800

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Or you can do this all at many other normal programs in a more desirable location without the malignancy, pretty much anywhere else. Surprised they can get away with it since OKC is a trash can.

Sadly, med students will still suck it up to rotate here. They'll do anything to match EM and work for $150/hr at an HCA hospital after graduating. Hence our current predicament.
 
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CajunMedic

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Or you can do this all at many other normal programs in a more desirable location without the malignancy, pretty much anywhere else. Surprised they can get away with it since OKC is a trash can.

One of the many things I like about my current program. Just as busy, see higher acuity, have as many procedures, and the program treats us great. We treat our med student rotators well also. We sure as heck don't put 8-10 of them on shift at one campus and have them fighting for patients with the interns.
 
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I'll be frank. Oklahoma is not the kind of place that physicians are dying to move to. I remember cringing when I heard about one of my classmates rotating here a few years ago.

It would behoove this program to treat their rotators like adults/human beings. What a joke.
 
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CajunMedic

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What the ****? This is one of the most malignantly-petty things I've heard about in EM.

Yup. Interns and PGY-2's stood at workstations on the end of the nurses' station. The senior on shift had a chair and workstation on the inside of that end. Attendings are in the fishbowl with Dragon and PACS. They literally didn't have stools to sit on until the year I auditioned.
 

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More residents per square foot than I’ve ever seen at once. Bizarre interview where you are judged in front of about 15-20 people at once. They try to sell you on the awesome moonlighting. I would have to say they did overall have some of the friendliest residents when I was there, albeit they were usually the interns.
 
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Do medical students really do a bunch of grunt work like cleaning rooms between patients? I'm not saying medical students, residents, or attendings are "above" those tasks, but I don't think this is appropriate.

Students are paying insane money for clinical rotations, and they should not be used for free labor for housekeeping duties by hospitals. They should be spending their time on educational tasks to the greatest extent possible.

What's next? Washing linens? Working in the cafeteria? These tasks should be completed by people employees by the hospital... Not people paying to be there to learn.

If this is true, why on Earth is the PD ok with medical students being used to turn over rooms between patients? I never encountered this in medical school or during interviews. Does it happen at many other places?
 

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Yes students do this but for me it was to kill time standing against the wall with nothing to do. Very interesting place. Seems to put out strong residents though. Seniors all seemed very strong when I was there in 2017. FWIW.
 

The Knife & Gun Club

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The interns weren't allowed to sit on shift until '17, pretty sure the attending are still the only ones that can use Dragon. You'll have to fight the other med students as well as interns to see patients. I had charts snatched out of my hands and had to figure out where to stand and catch the patients being roomed. Got no real procedures, wound up doing a lot of EKG's and starting IV's. No Epic access unless you were there during your 3rd year, so don't plan on checking your patients labs, etc.

This is just absurd. It’s hazing, like some 1970s general surgery crap. Any place that’s treating their interns or their Med students like this isn’t a place to train.

In a county or otherwise strapped setting Im all for having students do things like lines or DREs or other scut. But it has to be balanced with independence on shift, good education, and procedures.

If you’re gonna ask someone to do an EKG, as a resident/attending better be prepared to talk it through with the student.



And interns need chairs. And dragon. WTF?
 
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Papa Oso

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Do medical students really do a bunch of grunt work like cleaning rooms between patients? I'm not saying medical students, residents, or attendings are "above" those tasks, but I don't think this is appropriate.

Students are paying insane money for clinical rotations, and they should not be used for free labor for housekeeping duties by hospitals. They should be spending their time on educational tasks to the greatest extent possible.

What's next? Washing linens? Working in the cafeteria? These tasks should be completed by people employees by the hospital... Not people paying to be there to learn.

If this is true, why on Earth is the PD ok with medical students being used to turn over rooms between patients? I never encountered this in medical school or during interviews. Does it happen at many other places?
100% agree with you. Students are desperate enough to do anything especially if they are not from a good medical school hence lack any good em advice or even home institution and don't have strong board scores. The SLOE ends up being these students saving grace so they'd kiss your feet if it meant securing a top 1/3 SLOE. Really sad to take advantage of someone who has zero leverage.
 

