Is scutting your students good for them?

[Ypo.]

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I second the comment about interns from India. I can't say how their system is differs from ours, but I can say that most of the interns/residents/attendings I have worked with from India made an effort to teach and were damn good at it, too.

 

[roja]

Many foriegn medical systems function on a different educational philosophy which are based on more progressive adult educational models.

Some of the things you see are more specialty based. Surgery and IM, due to their long established fields, often function in a more 'traditional' educational banking, rank based educational model.

 

[swpm]

Because it is non-educational the only motivation to do clerical work is living under the threat of a bad eval

Here's the key - and I think this is a big part of what's getting lost in this devolving thread - the label "non-educational" is a subjective one.

Students and residents are not always the best judge of what is and isn't important to learn. That's why we have teachers. My daughter is a first-grader and she doesn't get to choose what she learns. I'm a PGY3 anesthesiology resident (23rd grader 🙂 ) and there are things I'm required to do for "educational" value that I don't necessarily agree with or appreciate.

The point is that all that crappy paperwork, from H&Ps to discharge summaries, are part of the practice of medicine, and you need to learn how to do it efficiently. What better time to practice those skills (and they are skills) than when you're a student?

 

[DarthNeurology]

Here's the key - and I think this is a big part of what's getting lost in this devolving thread - the label "non-educational" is a subjective one.

Students and residents are not always the best judge of what is and isn't important to learn. That's why we have teachers. My daughter is a first-grader and she doesn't get to choose what she learns. I'm a PGY3 anesthesiology resident (23rd grader 🙂 )

Well, I think there is a fair amount of infantalization of medical students to the point where some residents act like we don't know what is good for us. I do have a better appreciation of what is scut that a first grader, any college educated person could probably figure out what scut is and what it isn't. Then again first graders are taught by a curriculum and aren't ask to do things outside that curriculum, which medical students are asked to do. What would you say to your child's school if she was required to spend one hour a day watering the school's plants (without explanation of what the plants were) everyday after school. You would complain that is not her 'job' as a student, well the principle could say it is "educational" as she learns about gardening and how to water and how to budget her time on each plan and how to operate a hose. I'm sure even your daughter would agree that this isn't what children in school should be doing (first graders are pretty smart). Same with the residents, I don't NEED to run around getting vitals on 30 patients, especially when I don't even have to time to analyze them and on patients I am not following and have no idea what they have, it is this sort of attitude that "Skippy" should be given a little job to help him/her become an adult. How does running things to lab become educational? I have never had an educational discuss with lab technicians?? Yet, I am asked to do this frequently by residents, only by living under the threat of bad eval . . . so resident's do abuse their power to a certain extent.

 

[DarthNeurology]

Many foriegn medical systems function on a different educational philosophy which are based on more progressive adult educational models.

Some of the things you see are more specialty based. Surgery and IM, due to their long established fields, often function in a more 'traditional' educational banking, rank based educational model.

I have seen American surgeon attendings that are pure snobs when it comes to students in their OR, so much so that it is generally tollerated in the american medical system. I have worked with indian surgery attendings who were more nicer to me than the american attendings, so much so that it is a culture shock. So basically one does not need to be a supreme pain the !@&% to be an excellent surgeon . . .

 

[Finding Chi]

It seems a little cynical to think that evaluations are the chief motivating factor behind student and resident actions. This surely varies from program to program, but I can say that as a resident my attending evals frankly do not have a huge effect on my career. Knowing a few faculty who can write good letters of rec far outweighs any given month's eval. Most of my motivation to do scut work is necessity. Working in an underfunded public hospital, if I (or members of my team) don't do it, no one will. Am I being taken advantage of? Probably. Welcome to life.

Certainly evals do matter more for students, and I think that's important for all residents to keep in mind. Negative comments will follow a student through their residency application and dean's letter, so it is probably better to err on the side of not lambasting unless things were really ugly.

That said, the best medical students I've worked with, and the one's who I was most excited to teach, were the those who showed true enthusiasm for medicine. By and large, and maybe I'm being a bit pie in the sky, their main motivation really seemed to be good patient care. Their learning was directed at helping solve clinical problems on the wards. As for scut work, they filled out forms, ran labs not because I was demanding it, but because they were in the best position to do it (i.e not admitting their 10th patient of the night, answering night float pages etc), and because they knew the patient benefit (i.e. timely d/c, labs actually being drawn and sent). They understood... it's not about you, your grades, your evals or your shelf. It's about that dude over there dying in bed 3.

At the end of the day, they got the best evals from residents and attendings alike, and did not suffer on the shelf exams.

 

[swpm]

Well Darth, your strawman construction has now crossed over into the "willfully obtuse" zone. I defended the practice of assigning students to write discharge summaries; now you're claiming I'm condoning the use of students as specimen couriers.

