Integris Health EM Rotation

[NicMouse64]

The problem is isolated to the ED. In the surgical and medicine floors, medical students are treated well by staff and physicians although it is not an academic service. We were invited into the Physician lounge, given free food, and I was allowed to get hands-on experience with procedures such as LPs, intubations, and CVLs. When I talked to those rotating in the ED they thought I was lying and they got a little bitter. YMMV but I'd say stay away from the ED rotation there.

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[RoyBasch]

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...

This sounds like the worst program I have ever heard of. Literally. If you are allowing people to treat you this way in this day and age, even as a student, you are making mistakes.

The "Love it" aspect of this program, sounds pretty par for the course for any regular program. Running codes, doing lines, what? You will do those in any residency without the 1950s fraternity hazing style humiliation.

 

[Fox800]

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 transferring to a general surgery residency program?

 

[GonnaBeADoc2222]

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.

A medical student should never be cleaning rooms.

Attendings cleaning rooms?? Surely you jest. When the hospital CEO comes down and does this, that's when you'll catch me doing it.

 

[EMhawkeye]

Have you considered a career in administration?

I'm sorry Mrs Smith. Your husband died because when the doctor could have been at the hospital learning about this condition, he was engaging in wellness activities and getting a mandatory foot massage as part of his 40 hr work week. Rest assured though, at least your doctor had no signs of burnout when he pronounced him dead.

 

[GeneralVeers]

A medical student should never be cleaning rooms.

Attendings cleaning rooms?? Surely you jest. When the hospital CEO comes down and does this, that's when you'll catch me doing it.

They asked us once as attendings to "help out the nurses" and start IVs on patients. I politely declined.

 

[sylvanthus]

I'm sorry Mrs Smith. Your husband died because when the doctor could have been at the hospital learning about this condition, he was engaging in wellness activities and getting a mandatory foot massage as part of his 40 hr work week. Rest assured though, at least your doctor had no signs of burnout when he pronounced him dead.

Best get back to work/studying instead of wasting time on here so you can save lives dude. I expect you to sleep no more than 4 hours tonite.

 

[sylvanthus]

I'm sorry Mrs Smith. Your husband died because when the doctor could have been at the hospital learning about this condition, he was engaging in wellness activities and getting a mandatory foot massage as part of his 40 hr work week. Rest assured though, at least your doctor had no signs of burnout when he pronounced him dead.

“I passed all my steps on the first attempt however my scores on the step were approx 210/ 230 respectively.”


You shoulda worked harder in med school. You prob just killed people with your lack of dedication and hard work.

 

[SeekerOfTheTree]

Some of the people on here are trolling right? I mean because we were medical students and we had to do it doesn't mean we should continue the culture of abuse. I remember a time when women couldn't vote either but times change because that was stupid and so is hazing medical students. I am sorry I know where leads on an EKG go but I would never do an EKG because if we are that busy then my time is more valuable seeing patients...if we are so slow than the tech gets paid enough to do it. Not sure why we as physicians always just try to make it worse for each other while NPs/PAs are always finding ways to make it better for each other. We hate each other so much that we want suffering for our colleagues to continue. We need to work over 80 hours so we can do that 3rd life saving appendectomy in the middle of the night.

When is the last time one of us who works in the community has thought to themselves "man, if only I had worked a hundred hours a week I could have saved Mrs. X with my knowledge of Y?"

 

[MedScat]

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!

As a medical student, I find it VERY important to tell you that NO MED STUDENT WANTS TO STAND - we want to sit, we always want to sit. So get this silly assumption out of your, and everyone else head.

 

[Birdstrike]

I remember a time when women couldn't vote

Damn, you're old.

 

[Birdstrike]

As a medical student, I find it VERY important to tell you that NO MED STUDENT WANTS TO STAND - we want to sit, we always want to sit.

"Sitting is hard. But not as hard as standing." - A medical student.

 

[GonnaBeADoc2222]

They asked us once as attendings to "help out the nurses" and start IVs on patients. I politely declined.

I have to start the IV 10% of the time anyway cause "tough stick"

 

[bravotwozero]

I'm sorry Mrs Smith. Your husband died because when the doctor could have been at the hospital learning about this condition, he was engaging in wellness activities and getting a mandatory foot massage as part of his 40 hr work week. Rest assured though, at least your doctor had no signs of burnout when he pronounced him dead.

The only place where foot massages and 40 hour workweeks are a thing for EP’s, (resident or otherwise) is if you work for ABEM.

 

[GeneralVeers]

The only place where foot massages and 40 hour workweeks are a thing for EP’s, (resident or otherwise) is if you work for ABEM.

I think they only get one foot massage during the Hawaii "retreat".