Papa Oso

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Yes students do this but for me it was to kill time standing against the wall with nothing to do. Very interesting place. Seems to put out strong residents though. Seniors all seemed very strong when I was there in 2017. FWIW.
Just my $.02 but at the residency I auditioned at and am ranking #1, they would tell me do look up a topic or procedure so that the next time I worked with the resident and the department was slow, we would go up to the whiteboard in the middle of the ED and do a mini lesson of the topic. I feel that is a much more educational and respectful use of a med student's time and also gives the resident an opportunity to learn by teaching. No. A student should not be responsible for janitorial work (given the huge amount of money they are paying as aforementioned). A student should only be picking up the room if they are cleaning up after a procedure they did or a resident did teaching them a procedure.
 

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It's very telling that there are no current residents speaking up to defend this program.

However, medical students will literally eat a turd in a hot dog bun to match so they'll keep doing stuff like this, because they can get away with it.
 
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mkeuchel

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Don't do it. Terrible culture. They have a "med student wall" where they make you STAND for your 12 hour shift. Then they openly judge you by how quickly you clean the room after patient discharge.

Hi, Mark Keuchel here! I'm the Associate Program Director and have been involved with the program since 2013. Your statement is factually inaccurate. While I do agree there is a wall that medical student end up congregating, this is solely because the department layout was made in the days of paper charting and before the establishment of the residency. We certainly do not make medical students stand - although many actually prefer to stand. There are always chairs available and I personally make sure the students know they are welcome to sit! We also don't ask or expect students to clean rooms! 🤷‍♂️

Best news though, we are renovating the workstations and will have a much better layout for our nurses, residents, and medical students!
 

mkeuchel

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I finally went to this program's website. Too many faculty wearing suits in their pictures. ER doctor in a suit is a warning sign if there ever was one.

Hi! Mark Keuchel, associate program director, here! Not sure what this means exactly! 🤷‍♂️ I thought I looked good in my suit! 😂
 

mkeuchel

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I auditioned there and it's a love it or hate it experience. I was 6 hours into my first shift and officially went "F This". The med student wall is real. I gave up and pulled a stool out of a room and sat down. The interns weren't allowed to sit on shift until '17, pretty sure the attending are still the only ones that can use Dragon. You'll have to fight the other med students as well as interns to see patients. I had charts snatched out of my hands and had to figure out where to stand and catch the patients being roomed. Got no real procedures, wound up doing a lot of EKG's and starting IV's. No Epic access unless you were there during your 3rd year, so don't plan on checking your patients labs, etc. There's a paper sheet to scratch out an H&P, Assessment and Plan on.

On the flip side. I have a classmate and a couple of friends who matched there and love every minute of it. It's busy, the acuity is high, and you're unopposed. So you're running codes in the ICU; doing lines, ETT, Chest tubes, etc. He was allowed to moonlight at the start of 2nd year and had most, if not all of his procedures. You'll see a LOT of patients quickly and learn how to be efficient. The PD and most of the attendings were good to work with and seemed extremely strong. I auditioned at another OK program with attendings that had trained there, and were great clinically.

Hi CajunMedic! We certainly remember you! Glad you enjoyed the high acuity and lots of procedures.

I do have to disagree however that students weren’t allowed to sit and that our interns weren’t allowed to sit either. I was an intern in 2013 and had a chair at that time and have been with the program ever since so I definitely can speak to the fact that all the residents have had chairs since at least 2013! 🤷‍♂️ Many of the residents actually chose to stand but they are certainly all provided chairs! That would be crazy to not give them chairs! 👀

You also rotated with us around the time of our conversion to EPIC. I do agree that at that time, students probably didn’t have access. Frustrating, I know! Luckily, that was fixed years ago and students have access to the EMR on shift. Furthermore, we have dedicated computers and even a few iPads for students to use on shift!

Hope you’re doing well!
 

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Hi CajunMedic! We certainly remember you! Glad you enjoyed the high acuity and lots of procedures.

I do have to disagree however that students weren’t allowed to sit and that our interns weren’t allowed to sit either. I was an intern in 2013 and had a chair at that time and have been with the program ever since so I definitely can speak to the fact that all the residents have had chairs since at least 2013! 🤷‍♂️ Many of the residents actually chose to stand but they are certainly all provided chairs! That would be crazy to not give them chairs! 👀

You also rotated with us around the time of our conversion to EPIC. I do agree that at that time, students probably didn’t have access. Frustrating, I know! Luckily, that was fixed years ago and students have access to the EMR on shift. Furthermore, we have dedicated computers and even a few iPads for students to use on shift!