Of course "scut" is bad - it is by definition non-educational. The problem is that various people in this thread have applied the label inappropriately to activities that involve skills critical to the practice of medicine. For example, the ability to put together a clear, concise bit of documentation in an efficient manner.

We're talking past each other, speaking of wholly different situations - and you're determined to be angry. There's no progress to be made in this debate. But carry on with the righteous indignation if it makes you feel better.

 

[DarthNeurology]

Most of my motivation to do scut work is necessity. Working in an underfunded public hospital, if I (or members of my team) don't do it, no one will. Am I being taken advantage of? Probably.

Certainly evals do matter more for students, and I think that's important for all residents to keep in mind. Negative comments will follow a student through their residency application and dean's letter, so it is probably better to err on the side of not lambasting unless things were really ugly.

That said, the best medical students I've worked with, and the one's who I was most excited to teach, were the those who showed true enthusiasm for medicine. By and large, and maybe I'm being a bit pie in the sky, their main motivation really seemed to be good patient care. Their learning was directed at helping solve clinical problems on the wards. As for scut work, they filled out forms, ran labs not because I was demanding it, but because they were in the best position to do it (i.e not admitting their 10th patient of the night, answering night float pages etc), and because they knew the patient benefit (i.e. timely d/c, labs actually being drawn and sent).

At the end of the day, they got the best evals from residents and attendings alike, and did not suffer on the shelf exams.

Sure I have always ran down labs with gusto as I knew it would benefit the patient, i.e. I would take the stairs instead of elevator and saw other students leisurely walk out of the unit with the ABGs, so they really didn't ask these students who were less interested in patient care do more and they got worse evals and didn't ace the steps . . . I already know that the way to do do excellently on a clerkship is to focus on the care of the patient and do what is necessary for excellent patient care, I have transported multiple patients at the wea hours of the am because our hospital only hired one transporter because they knew students would pick up the slack. However, there should be change so hospitals have more support for residents and students so that extra work doesn't become required work. It sucks when you show up to a rotation and the residents act like a donkey towards you and basically order you around all day doing things when they have time. Residents do have free time as I have worked with many there were so inefficient it made me want to cry because I knew I would have to do a lot of scut while they sat in the resident's call room. I was on a rotation where the chief resident told us "Nobody sleeps" (I never did because I was going crazy doing work and other students work) but heard he was in the call room sleeping by 2 am . . . he just wanted to make sure we got things ready by 6 am rounds.

In terms of motivation, if you are driving by a hospital on vacation doing you stop in and volunteer to help because there is a "man dying in bed 3"? Of course not, there are boundaries, all I am saying is that medical students should have more boundaries in place when in the hospital or at least make it official that we have to do all of this scut work as often one student is doing ALL the scut while the other lounge and are so lazy that the resident won't ask them again to stuff like do an ABG on that patient. There is a lot of scut that is NOT vital to patient care like filling out forms of non-educational value, regardless, attendings should be more upfront with students and tell them that they will be abused and asked to do a lot of things of no educational value.

 

[Ypo.]

How does running things to lab become educational?

Finding out where the lab is? I did this once with a resident.

Darth, how are you going to react to all this scut once you are a resident? I'm just curious.

Others make a valid point that this all has to do with the practice of medicine. It might not be as glamorous as we thought it was going to be when we started medical school, but it's the reality. It sounds like you have been scutted out a lot more than I have. But in a way, that's going to make you more prepared than I for residency.

The educational process in third year has been overall a disappointing and inefficient way to learn, what can I say? If people were more enthusiastic to teach, it could have been a lot better. But it's just the way it is, i suppose.

 

[pillowhead]

Finding out where the lab is? I did this once with a resident.

Darth, how are you going to react to all this scut once you are a resident? I'm just curious.

Others make a valid point that this all has to do with the practice of medicine. It might not be as glamorous as we thought it was going to be when we started medical school, but it's the reality. It sounds like you have been scutted out a lot more than I have. But in a way, that's going to make you more prepared than I for residency.

The educational process in third year has been overall a disappointing and inefficient way to learn, what can I say? If people were more enthusiastic to teach, it could have been a lot better. But it's just the way it is, i suppose.

As far as carrying specimens to the lab, if it's your patient as a student, and esp. if you were doing the procedure, you should take the specimen to the lab. Just like if you do a procedure, you should clean up after yourself and not expect the nurse or tech to do it. The priority for medical students should absolutely be education, but only one nanometer behind that is patient care. Esp. later in the year, medical students should be attempting to take complete care of their own patients. This includes the scutwork. You won't magically learn to do these things July 1st of intern year and it helps to have some idea of how to get things done.

Scutwork on patients you're not taking care of is a very different story. Only very rarely have I had a med student do something like that and it's usually under bad circumstances--like the other residents are in clinic and we have a crashing patient that needs urgent attention. In situations like these, if medical students expect to treated like full members of the team, then they need to act like full members of the team and help out. (Then they should be thanked accordingly and hopefully followed up with some one on one teaching or at least told to go home and the soonest reasonable time).

