Is M3 supposed to be super hands-on?

[Hollow Knight]

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Hi guys. I'm only on my second rotation now as a new M3. So far it's been hit or miss. Sometimes I see patients, staff them with attendings, and write notes, but a shocking amount of time so far has just been shadowing (and I'm at a somewhat well-regarded MD school).

Is this normal? Any tips for getting to do more? I am admittedly a very reserved "don't rock the boat" person, but I have asked on some of my less-involved weeks to see/present patients, and at times the attending/resident just tells me not to.

It's definitely not a work ethic thing- I'll be getting to the hospital at 4:30am tomorrow to preround. I'll write notes, but the team won't read them, and I won't present the patients at checkout (the team I'm with just doesn't do those things). I also don't think it's an attitude thing- the surgery residents I was with the previous few weeks thanked me for being such a good and interested student. And I was interested, and they were nice to me...... but I still spent 95% of my time on that rotation watching other people instead of doing anything myself. I maybe sutured like 3 port sites closed in the whole time I was with that team.

I'm just wondering if this is a typical M3 experience or if I should be raising hell with administration. All my preclinical attendings were like "Go work your butt off M3 and get all the experience you can!" But if nobody reads my notes or listens to me present, how do I get better? I can sit around reading Harrison's at home.........

For the record, I want to do primary care. I don't give a rip about honors. But I want to be a good doctor, and as an M3 I'm doing the same stuff I did as a premed student greater than 50% of the time.

 

[DarkBluMage]

Hi guys. I'm only on my second rotation now as a new M3. So far it's been hit or miss. Sometimes I see patients, staff them with attendings, and write notes, but a shocking amount of time so far has just been shadowing (and I'm at a somewhat well-regarded MD school).

Is this normal? Any tips for getting to do more? I am admittedly a very reserved "don't rock the boat" person, but I have asked on some of my less-involved weeks to see/present patients, and at times the attending/resident just tells me not to.

It's definitely not a work ethic thing- I'll be getting to the hospital at 4:30am tomorrow to preround. I'll write notes, but the team won't read them, and I won't present the patients at checkout (the team I'm with just doesn't do those things). I also don't think it's an attitude thing- the surgery residents I was with the previous few weeks thanked me for being such a good and interested student. And I was interested, and they were nice to me...... but I still spent 95% of my time on that rotation watching other people instead of doing anything myself. I maybe sutured like 3 port sites closed in the whole time I was with that team.

I'm just wondering if this is a typical M3 experience or if I should be raising hell with administration. All my preclinical attendings were like "Go work your butt off M3 and get all the experience you can!" But if nobody reads my notes or listens to me present, how do I get better? I can sit around reading Harrison's at home.........

For the record, I want to do primary care. I don't give a rip about honors. But I want to be a good doctor, and as an M3 I'm doing the same stuff I did as a premed student greater than 50% of the time.

Try to be more aggressive about presenting patients and participating in patient care. Having students slows them down, but this is our education and we are paying for access to learn from residents/attendings. I tried to do as much as they would allow me to do as a student, even as far as making incisions, operating scopes etc. I was vocal about wanting to be as involved as possible. Closed mouths don’t get fed. You’re not there to shadow, you’re there to train as a future physician. Just be careful how you phrase things. Make sure to put the focus on your training and wanting to make sure you’re doing things right and well so no one gets defensive or dismisses your attempts to be involved.

 

[operaman]

Yeah pretty typical actually. Very team dependent and a super busy service may just be grinding through the work. You’re doing the right things so keep at it. EMR has destroyed most of inpatient note writing - interns just copy forward the last note and tweak the numbers that changed (if they remember). And nobody reads most of their notes either.

Definitely keep asking to do things, especially to present and be part of rounds and periop mgmt. Practice your sewing and knot tying at home and during down time at the hospital. The better you are, the more they will let you do, and the more they see you practicing the more they will let you do.