Hope you’re doing well!

The chipper attitude and salesmanship reminds me of this.
 
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I've always found these damage control type posts to be a little weird and come off as desperate. You know what really makes people have a good opinion of a place? Actually giving students a great experience that they don't need to complain about online to warn other students.
 
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Arcan57

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Hi, Mark Keuchel here! I'm the Associate Program Director and have been involved with the program since 2013. Your statement is factually inaccurate. While I do agree there is a wall that medical student end up congregating, this is solely because the department layout was made in the days of paper charting and before the establishment of the residency. We certainly do not make medical students stand - although many actually prefer to stand. There are always chairs available and I personally make sure the students know they are welcome to sit! We also don't ask or expect students to clean rooms! 🤷‍♂️

Best news though, we are renovating the workstations and will have a much better layout for our nurses, residents, and medical students!
I'm going to spot that you genuinely care about the experience of your students, and aren't just doing damage control for the sake of recruiting. So it's clear that your view of your rotators experience and the experience of at least some of the rotators through your department don't match up. Best option would be to DM the people who had negative experiences and take their feedback to craft a better experience. 2nd best would be coming here and posting a refutation with strong evidence why what they experienced wasn't what actually happens during a rotation with a promise to take their feedback to heart so that no one rotating through your department has the experience they described. Way distant third would be offering no evidence, combined with some things that sound objectively off ("prefer to stand") while tossing in a weird mix of non-committal emojis and over enthusiastic exclamation points.

Then to post 3 times in a row, tell a poster you remembered them IRL and saying you're glad they enjoyed the rotation when their post said they made it 6 hours before saying "f this" is actively hurting your cause. It comes across in a similar vein to someone from a commune saying "Everyone's happy here and it's definitely not a cult".
 
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DO3

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Rotated here + 3 other places in med school. Ended up not doing residency here due to wanting to be closer to home. Been an attending for several years now (not at this program), so here are my thoughts:

The residents who graduate from this program likely are some of the best prepared for real-world, community EM in the whole country. As a student, I found the residents to be proud of their program and willing to teach. I found the attendings expected a lot out of students and residents, but most were still approachable and although they were tough, the attendings and the residents seemed to have a good, collegial relationship. Did I clean rooms, yes. Did I do EKGs, yes. Did I stand on the wall, yes, but at the same time, space is at a premium at this place. And I also would occasionally pull a stool out of a patient room and no one said anything to me about doing that. I really didn’t see it as “hazing” or a problem as others have alluded to. It’s not like a wall of shame or something. Space is just hard to come by. However, did I get a good, educational experience where I got to do a lot as a student and felt like I got a good amount of facetime with the attendings, PD, APDs, and residents? Yes, prob moreso than at my other rotations. I felt like they actually knew who I was at the end of it.

As far as facilities, it is an older ED, but to put it in perspective, they see 2x’s the number of patients per year that my current ED sees in about the same number of beds. They are efficient. I’ve often thought about what it would be like to go back and shadow as an attending, just to refresh on their processes and style of practice. I think I’d learn a lot.

The student rotation isn’t perfect, but nowhere is. As others have said, it’s a love it or hate it type place. If you don’t like working hard or being pushed, this probably isn’t the place for you.
 
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skougess

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Rotated here + 3 other places in med school. Ended up not doing residency here due to wanting to be closer to home. Been an attending for several years now (not at this program), so here are my thoughts:

The residents who graduate from this program likely are some of the best prepared for real-world, community EM in the whole country. As a student, I found the residents to be proud of their program and willing to teach. I found the attendings expected a lot out of students and residents, but most were still approachable and although they were tough, the attendings and the residents seemed to have a good, collegial relationship. Did I clean rooms, yes. Did I do EKGs, yes. Did I stand on the wall, yes, but at the same time, space is at a premium at this place. And I also would occasionally pull a stool out of a patient room and no one said anything to me about doing that. I really didn’t see it as “hazing” or a problem as others have alluded to. It’s not like a wall of shame or something. Space is just hard to come by. However, did I get a good, educational experience where I got to do a lot as a student and felt like I got a good amount of facetime with the attendings, PD, APDs, and residents? Yes, prob moreso than at my other rotations. I felt like they actually knew who I was at the end of it.