 

[DarthNeurology]

Finding out where the lab is? I did this once with a resident.

Darth, how are you going to react to all this scut once you are a resident? I'm just curious.

If I am not going to do a residency in Hospital X where I did say IM then no, I don't need to know where the lab is. When you have 7 patients in the ICU and you are running down labs for all of them this becomes 20+ lab runs in a day. I guess that is how I got my exercise. The worst scut jobs I have had is when a lab tech or somebody gets angry at me for not knowing the proper way to do things in their hospital (it becomes confusing after rotating at so many hospitals, which I have done). I.e. a lab tech tells me with a lot of attitude, "Don't you know that you need the white form not the yellow form" and complains about how the lab is getting all these messed up results, and I have to go back to the resident and get it fixed and then this happens with the same resident 10 times because they just tell me "Oh, go get the white form and fill it all out over again." I feel like telling them that I will never work in the hospital after I leave in two weeks and I am new here so get it that I am trying to do my best. Same thing in a new clinic where you are made to look like an idiot because "don't you know if a patient needs an ultrasound then you have to get the resident to this" Don't these people understand we haven't ever worked in their clinic and never will and could they please just tell me what @&!@&@! form I need without me having to grovel and tell them that it is my first day or week in clinic and I have needed gotten this form before?

I don't have a problem running stuff to the lab but when there isn't any teaching and the residents are all jerks I care less about NON-CARE related work. As students are pretty much defacto employees of the hospital we should get recognition for this, i.e. free meals like residents, more respect, and maybe even a tuition discount, I mean somebody should look into the legality of pushing students really hard with scutwork and not paying them, i.e. it might violate labor laws or something as we are taken advantage of.

As a resident, well, there ARE programs out there with competent nurses who do send labs off on their own and where everything is recorded electronically in the computer, the problem is hospitals where there is poor infrastructure support that rely on students too much. Residency will probably be easier as I will get used to the forms at 2-3 training sites and won't have to find what floor the lab is on every 3 months, I already know how to do hardwork and could do well at probably any hospital. I doubt I would scut students because if you want something done right you do it yourself.

 

[Anka]

Honestly, Darth, a lot of them don't know where you're coming from. They're shift workers who are told exactly what the policies are that are relevant to them, and many of them think that you're the same way. They think you just managed to forget the inservice you had on white versus yellow forms. They don't realize you've been awake continuously for 30 hours.

I once had an RN I had known for a while go off about a med student (second day in the clinics) who didn't know that it was really important to make sure the attending knew the patient was on Warfarin for a mechanical valve, given that major surgery was planned (it had, of course, been documented in her painfully complete H&P). At one point she asked me, expecting me to take her side, "don't they teach you that in med school?" And I said, "Yeah, She's in med school right now.... and she just learned it... from you... when you embarrased her in front of her resident and attending. She won't forget, but wasn't there a kinder way for you to teach her that?" The nurse felt genuinely bad about it, and basically explained that by the time they were put in that sort of situation, they had been specifically taught what they were supposed to do, what needed to be documented, and so on.

Heck, just watch the way scrub techs are taught. They double scrub cases, everything gets explained, there's always backup. Floor nurses have long orientations to the unit they are going to work in, and then they stay there for a long time. They really don't understand what it's like to be thrown in a completely new environment every four weeks, and be expected to magically know what the heck is going on, and which form to use. The techs all have something similar.

But you aren't being trained to do that, really. You're being trained to be captain of the ship in waters that are often unfamiliar. While they're being trained to follow protocols, you're being trained to be the person ultimately and personally responsible for your patient's welfare -- a role that often means breaking or remaking protocol, doing things outside anyone's 'job description' or 'scope of practice'... and that can be anything from an ED thoracotomy, to transporting your patient down to the CT scanner when everyone else has clocked out.

Another note -- a lot of your posts have a theme that the way to do well (or even get by) is by grovelling before your attendings, residents, ancillary staff, etc. You actually don't have to. You'll find people will learn to respect you when they see that the patient's interest is your only interest.

Anka

 

[DarthNeurology]

Honestly, Darth, a lot of them don't know where you're coming from. They're shift workers who are told exactly what the policies are that are relevant to them, and many of them think that you're the same way. They think you just managed to forget the inservice you had on white versus yellow forms. They don't realize you've been awake continuously for 30 hours.

I once had an RN I had known for a while go off about a med student (second day in the clinics) who didn't know that it was really important to make sure the attending knew the patient was on Warfarin for a mechanical valve, given that major surgery was planned (it had, of course, been documented in her painfully complete H&P). At one point she asked me, expecting me to take her side, "don't they teach you that in med school?" And I said, "Yeah, She's in med school right now.... and she just learned it... from you... when you embarrased her in front of her resident and attending. She won't forget, but wasn't there a kinder way for you to teach her that?" The nurse felt genuinely bad about it, and basically explained that by the time they were put in that sort of situation, they had been specifically taught what they were supposed to do, what needed to be documented, and so on.