The other big trick for getting to do stuff body positioning. If you’re standing/seated in the circle and part of the discussion, much more likely you’ll end up part of the discussion. So many students sit back in the shadows and it’s easy to forget about them. Same for procedures - ask to do the thing that comes before the procedure. Wanna do a central line? Ask to prep and set up, or to ultrasound the vessels. Want to intubate? Then ask to practice masking during induction. If you’re already standing there in position, half the time you’ll just get to do the whole thing.

 

[ACSurgeon]

Try to be more aggressive about presenting patients and participating in patient care. Having students slows them down, but this is our education and we are paying for access to learn from residents/attendings. I tried to do as much as they would allow me to do as a student, even as far as making incisions, operating scopes etc. I was vocal about wanting to be as involved as possible. Closed mouths don’t get fed. You’re not there to shadow, you’re there to train as a future physician. Just be careful how you phrase things. Make sure to put the focus on your training and wanting to make sure you’re doing things right and well so no one gets defensive or dismisses your attempts to be involved.

Yes. Try to be more aggressive as a student on a surgery rotation and come back and report to the group. That’ll go over very well…

 

[ACSurgeon]

Hi guys. I'm only on my second rotation now as a new M3. So far it's been hit or miss. Sometimes I see patients, staff them with attendings, and write notes, but a shocking amount of time so far has just been shadowing (and I'm at a somewhat well-regarded MD school).

Is this normal? Any tips for getting to do more? I am admittedly a very reserved "don't rock the boat" person, but I have asked on some of my less-involved weeks to see/present patients, and at times the attending/resident just tells me not to.

It's definitely not a work ethic thing- I'll be getting to the hospital at 4:30am tomorrow to preround. I'll write notes, but the team won't read them, and I won't present the patients at checkout (the team I'm with just doesn't do those things). I also don't think it's an attitude thing- the surgery residents I was with the previous few weeks thanked me for being such a good and interested student. And I was interested, and they were nice to me...... but I still spent 95% of my time on that rotation watching other people instead of doing anything myself. I maybe sutured like 3 port sites closed in the whole time I was with that team.

I'm just wondering if this is a typical M3 experience or if I should be raising hell with administration. All my preclinical attendings were like "Go work your butt off M3 and get all the experience you can!" But if nobody reads my notes or listens to me present, how do I get better? I can sit around reading Harrison's at home.........

For the record, I want to do primary care. I don't give a rip about honors. But I want to be a good doctor, and as an M3 I'm doing the same stuff I did as a premed student greater than 50% of the time.

This is mostly normal. You’ll learn a lot by being there. Try to make small talk with the residents and be well liked.

The part about being mostly ignored is thanks to years of medical students complaining about being offended during rounds and “being forced to do scut work”. Now, it’s much easier for a resident to smile at you and complement you and proceed to ignore you. Because when they used to care about student teaching, they got written up for offending the student by asking questions on rounds or giving the student a chore that was deemed beneath them.

 

[operaman]

This is mostly normal. You’ll learn a lot by being there. Try to make small talk with the residents and be well liked.

The part about being mostly ignored is thanks to years of medical students complaining about being offended during rounds and “being forced to do exit work”. Now, it’s much easier for a resident to smile at you and complement you and proceed to ignore you. Because when they used to care about student teaching, they got written up for offending the student by asking questions on rounds or giving the student a chore that was deemed beneath them.

Sad but all too true.

I remember a clerkship feedback group after my m3 surgery rotation and students who’d been on service with me saying the conditions were abusive and they were doing scut and it blew my mind because I was literally right beside them in those moments and didn’t take it that way at all.

Then definitely saw residents get crap about students saying they overworked them and whatnot. Much easier to ignore.

For seemingly interested students I actually went to a system of offering them above and beyond experiences (fresh cadaver dissections, drilling mastoids in the bone lab, etc) but only AFTER the rotation if they were interested. They would have to text me to set up a time. That seemed to ensure only students who really cared would reach out since it was long past grade/eval time.