 

[EMhawkeye]

Best get back to work/studying instead of wasting time on here so you can save lives dude. I expect you to sleep no more than 4 hours tonite.

And I worked by rear end off in residency. Saw and learned from as many patients as I could. Read up on my patients every night.
I knew residency was going to be the last time I was in a structured academic program and wanted to take full advantage.
I didn't think of residency as just ab obstacle to get past and half a$$ my way through.
Wish that attitude was more common.

The attitude on this thread is a little disturbing. The worst inner attitudes of doctors coming out. Arrogant little medical students who think placing an IV or ambulating a patient is a job below them. That arrogance as a medical student, I can only imagine the narcissism that has blossomed as an attending.

 

[skougess]

And I worked by rear end off in residency. Saw and learned from as many patients as I could. Read up on my patients every night.
I knew residency was going to be the last time I was in a structured academic program and wanted to take full advantage.
I didn't think of residency as just ab obstacle to get past and half a$$ my way through.
Wish that attitude was more common.

The attitude on this thread is a little disturbing. The worst inner attitudes of doctors coming out. Arrogant little medical students who think placing an IV or ambulating a patient is a job below them. That arrogance as a medical student, I can only imagine the narcissism that has blossomed as an attending.

You do realize there’s a difference between thinking a job is below you versus refusing to be abused, right? You’re not harder working, or a more “pure” physician than us. You’re just a pushover.

I bet you thought it was reasonable for physicians to volunteer their time administering Covid vaccines alongside nurses making $5k/week to do the same job.

 

[EMhawkeye]

You do realize there’s a difference between thinking a job is below you versus refusing to be abused, right? You’re not harder working, or a more “pure” physician than us. You’re just a pushover.

I bet you thought it was reasonable for physicians to volunteer their time administering Covid vaccines alongside nurses making $5k/week to do the same job.

If you think being asked to start an IV, perform an ekg, or turn over an occasional room is abuse; you have had a very pampered and uneventful life.

Millennial mentality run wild in here

.

 

[skougess]

If you think being asked to start an IV, perform an ekg, or turn over an occasional room is abuse; you have had a very pampered and uneventful life.

Millennial mentality run wild in here

.

I’m being serious. Apply for admin positions. They will love you.

 

[EMhawkeye]

I’m being serious. Apply for admin positions. They will love you.

Some argue that a tiara clashes with scrubs and lab coats, I wonder how some princesses in the ER pull it off.

Say some of the things here to where you are going to do audition rotations. Give them a long list of the things you refuse to do, the hours you are available during the month (work/ life balance). I'm sure that will go over well.

I weep for the future of medicine.

 

[Pokemed2014]

I trained at Integris Southwest, and reading these definitely brings back memories of my medical school rotation here. As a student, I did help to turn over rooms during down time and grabbed plenty of EKGs on rotation, but it was definitely not required or expected. As many others have said, there are plenty of students during audition months, and showing you are not above any one job in the ED helps to not only show your work ethic but also builds report with the nurses and techs that you may be doing the next four years with.
This program really isn’t for everyone as it is very physically and mentally demanding, and as with anything, different people learn and thrive in different environments. This program pushes you to see as many patients as possible day in and day out, requires you to develop efficient work flow practices, and overall prepares you for any fast paced high acuity community setting. It’s a level 2 setting so no dedicated trauma call, however it is located in the south side of OKC where trauma is abundant and where the south side locos live (look up gangland). The unopposed setting is nice as the residents have access to any and all procedures in the hospital, and you directly interact with the subspecialist attendings who genuinely love helping train the EM residents (probably so they do not get called in the middle of the night for random stuff).
I hated the wall and lack of seating (which has been addressed since my time as above) while I was a student also, but ultimately that had no impact on where I chose to do my four years of training. This program gives you to the patient volume, diversity, and confidence to start moonlighting during your second year. I am a firm believer that moonlighting is a crucial step in the smooth transition from a resident to an attending, and overall helps you get more out of your residency experience once you know what it is like being on your own… plus the extra money is very nice! I ended up doing 2000+ hours of moonlighting during residency and had no issues after graduation. Moonlighting different places gives you the experience of working in resource limited settings, different nursing cultures, etc.
Overall I’m very blessed to have had the opportunity to train at such a great program and wouldn’t have changed anything looking back on it now.

 

[GassYous]

If you're pushing stretchers, cleaning rooms or doing anything else that is part of someone else's job description then you're being abused. What next, having medical students give discharge instructions or start wiping toilets? Your dysfunctional system needs to hire more orderlies, janitors or nurses. I say this as someone who did not have a pampered life and also trained in New York so know all about scut.