Another note -- a lot of your posts have a theme that the way to do well (or even get by) is by grovelling before your attendings, residents, ancillary staff, etc. You actually don't have to. You'll find people will learn to respect you when they see that the patient's interest is your only interest.

Anka

People do seem to respect me a lot as I am a very hard worker on the floors, . . . but it definitely makes things smoother if you know how to smooze the residents. For example if a resident pimps you with a tough question and you have a good heart about it and say you'll go look up the answer later or make a joke then things run more smoothly, but if you say, "I wasn't taught that in medical school" or give them a funny look or just look uninterested then it seems these students get slammed, often they truly don't care about the patient or service which we all know is how you get slammed. But, in my experience, there are attendings who don't pick up on how much you "care" about the patient and want students to act in a heiarchial manner i.e. suberservient and laugh at their jokes so if you don't do it then you get slammed.

Sometimes attendings are really funny and residents are good to work with. On one recent elective I worked hard i.e. saw more patients, came in on time unlike 1/2 the residents and 2/3 of the students, was interested in the material and worked very hard. Now, mostly the residents saw me working super hard, (which I didn't realize I was working hard just normal mode and as I guess slacker mode was the norm for the rotation this stood out). How would the attending know who was working hard? We rounded together, I presented my patients, maybe he would notice over the course of the week that I had taken more patients, maybe not. . . HOWEVER, the attending did make a lot of jokes which I though were truly funny and so I laughed at them a lot, and it made the rotation fun, the other students didn't like his sense of humor or something. I thought that the streak was over as the attending would be evaluating me, not the residents, but you know what? Excellent evaluation! Maybe word leaked out that I was doing a good job as residents have spontaneously given good recommendations on my behalf to attendings, but in the end it doesn't hurt to try to be able to work well with everyone.

Nurse's can use the excuse of a protocol to attack people. I had a nurse basically slap me for doing something that HIPPA could in theory site me for (not really) in a hallway unremoved from patient care, this nurse did this stuff all the time to students on the unit and really hated a lot of students. Same thing that if I was a resident and having a bad day I could berrate a student for not knowing or doing something and cover my booty by saying I was teaching them a lesson. Same this with mechanical heart valve RN, while it is important to know that a pt. with mechanical heart valve is on what form of anticoagulation, this is so basic that the resident or attending had better be sure they on top of this, obviously for any patient going to the OR senior people will be evaluating use of anticoagulation, good job to the student if they pick it up first . . . Point being the nurse was being mean and coated it in an educational lesson-this is what happens all the time in medicine. You can justify anything with saying you were just trying to "educate" whoever . . . Nurses love to do this, I have seen some verbally berrate doctors for a breach in protocol because it is the only chance they have to do it. These 'shift workers" are not as innocent as you believe, . . . berrating medical students for not following protocol is a sport, harder to to verbally abuse medical students when they are doctors as they have a little more respect then.

 

[Tired]

And I am fairly certain that if you are actually a director of medical education (which would be odd as a resident as is stated in your profileand from your other comments in different sections: I'm an intern whose wife doesn't have to work; From my Trauma attending during last call: ) then you would know there is almost no 'power' in that position.

"Am am I" referred to your line about being grateful I am not one of your residents, not to me being a Director of Medical Education.

Genius.

 

[Blade28]

You'll find people will learn to respect you when they see that the patient's interest is your only interest.

Well said. 👍

 

[roja]

"Am am I" referred to your line about being grateful I am not one of your residents, not to me being a Director of Medical Education.

Genius.

Your wit is astounding. 🙄

 

[deleted109597]

Not quite. I have never seen a discharge summary that didn't include "Hospital Course" in it. You do have an obligation to at least summarize the diagnostic/treatment course and major complications. Nothing worse than looking at a previous D/C summary for a patient who was in-house for 3 weeks, only to see what you describe above.

Well, ok, hospital course, in vague summary, should suffice. No lab value should ever be mentioned (other than qualitative positive blood cultures). It shouldn't be more than a page. Truly, nobody wants to read a day to day story about the patient. And if they do, then there is always the chart.
However, diagnoses and procedures should not be left out, so that someone can know that the patient actually had stuff done to them.

 

[TRAMD]

I usually ask the med students how they learn best and let them know right off that they do not need to kiss up or act excited about anything that they aren't. I never make MS's do scut work. That is my job as a resident and will be theirs when they are residents. If I have them read something it is related to a case we are seeing or something that I don't know and am interested in. Giving positive feedback, being receptive to their ideas about Ddx and making helpful suggestions for change create a strong teaching relationship and will foster better performance as they will desire to please you. Plus, we are only a few years ahead of these people and should keep our egos in check.