 

[Hollow Knight]

Sounds like I'm being dramatic.

While of course students should be treated well, it really is sad that for some people, pimping = abuse. I was an undergraduate chemistry tutor and I "pimped" my students all the time because it's a great way to teach. Better to see if you can remember the answer than for me to stand there and lecture at you.

I appreciate all the current (and future) recommendations

 

[DarkBluMage]

Yes. Try to be more aggressive as a student on a surgery rotation and come back and report to the group. That’ll go over very well…

Worked well for me. Tact matters

 

[ACSurgeon]

Worked well for me. Tact matters

I just don’t like the A word…

 

[DarkBluMage]

I just don’t like the A word…

lol ok

 

[xDNA]

Hi guys. I'm only on my second rotation now as a new M3. So far it's been hit or miss. Sometimes I see patients, staff them with attendings, and write notes, but a shocking amount of time so far has just been shadowing (and I'm at a somewhat well-regarded MD school).

Is this normal? Any tips for getting to do more? I am admittedly a very reserved "don't rock the boat" person, but I have asked on some of my less-involved weeks to see/present patients, and at times the attending/resident just tells me not to.

It's definitely not a work ethic thing- I'll be getting to the hospital at 4:30am tomorrow to preround. I'll write notes, but the team won't read them, and I won't present the patients at checkout (the team I'm with just doesn't do those things). I also don't think it's an attitude thing- the surgery residents I was with the previous few weeks thanked me for being such a good and interested student. And I was interested, and they were nice to me...... but I still spent 95% of my time on that rotation watching other people instead of doing anything myself. I maybe sutured like 3 port sites closed in the whole time I was with that team.

I'm just wondering if this is a typical M3 experience or if I should be raising hell with administration. All my preclinical attendings were like "Go work your butt off M3 and get all the experience you can!" But if nobody reads my notes or listens to me present, how do I get better? I can sit around reading Harrison's at home.........

For the record, I want to do primary care. I don't give a rip about honors. But I want to be a good doctor, and as an M3 I'm doing the same stuff I did as a premed student greater than 50% of the time.

Sounds really typical. Your whole clerkship experience will be heavily based on your team. Same thing happened to me, like I would stand scrubbed into a laparoscopic surgery for hours not doing anything, and then when its time to close, do the one smallest port hole.

 

[Tenk]

Residents are not attendings, they are still learning. This is one of the downsides of big academic centers: too many learners. As an MS3 you’re at the bottom of the “get to do cool stuff” list. For instance, when I was a PGY-1 and a procedure came into the ED, I was going to jump all over that. When I was a PGY-3 and there weren’t any PGY-2 or PGY-1 and a student was around, I’d take the time to walk them through it. A lot of time it’s just chance and when you have a crap ton of residents around, chances are you won’t take priority… yet.

Pro tip: some of my best rotations were out in small town nowheresville where I got to scrub in and first assist on every single surgical case or present every single patient independently to a private practice FP. If you can, try to do some smaller independent rotations in podunk towns. They rock and you learn more for sure.

 

[WIFEL585]

Not really. Much isn’t expected as a medical student. Most of what you need can be learned in residency but even if you slack off in residency and feel underprepared at the end of it, you can always do fellowships to narrow in on scope / fill in gaps in knowledge / training.

Just enjoy being a medical student where your responsibilities basically don’t matter.

 

[DarkBluMage]

Not really. Much isn’t expected as a medical student. Most of what you need can be learned in residency but even if you slack off in residency and feel underprepared at the end of it, you can always do fellowships to narrow in on scope / fill in gaps in knowledge / training.

Just enjoy being a medical student where your responsibilities basically don’t matter.