As far as facilities, it is an older ED, but to put it in perspective, they see 2x’s the number of patients per year that my current ED sees in about the same number of beds. They are efficient. I’ve often thought about what it would be like to go back and shadow as an attending, just to refresh on their processes and style of practice. I think I’d learn a lot.

The student rotation isn’t perfect, but nowhere is. As others have said, it’s a love it or hate it type place. If you don’t like working hard or being pushed, this probably isn’t the place for you.
You cleaned rooms and did EKGs. I don’t care if you got 20 tubes and 10 CVLs that month. They abused you.
 
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EMhawkeye

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You cleaned rooms and did EKGs. I don’t care if you got 20 tubes and 10 CVLs that month. They abused you.
I have noticed this sense of entitlement on medical twitter. You are a medical student. You are there to learn. You are also there to help the department teaching you with some labor in exchange for doing so.
No job is beneath you.
This is the same crowd crying about employment is "human rentals" or pimping you on rounds makes a place "toxic".
Get over yourself.
 
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skougess

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I have noticed this sense of entitlement on medical twitter. You are a medical student. You are there to learn. You are also there to help the department teaching you with some labor in exchange for doing so.
No job is beneath you.
This is the same crowd crying about employment is "human rentals" or pimping you on rounds makes a place "toxic".
Get over yourself.
Bull****. Every job in the hospital is important. I thank our janitorial staff regularly, and especially when they are cleaning the trauma room between codes, making sure they know how no one can do their job in the hospital without them. But a medical student, like you said, is there to learn. And they are paying $50k/yr to do so. I would never make a medical student get an EKG or clean a room. Respect their role and don’t make them clean rooms. Teach them. Or pay them.
 
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I have noticed this sense of entitlement on medical twitter. You are a medical student. You are there to learn. You are also there to help the department teaching you with some labor in exchange for doing so.
No job is beneath you.
This is the same crowd crying about employment is "human rentals" or pimping you on rounds makes a place "toxic".
Get over yourself.

Lol I had to carry the lunch trays of my surgery residents etc on my trauma rotation as a third year in the 90s. At the most recent academic institution I worked at they didn’t even have to pre-round or stay overnight on surgery rotations, so they’d have time to study. Let alone take q3 call. Different times tho. Not sure I learned much except how to survive hazing, sleep deprivation and getting yelled at for my poor retractor holding in the OR.

I did get some semblance of revenge though. I lived in a big rented house and we had great Halloween parties every year (imagine 200 people all in a costume). One of the PGY 3s was a real jerk to us students. He was married to a nurse and he was on call so she went to the party by herself. I was going to upstairs to my bed when I caught her in my room with one of the ER residents. I politely threw them out but whenever I encountered him in the hospital afterwards I always had a small, secret grin on my face…
 
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Fox800

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I have noticed this sense of entitlement on medical twitter. You are a medical student. You are there to learn. You are also there to help the department teaching you with some labor in exchange for doing so.
No job is beneath you.
This is the same crowd crying about employment is "human rentals" or pimping you on rounds makes a place "toxic".
Get over yourself.
Strongly disagree. There are people paid to do these things. Do you know who is not getting paid, and actually losing money to be there? The medical student. Each time they're cleaning a bed or doing scut work that the tech should be doing, they could be learning something.

Do not rotate or interview at places that make you do this scutwork BS.
 
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Lexdiamondz

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I have noticed this sense of entitlement on medical twitter. You are a medical student. You are there to learn. You are also there to help the department teaching you with some labor in exchange for doing so.
No job is beneath you.
This is the same crowd crying about employment is "human rentals" or pimping you on rounds makes a place "toxic".
Get over yourself.
disagree

med students are paying hundreds of thousands of dollars to learn. scutting them out by making them do labour that your techs are paid to do is abusive. doing ekgs and cleaning rooms do nothing to further your actual medical knowledge.
 
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RustedFox

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I'll argue that learning to do an EKG is learning.

I used to get a touch agitated when some RN/techs used to hand me awful tracings and say things like: "that's as good as we could get", and then I look at the chest and the leads are just haphazardly slapped on there.
 