 

[telenurse]

Nurse's can use the excuse of a protocol to attack people. I had a nurse basically slap me for doing something that HIPPA could in theory site me for (not really) in a hallway unremoved from patient care, this nurse did this stuff all the time to students on the unit and really hated a lot of students. Same thing that if I was a resident and having a bad day I could berrate a student for not knowing or doing something and cover my booty by saying I was teaching them a lesson.

Maybe she was covering her booty. I worked for nurse manager who had a family member that was frequently in the hospital. When his family was in the hospital, he'd use that time to do 0200 sneak rounds to see if the night shift was holding everything up to "standards". Nurses can and do get reprimanded for "allowing" doctors, residents, and med students to violate HIPAA, OSHA, and JACHO protocols. I've been written up for allowing MD's to have coffee at the desk. Personally I think it's bullcrap, the NM should yell at the MD, not the nurses for allowing it. We're all adults, and I sure ain't nobody's momma.

 

[Blade28]

I've been written up for allowing MD's to have coffee at the desk. Personally I think it's bullcrap, the NM should yell at the MD, not the nurses for allowing it. We're all adults, and I sure ain't nobody's momma.

What? That's ridiculous. 😱

 

[orientedtoself]

disagree. if somebody had a troponin of 15 while they were in the hospital, i want to know about it.

Well, ok, hospital course, in vague summary, should suffice. No lab value should ever be mentioned (other than qualitative positive blood cultures). It shouldn't be more than a page. Truly, nobody wants to read a day to day story about the patient. And if they do, then there is always the chart.
However, diagnoses and procedures should not be left out, so that someone can know that the patient actually had stuff done to them.

 

[Faebinder]

On a side topic...

With regards to discharge summaries, there is nothing absolutely nothing... more annoying than a discharge summary that didn't state a complication during the hospital course.

F-ups the followup and f-ups the research (prospective and retrospective). I found out that the most common complications and the ones most commonly avoided: UTIs, pneumonia and wound infections. 😡

 

[Faebinder]

Maybe she was covering her booty. I worked for nurse manager who had a family member that was frequently in the hospital. When his family was in the hospital, he'd use that time to do 0200 sneak rounds to see if the night shift was holding everything up to "standards". Nurses can and do get reprimanded for "allowing" doctors, residents, and med students to violate HIPAA, OSHA, and JACHO protocols. I've been written up for allowing MD's to have coffee at the desk. Personally I think it's bullcrap, the NM should yell at the MD, not the nurses for allowing it. We're all adults, and I sure ain't nobody's momma.

👎 Amazing hospital bureaucracy for ya. She couldn't just be nice and inform the person who brought the coffee? As if the world will end if we actually just tell people they shouldn't do something instead of yelling/writing-up/marauding?

 

[DarthNeurology]

Maybe she was covering her booty. I worked for nurse manager who had a family member that was frequently in the hospital. When his family was in the hospital, he'd use that time to do 0200 sneak rounds to see if the night shift was holding everything up to "standards". Nurses can and do get reprimanded for "allowing" doctors, residents, and med students to violate HIPAA, OSHA, and JACHO protocols. I've been written up for allowing MD's to have coffee at the desk. Personally I think it's bullcrap, the NM should yell at the MD, not the nurses for allowing it. We're all adults, and I sure ain't nobody's momma.

The manner in which many floor managers (i.e. non-RNs) and nurses behave towards students is pretty bad. At a respiratory distress and intubation I was helping out on the medicine floor I was handed a piece of equipment to give to the residents and attendings who were taking care of the patient and when I ran out to get something we needed a nurse grab my hand twisted it and was going to give me a lecture about having to know where this equipment was or something I couldn't believe she was bothering me about something she could have done herself in the middle of an intubation! I twisted me hand out and told her that she is NEVER to physically restrain or touch me, and walked away. It was almost a code and I was just getting what the resident needed and EVERYBODY knew I was supposed to be doing that. Basically, I think nurse's attacking doctors and medical students is very poor form. In the military it is consider bad form for someone say in the navy to harass and dress down someone in the air force, i.e. different command structures.

 

[Faebinder]

The manner in which many floor managers (i.e. non-RNs) and nurses behave towards students is pretty bad. At a respiratory distress and intubation I was helping out on the medicine floor I was handed a piece of equipment to give to the residents and attendings who were taking care of the patient and when I ran out to get something we needed a nurse grab my hand twisted it and was going to give me a lecture about having to know where this equipment was or something I couldn't believe she was bothering me about something she could have done herself in the middle of an intubation! I twisted me hand out and told her that she is NEVER to physically restrain or touch me, and walked away. It was almost a code and I was just getting what the resident needed and EVERYBODY knew I was supposed to be doing that. Basically, I think nurse's attacking doctors and medical students is very poor form. In the military it is consider bad form for someone say in the navy to harass and dress down someone in the air force, i.e. different command structures.

😱

DarthNeurology... Comas and periods are your friends. Paragraph for us verbally challanged people. Read your posts and you'll see how hard it is.