 

[skougess]

Say some of the things here to where you are going to do audition rotations. Give them a long list of the things you refuse to do, the hours you are available during the month (work/ life balance). I'm sure that will go over well.

I weep for the future of medicine.

Im a senior resident. Matched at a place that respected my role as a medical student when I rotated there. In turn, I respect my medical student’s roles as well.

 

[EMhawkeye]

Im a senior resident. Matched at a place that respected my role as a medical student when I rotated there. In turn, I respect my medical student’s roles as well.

I'm sorry the medical student tag on your profile and attitude threw me off.

 

[GeneralVeers]

If they want med students or attendings to do the job of techs or nurses I'm okay with that. Just pay the appropriate rate for doing the extra job on top of regular pay. By "helping out" you are just helping evil hospital corporations like HCA avoid hiring sufficient staff.

 

[Fox800]

If you think being asked to start an IV, perform an ekg, or turn over an occasional room is abuse; you have had a very pampered and uneventful life.

Millennial mentality run wild in here

.

OK, boomer.

Someone had to say it.

Will I wipe down a bed or put sheets on if someone is sick and needs a room? Or start an IV if I'm bored? Sure, once in a blue moon. But it isn't my job to do this on the regular. Stay in your lane. Do your job. Know your worth. Don't get walked on.

 

[emergentmd]

A medical student should never be cleaning rooms.

Attendings cleaning rooms?? Surely you jest. When the hospital CEO comes down and does this, that's when you'll catch me doing it.

To each his own. I won't hold it against anyone for always refusing. I have turned over a room as an attending but can count on one hand in 20 yrs. If we are short of staff b/c a bunch of call ins, place is slammed, and if everyone is running around fully stretched then I will definitely turn over a room.

But would only if this was a rare instance and not b/c the hospital deemed working short was the way to run an ER.

 

[The kitchen sink]

If you think being asked to start an IV, perform an ekg, or turn over an occasional room is abuse; you have had a very pampered and uneventful life.

Millennial mentality run wild in here

.

I’m a millennial and I did all of those things and at first I felt it towed the line of abuse versus responsibility; especially having trained at these inner city hospitals with strong unionized nursing. However, as I’ve become an attending I actually look back at a lot of those experiences positively. I won’t list all the reasons but if I’m spending all day telling my RNs to place IVs, get EKGs, transport pts etc…. It makes a huge difference when they know you’ve done all of that in the past without hesitation, and you can run your unit much more efficiently with that sort of mutual respect. Just my personal experience.
And although I don’t go around looking for more work, it does feel pretty damn good to get an IV on a pt even the most seasoned nurses couldn’t get, once in a while.
In my training program, the residents unionzed and actually changed hospital bylaws creating a system where all peripheral blood draws had to be done nursing and phlebtomy (in addition to the routine hours they did them). A small victory but our group of residents definitely wanted to break the cycle of abuse.

 

[Arcan57]

Can we get Hawkeye some "Hardcore" flair so when he posts people know that truth is being piped straight into their eyeholes by the EM equivalent of Chesty Puller?

I've done 116 hr weeks on a surgery rotation, 36 hour L&D shifts, powering through 2 months of medicine wards while coughing constantly from what would eventually be diagnosed as a pneumonia. I went hard core as a student, I did some cool stuff (thanks giant Chinese neurosurgeon that let me do a bedside burrhole!). Mostly though, I learned how to be physically in a hospital for long periods of time. I learned to internalize, then externalize, some of the worst aspects of medical culture. I learned how to tolerate abuse, function in a hierarchy where punching down is encouraged, and mistake being present for actually caring. I learned how to view patient needs as obstacles to fulfilling the lowest hierarchy of Maslow's pyramid. I learned that bringing carbohydrates to the team was more important than learning how to take care of patients.

I don't miss that time. In residence, we also went hard (I agree with some of your points regarding residency) but it had purpose. And there were classmates that came from much cushier med schools that were better prepared and more successful initially than the ones from resource destitute county programs. If you make it out of med school caring about patients and with a drive to be personally excellent as a doctor, that's a win. If you need austerity to meet those metrics, then find austere programs. But this fiction that the only (or even best) way to train docs is by dropping them into punishing environments that lack the resources to perform their stated mission needs to end.

That environment is a great place to learn how to suck it up and keep going, but that's not a long term strategy. Admin, insurers, and private equity all take advantage of the fact that we adapt to suboptimal conditions by nature of our training. At some point, we're going to adapt in a way that fundamentally breaks the specialty. If we're going to stop that, it's going to be because of pushback from docs that don't consistently meet every new hardship with "Bring it on".

 

[Siggy]

I'm sorry the medical student tag on your profile and attitude threw me off.

He does that on purpose, apparently, because he thinks false advertising is being sly.