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If you don’t like working hard or being pushed, this probably isn’t the place for you.
Something about this just irritated me. I've never even heard of this place; I would have to look up where this is. Your comment at the end here sounds condescending. If you gave your same pitch to someone at UTSW or USC-LAC, they would probably laugh at you. And, in EM, people have heard of UTSW and USC-LAC.

I guess what I'm saying is, is that this Integris place doesn't have any semblance of singular ownership of that sentiment.
 
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sylvanthus

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I have noticed this sense of entitlement on medical twitter. You are a medical student. You are there to learn. You are also there to help the department teaching you with some labor in exchange for doing so.
No job is beneath you.
This is the same crowd crying about employment is "human rentals" or pimping you on rounds makes a place "toxic".
Get over yourself.

You are NOT there as slave labor. You pay a crazy amount of money in tuition per year, no reason you need to be peoples bitch in addition.

This attitude makes for weak med students, weak residents, and attendings that roll over and do what everyone tells them to do. Have a spine.
 
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southerndoc

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disagree

med students are paying hundreds of thousands of dollars to learn. scutting them out by making them do labour that your techs are paid to do is abusive. doing ekgs and cleaning rooms do nothing to further your actual medical knowledge.
Cleaning rooms, yea, probably not going to help a medical student's education.

However, doing EKG's is something many medical students have no idea how to do efficiently when they graduate. In order to read EKG's, you really should know how to obtain them. Lead placement can have serious effects on EKG's (especially lead reversals). For that reason, EVERY medical student should be learning to obtain EKG's in the ER. We don't currently require our students to do them, but it gives me food for thought to discuss with residency leadership about having them hang out with the techs for a few hours to get comfortable doing them.
 
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Fox800

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Sounds like a lack of resiliency here. Probably think getting ask to hold a retractor is “abuse”, overnight call is “inhumane” etc
It seems that MOAR mandatory wellness lectures are required. On your day off. At 0700. And you need to dress up. No, you can't watch them on Zoom.

Maybe if you just did more yoga you'd be more resilient.
 
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bravotwozero

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Sep 19, 2004
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Cleaning rooms, yea, probably not going to help a medical student's education.

However, doing EKG's is something many medical students have no idea how to do efficiently when they graduate. In order to read EKG's, you really should know how to obtain them. Lead placement can have serious effects on EKG's (especially lead reversals). For that reason, EVERY medical student should be learning to obtain EKG's in the ER. We don't currently require our students to do them, but it gives me food for thought to discuss with residency leadership about having them hang out with the techs for a few hours to get comfortable doing them.
I did an EM rotation at texas A & M as a Med student, and they required the Med students to obtain an ekg and place leads as part of their procedure logs requirement.
 

emergentmd

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I see utility in being able to put on EKG leads, peripheral lines as a med student esp when slow.

I can see a med student helping to turn over rooms on those rare days when busy, short staffed, all hands on deck so pts can be seen. But the attendings better be cleaning the rooms too.

Having med students clean the rooms on a typical day is abusive and is not a program I would want to be at. Having medical students stand on a wall b/c there are no places to sit is abusive. If you have no space, then don't bring in med students. If you are adamant about having students, create some space.

To say that Integris produces some of the best prepared community docs is laughable.
 
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EMhawkeye

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It seems that MOAR mandatory wellness lectures are required. On your day off. At 0700. And you need to dress up. No, you can't watch them on Zoom.

Maybe if you just did more yoga you'd be more resilient.
I laughed when my classmates complained about 80 hr work weeks coming from an internal medicine residency initially .
No perspective.
Im a young guy but firmly believe tough programs in the 1980’s and earlier turned out better products from residency.
Residency and med school are supposed to be hard. Thats where learning and growth happens.
Now the med students wine if you ask them questions. The residents will probably start demanding 20 hr work weeks and q2 hr massages.
 

skougess

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I laughed when my classmates complained about 80 hr work weeks coming from an internal medicine residency initially .
No perspective.
Im a young guy but firmly believe tough programs in the 1980’s and earlier turned out better products from residency.
Residency and med school are supposed to be hard. Thats where learning and growth happens.
Now the med students wine if you ask them questions. The residents will probably start demanding 20 hr work weeks and q2 hr massages.
Have you considered a career in administration?
 
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