 

[Anka]

Maybe she was covering her booty. I worked for nurse manager who had a family member that was frequently in the hospital. When his family was in the hospital, he'd use that time to do 0200 sneak rounds to see if the night shift was holding everything up to "standards". Nurses can and do get reprimanded for "allowing" doctors, residents, and med students to violate HIPAA, OSHA, and JACHO protocols. I've been written up for allowing MD's to have coffee at the desk. Personally I think it's bullcrap, the NM should yell at the MD, not the nurses for allowing it. We're all adults, and I sure ain't nobody's momma.

Yeah, this sort of thing is annoying; I feel like it puts most RNs in very uncomfortable situations (although, as Darth points out, there are a few RNs who relish this part of their job, they're in the minority). At our hospital, the system is similar. While it was originally intended to ensure patient safety through the ability to collect data on trends, from what I have seen it is detrimental to the free and open communication so essential to providing quality patient care. One thing that helps, for me at least, is when the RN entering the report talks to me about it first, lets me know that he or she has to enter the report, and then does it so I don't feel blindsided, or like it was personal.

Anka

 

[Ypo.]

😱

DarthNeurology... Comas and periods are your friends. Paragraph for we verbally challenged people. Read your posts and you'll see how hard it is.

Fixed. 😉

But YES, you are right. I've been wanting to say that as well. 👍

 

[Tired]

disagree. if somebody had a troponin of 15 while they were in the hospital, i want to know about it.

Even if discharge diagnosis #1 is "Acute Myocardial Infarction"?

 

[deleted109597]

disagree. if somebody had a troponin of 15 while they were in the hospital, i want to know about it.

Seriously. If AMI/myocarditis are the in the diagnoses, does the troponin of 15 make any difference from a troponin of 5? Ejection fraction, being a procedure, should be in there, because 20% is different than 40%. PFTs are another.

 

[elwademd]

Seriously. If AMI/myocarditis are the in the diagnoses, does the troponin of 15 make any difference from a troponin of 5? Ejection fraction, being a procedure, should be in there, because 20% is different than 40%. PFTs are another.

i thought an echocardiogram was a procedure/test from which an ejection fraction was derived.😉

 

[Faebinder]

Fixed. 😉

But YES, you are right. I've been wanting to say that as well. 👍

See what I mean.. I get dizzy after reading all that.😛

 

[Apollyon]

😱

DarthNeurology... Commas and periods are your friends. Paragraph for us verbally challanged people. Read your posts and you'll see how hard it is.

Fixed. 😉

But YES, you are right. I've been wanting to say that as well. 👍

Haha dummy - are YOU in a coma?

 

[Strength&Speed]

No, not you personally, but have seen residents wrapped up in "learning by doing" and have told students how to do this or that without understanding why it is done that way . . . seriously had an intern who told me that we needed to order haptoglobin for an anemia workup, didn't know what haptoglobin was or why would be elevated, . . .just sort of following along, had no idea what definition of sirs, from sepsis, to Multi-organ failure, but really great clinical experience halfway into internship, LOL Best experience is watching surgical residents, pgy-2 manage sicu patients, totally clueless to why things are done, and attending smashes them for it, even stuff I know I need to order stuff that they miss, can't see big picture of our sickest patients, and then they us about how much they have "learned" in the SICU, . . . unacceptable, unacceptable (granted I have a lot more clinical experience than most residents, i.e. before med school😀) but still UNACCEPTABLE, UNACCEPTABLE

apparently that resident didnt teach you, because a haptoglobin would be low 😛

 

[Strength&Speed]

it gets even better. we aren't supposed to scut students out to get food here. so last night, i was the night float r2 and i offered to get food for the overnight interns. somehow, an ms3 (who don't stay overnight here) managed to tack her order onto the list. so i scutted myself out, picked up food for the whole team (including the ms3) while the ms3 did whatever it is that ms3's do while waiting for their upper level resident to pick up food.

why is getting food bad? christ, when i was a medical student that was my favorite thing to do. I got a break, everyone valued my help, and i couldnt possibly screw it up. and i actually felt like i was helping. how is that not good??

 

[DarthNeurology]

why is getting food bad? christ, when i was a medical student that was my favorite thing to do. I got a break, everyone valued my help, and i couldnt possibly screw it up. and i actually felt like i was helping. how is that not good??

I knew many medical students who loved to go out and get food, i.e. they loved it because they were able to get out of the hospital for 45-minutes and then take an extra-long dinner eating it. I personally would be neutral about it as I have never been asked to do it. However, I can easily see why many students would not like it. It is sort of being a delivery boy or girl for the resident and essentially says that the student might as well be delivery food for the resident as their time in the hospital is not valued. You can from the above post that a "high-level residents" doesn't like being the delivery boy/girl for a student, so people who don't like feeling how lowly they are on the totem pole don't like doing this job.

 

[Ypo.]

Haha dummy - are YOU in a coma?