I hate this view of medical school. We’re not paying 100’s of thousands of dollars to shadow. It’s such a waste of a students time. If basically waiting until residency to learn to be a physician is the standard then medical school should be cut down and made more efficient. It’s disrespectful to pay so much money to learn and train just to be shoved aside like our education in this phase isn’t important. And before anyone gets in their feelings, I understand that med students are low on the totem poll in terms of those who need to be taught. However, that doesn’t mean it’s acceptable for medical students to be relegated to essentially shadowing during the clinical phase of their education

 

[WIFEL585]

I hate this view of medical school. We’re not paying 100’s of thousands of dollars to shadow. It’s such a waste of a students time. If basically waiting until residency to learn to be a physician is the standard then medical school should be cut down and made more efficient. It’s disrespectful to pay so much money to learn and train just to be shoved aside like our education in this phase isn’t important. And before anyone gets in their feelings, I understand that med students are low on the totem poll in terms of those who need to be taught. However, that doesn’t mean it’s acceptable for medical students to be relegated to essentially shadowing during the clinical phase of their education

I mean yea, I totally agree with you but just explaining the way things are. As a resident / fellow you’re also pretty much expected to do whatever is told of you without that much say in changing the system / curriculum. Medical students will have even less ability to change anything because of the system.

Just play the game. I played it the same way. The system is flawed but there isn’t much that can be done about it.

 

[Hollow Knight]

Part of my frustration might be the difference in our healthcare system between specialists and generalists.

Yeah, if you're a MOHS surgeon, you're probably OK not remembering a good portion of the stuff you learned in medical school. You go to residency for a long time and learn to do that one job. In that case, spending M3 as a tourist is fine.

I want to be a rural FM doc. Theoretically, this means I should try to remember as much of all of this as possible, and have as many patient touches as possible in resource-poor settings (my med school is in a resource-poor setting).

From talking to friends at other schools, apparently my M3 year has been more hands-on than most. It just hasn't been as hands-on as I would like to be.

Although, it's not all bad- I was with a surgeon the other day who left the room (like I was a resident) and let me close every case, let me do TAP blocks, etc. But I wish every day of this rotation had been like that as opposed to just one day...... I'm going to operate with that surgeon now as much as I can. When I did my 28-hour call the nocturnist let me do a paracentesis. But these interactions are super rare.

I think the idea of "It's OK, they'll become competent in residency/fellowship" is OK if you're going to be a subspecialist. But for FM/general IM/general surgery, the idea of kicking the can of clinical training further and further down the road seems like a bad idea.

 

[WIFEL585]

Part of my frustration might be the difference in our healthcare system between specialists and generalists.

Yeah, if you're a MOHS surgeon, you're probably OK not remembering a good portion of the stuff you learned in medical school. You go to residency for a long time and learn to do that one job. In that case, spending M3 as a tourist is fine.

I want to be a rural FM doc. Theoretically, this means I should try to remember as much of all of this as possible, and have as many patient touches as possible in resource-poor settings (my med school is in a resource-poor setting).

From talking to friends at other schools, apparently my M3 year has been more hands-on than most. It just hasn't been as hands-on as I would like to be.

Although, it's not all bad- I was with a surgeon the other day who left the room (like I was a resident) and let me close every case, let me do TAP blocks, etc. But I wish every day of this rotation had been like that as opposed to just one day...... I'm going to operate with that surgeon now as much as I can. When I did my 28-hour call the nocturnist let me do a paracentesis. But these interactions are super rare.

I think the idea of "It's OK, they'll become competent in residency/fellowship" is OK if you're going to be a subspecialist. But for FM/general IM/general surgery, the idea of kicking the can of clinical training further and further down the road seems like a bad idea.

It’s still easily possible for FM. Do a lot of ER when you do your FM residency. If you dont feel proficient in procedures post FM residency there are 1-year rural ER fellowships in FM. ER fellows get 100% dibs on all procedures as it’s essentially mandated (not just optional, or if one is interested only) that ER providers are proficient in procedures such as intubation, thoracentesis/paracentesis, lumbar puncture, arterial / central lines, chest tubes, laceration repairs etc etc.