I like sleeping, does that count?

 

[GoodMonkey]

i loved being the food runner when i was a med student. especially on the painful rotations. got me out of the hospital, took a good chunk of time out of being there ... 👍

 

[Strength&Speed]

I knew many medical students who loved to go out and get food, i.e. they loved it because they were able to get out of the hospital for 45-minutes and then take an extra-long dinner eating it. I personally would be neutral about it as I have never been asked to do it. However, I can easily see why many students would not like it. It is sort of being a delivery boy or girl for the resident and essentially says that the student might as well be delivery food for the resident as their time in the hospital is not valued. You can from the above post that a "high-level residents" doesn't like being the delivery boy/girl for a student, so people who don't like feeling how lowly they are on the totem pole don't like doing this job.

Well, I'll be honest with you, you are less valued. It's not because you are dumb, but because the hospital will not grind to a halt if you are not there. The residents do need to be there. If they send you on ridiculous tasks however, they should reward you with high quality teaching. For instance, I had a med student wash my car once, and he got the best 10 minute lecture on PEA that you've ever seen.

 

[Strength&Speed]

I usually ask the med students how they learn best and let them know right off that they do not need to kiss up or act excited about anything that they aren't. I never make MS's do scut work. That is my job as a resident and will be theirs when they are residents. If I have them read something it is related to a case we are seeing or something that I don't know and am interested in. Giving positive feedback, being receptive to their ideas about Ddx and making helpful suggestions for change create a strong teaching relationship and will foster better performance as they will desire to please you. Plus, we are only a few years ahead of these people and should keep our egos in check.

Tra, are you running for President? Because this post sounded very presidential. You even used the word "foster". That, my friend, portends very big things. 🙂

 

[Strength&Speed]

repeat of below post.

However, I will take use of this valuable space to say Darth...take a deep friggin breath. You are exhausting me. Either you are preparing a book on the resident/medical student relationship, or you are just typing too damn much.

 

[Strength&Speed]

Riiiiight.

See, as a resident, you are being paid to do this. Sure, it sucks, but its your job. If you don't enjoy it, and it seems NO resident enjoys it, then gather together and lobby for better treatment at your jobs. Bytchin about it won't change anything. Bullying medical students will only make you resentful and a horrible person. It seems many of the residents are stuck in the whole "if I suffered than the next guys down will too" attitude. Nothing will change if this is the prominent attitude.

Medical students are paying top dollar to learn medicine, not make life easier for residents. Sure this statement will end up generating a whole bunch of "WTF kind of attitude is that?" responses, but its true. It's far more important that a student graduate with prime knowledge of human disease and treatment. Knowing where something is in a chart = nowhere near as important.

Essentially, if you can hire a secretary to do it, its not relevant from a medical education standpoint.

I disagree. As a medical student you are part of a team. The team has work that needs to be done, and sometimes the medical student needs to do some of that work. Some of it will not be educational. Guess what? Too bad. You are helping the team. You are not a medical tourist who cherry picks what is interesting or may seem educational. Of course, protection from excessive scut is important. But you should not be evaluating every little piece of work to determine how educational it is. Sometimes the work just needs to get done. Frankly, the student should be happy about this as well. It is not an honorable position to be in where you are not helping an overworked team, because its not "educational" to you.

 

[Strength&Speed]

I don't mind.

"Following ______, the patient was admitted to the Surgical Intensive Care Unit. Please see the medical record for the full details of the admission. In summary, the patient was managed by the trauma service until deemed stable enough for transfer for the floor."

Agreed. My chosen field embarrasses me when they choose to write 2 page discharge summaries on patients who were admitted with uncomplicated pneumonia. Inefficiency of this nature should be punishable by death, at a minimum. The discharge summary should go like this.

Mr. so and so was admitted for pneumonia. He was too old and tired to go home so he was admitted. He was given ceftriaxone and azithromycin and eventually was moving around enough that we felt safe sending them home. On such and such date, he did go home. Follow up in one week with their PCP.

 

[Strength&Speed]

I've previously mentioned how I once took an attending's car to the mechanic.

Yes, it was demeaning. But man, what a nice afternoon.

Demeaning? Why? You are GUARANTEED to get a good recommendation from this person. And you seemed so normal otherwise Tired.....shame shame

 

[Finding Chi]

"Of course, protection from excessive scut is important"

Say's the man who had a med student wash his car...😉

 

[theCamel]

Your wit is astounding. 🙄

Tired -- you've definitely picked the wrong person to battle with in this case. roja's comments hit the nail on the head v clearly, and are far from brimming with 'new found power' lol. unlike you, she's not only identified and defined scutwork, but is trying to do something about it.

were you abused as a student/resident or something? : (

 

[Top Gun]

My definition of scut is something that has no medical relevance aka something a secretary could do. Transfer forms, home care forms, PT/OT forms, forms to set up outside non-medical consultations, STAT discharge summaries on patients you've never met, photocopying a ton of paperwork for rounds - that's scut. That's useless busywork for a medical student. Heck, residents shouldn't be doing this either: this is for secretaries to do. Unfortunately, we've let MDs become an undervalued member of the workforce that can be slaved around by insurance companies and lawyers. The fact that residents all think scut is ok doesn't fix the problem. If only residents would realize they are being used for secretary work half of the time...

Yes, learning medicine is important. But when you're an attending with your own private practice, you're going to have to fill out plenty of clinically irrelevant crap that is only there for the purpose of medicolegal documentation. In other words, its to protect you from getting sued. So as a student, you might as well learn to fill it out now. Its burdensome and a downright pain in the a$$, but its got to be done. Unit secretaries and clerks have plenty of their own paperwork to do, so I don't think any of them will be jumping at the chance to do yours.

 

[TRAMD]

Tra, are you running for President? Because this post sounded very presidential. You even used the word "foster". That, my friend, portends very big things. 🙂

You liked all the vague promises and lack of real substance, huh? I am already chancellor of the TRAMD School of Medicine or "TRAMDSOM" (tram-duh-som -- not to be confused with a sleep aid) to its friends.

 

[Tired]

Tired -- you've definitely picked the wrong person to battle with in this case. roja's comments hit the nail on the head v clearly, and are far from brimming with 'new found power' lol. unlike you, she's not only identified and defined scutwork, but is trying to do something about it.

were you abused as a student/resident or something? : (

Cute attempt to personalize the issue. BTW, if you don't put a space between the colon and the parenthesis, it makes an actual face, and looks less ******ed.

I'm not "battling" with anyone. This is a difference in philosophy. I believe in an older style of medical education, where everyone on the team from students to staff are expected to take ownership of their patients and do whatever is necessary to advance the interests of the team. Roja believes that students should be shielded from the actual practice of academic medicine in order to have more time to study.

I think that produces weak students who later become weak doctors, and I said so. I don't want to "do something" about scutwork, I want to divide it up and include the students in the fun. And, as I mentioned, the only thing Roja wants to do about scutwork is shove it all on the residents, and expect them to teach at the same time. Pretty crappy solution, if you ask me. The only real response from the "Let The Students Sleep" movement was a little one-line zinger, so I let it drop.

There are people who stand on the strength of their ideas, and people who stand on their titles. I suppose as an intern I ought to defer to attendings with titles like "Director of Medical Education". But honestly, the whole swinging-genitalia thing just doesn't impress me without some legit skills to back it up.

 

[roja]

Cute attempt to personalize the issue. BTW, if you don't put a space between the colon and the parenthesis, it makes an actual face, and looks less ******ed.

I'm not "battling" with anyone. This is a difference in philosophy. I believe in an older style of medical education, where everyone on the team from students to staff are expected to take ownership of their patients and do whatever is necessary to advance the interests of the team. Roja believes that students should be shielded from the actual practice of academic medicine in order to have more time to study.

I think that produces weak students who later become weak doctors, and I said so. I don't want to "do something" about scutwork, I want to divide it up and include the students in the fun. And, as I mentioned, the only thing Roja wants to do about scutwork is shove it all on the residents, and expect them to teach at the same time. Pretty crappy solution, if you ask me. The only real response from the "Let The Students Sleep" movement was a little one-line zinger, so I let it drop.

There are people who stand on the strength of their ideas, and people who stand on their titles. I suppose as an intern I ought to defer to attendings with titles like "Director of Medical Education". But honestly, the whole swinging-genitalia thing just doesn't impress me without some legit skills to back it up.

Please avoid trying to explain my educational philosophy. You do not make your stance any stronger by making passive-aggresive comments about my job or my genetailia, or with your inaccurate 'summaries' of my educational philosophies.

You only make your ideas appear weak and incapable of standing on their own.

 

[Tired]

Please avoid trying to explain my educational philosophy. You do not make your stance any stronger by making passive-aggresive comments about my job or my genetailia, or with your inaccurate 'summaries' of my educational philosophies.

😕

I said that you prefer to stand on your credentials as a substitute for actually explaining yourself. I also said that you substitute one-liner comebacks rather than substantiating your opinions (a point you adequately prove with this very post). I don't think that's passive-aggresive at all. I'd call it aggresive-aggresive.

And perhaps you could explain how my summary of your position was inaccurate. You said:

SCUT
-writing a resident's notes.
-getting labs on patients that aren't theirs.
-things to be done to make a resident's life easier and has no educational value to the medical student.

Like it or not, medical students are there to learn medicine. Reading is important. They should be reading about thier patients.

I said:

Roja believes that students should be shielded from the actual practice of academic medicine in order to have more time to study.

Please explain how I have misrepresented your opinions.

Or, if you prefer, you could just let this whole issue drop again. Whatever works for you. I'm not attacking you, just disagreeing and defending myself from a poster who came to the thread late.