Is scutting your students good for them?

[roja]

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

<-----inaccurate summaries of my 'philosophy'.



....

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.

<-----passive agressive (also, my genitalia don't swing)


You have jumped to alot of inaccurate conclusions. You have also used the weakest tools of discussion: trying to use insults to make people defensive and to make your arguement seem more valid.

If you had actually been interested in a discussion, instead of trying to prove whatever it is your trying to prove, you might have been surprised that there were areas where we might have agreed.

Instead, you took a low road and tried to bolster your ego by trashing someone else, without cause or merit. Whatever makes you happy.

---

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[Tired]

You have jumped to alot of inaccurate conclusions. You have also used the weakest tools of discussion: trying to use insults to make people defensive and to make your arguement seem more valid.

If you had actually been interested in a discussion, instead of trying to prove whatever it is your trying to prove, you might have been surprised that there were areas where we might have agreed.

Instead, you took a low road and tried to bolster your ego by trashing someone else, without cause or merit. Whatever makes you happy.

Trying to understand your underlying point is pretty difficult. Restating yourself is a poor substitute for actual explanation. I'm giving up.

Good one-liner at the end though (again).

 

[Anka]

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.

Well said.

 

[PathMD2010]

Just to give a (not necessarily universal) medical student perspective. While constantly being scutted out sucks, being on a service where you aren't part of the team sucks even more. Some of the most satisfying experiences I've had in medical school were when, as the junior medical student on the service, my intern would let me preround on everyone, write all the notes, get my orders in... and then show up 10 minutes before rounds to deal with any problems I came up with. I learned a lot doing it, although I was at the hospital about 2 hours before rounds (because I hadn't gotten efficient). Was it scut? Sure. Could you have argued the intern was taking advantage? I'm sure you could if you wanted to. But it was a great experience, and I learned more doing that then I could have reading in a corner. It also built up my confidence that he was willing to trust me to do that.

Most disatisfying experiences were ones where every two second the resident was like "Hey, we're not really doing anything, why don't you go read?" "Oh, that's just scut, you shouldn't do that." And pretty soon, I'm totally marginalized sitting in the corner reading.

Anka

Totally agree. This is especially true early in the third year. You are new to the wards and really appreciate being given responsibilities. It helped me learn, gave me confidence, and put me in a good mood. Then, I could go home and have something concrete to read about. It is good to be busy.

That said, there is a point where it is useless/ of low educational value - say prerounding on 20 pts and being at the hospital 14 hrs/day - that is just evil for a student who then has to go home and study for the shelves. This sort of thing should be saved for SubIs in hectic fields.

And as a fourth year, you should know how to do all these things around the hospital so you can effectively shine in your subI and get good LORs, be more efficient so that you can study for boards, know how to interact with a team so that you can gauge how to approach req time off for interviews, and generally know what is expected of you.

That said, having done my boards, finished all my interviews (14) and have matched - to my #, I don't mind being told to go home and "study".

 

[Kubed]

Just shy of a 2 year bump. Nice.

Anyway, reread most of this thread and a quote from the first page jumped out at me:

...

But with regards to your underlying point (having to clean up after med student mistakes) I'm all for it. The time for shadowing needs to taper off as 3rd year goes on, and independent action begins. Mistakes happen, errors are made, and these all need to happen for education to truly occur.

I hear that in the European programs, "residency" is one long shadowing experience. I think that's crap. Mistakes that can be fixed is a small price to pay for good student training. I had a lot of sutures torn out as a med student, but I was sewing like a pro by the first day of internship. And really, how much more "watching" do you really want to do these days?

100% agree with this attitude. When I think about who taught me the most as a student, more often than not, it was the person who was willing to let me try ... and fail, at something. I've worked hard to keep this attitude as an intern.

 

[DocDanny]

Clerkship year must be one of the things my school has done right. It is mid April, and (other than surgery) I think I've only done scutwork once.

And even that was a resident who wanted me to help make his skeleton for the next mornings rounds. And he even apologized AND said please.

Of course, surgeons made you do scutwork constantly. Putting stuff in charts, rechecking some lab or exam thing they missed, getting tape, hold the lidocaine bottle upside down, going to check the board, finding nurse X and telling them about something. But I can't blame my school for that.

On IM I really WISHED I could to more paperwork. I wish I had IM at the end of the year instead of first. By now all the interns are pretty good at what they do. And I am more knowledgeable, too. I honestly think I could to a respectable job of taking care of a simple patient by myself if I knew how to do more of the paper work.

But when I was on IM, the interns and residents only wanted to teach pathophys and pharm. Which was good, of course. But I don't want to be going into my Sub-Is not knowing how to fill out some of this stuff. They'll think I am dumb.

 

[gutonc]

Of course, surgeons made you do scutwork constantly. Putting stuff in charts, rechecking some lab or exam thing they missed, getting tape, hold the lidocaine bottle upside down, going to check the board, finding nurse X and telling them about something. But I can't blame my school for that.

That's not scut, that's "the job."

 

[Ishie1013]

Clerkship year must be one of the things my school has done right. It is mid April, and (other than surgery) I think I've only done scutwork once.

Of course, surgeons made you do scutwork constantly. Putting stuff in charts, rechecking some lab or exam thing they missed, getting tape, hold the lidocaine bottle upside down, going to check the board, finding nurse X and telling them about something. But I can't blame my school for that.

Carrying that blasted box. That was probably the job I hated most in med school, because not only were you forced to not fall asleep into it at 6 AM, and it limited how much you could actually do, since your hands were full, but it was prime material for ripping on you for either:

1. Not having enough _________ (Usually 4X4s)
2. Not being able to find _________ because there's too much stuff (Usually 4X4s).

Honestly, other scut stuff broke up tedium for me when there was nothing to do and I was in an inconvenient position to study. Though there's such thing as excessive scut (sending med students down the street in an iffy neighborhood at 10 PM to get cheesecake for your mom's birthday).

 

[DocDanny]

That's not scut, that's "the job."

Stuff like holding the lidocaine I can see as work. But most of that is scut work. Work with no educational value that serves no purpose to the student, but only makes the doctors job easier. It is not my "job".

If you don't consider checking the board for a surgeon who busy with facebook to be scut work, then what is???

 

[Mattchiavelli]

as an MS4, I've been asked to do things I consider par for the course and have residents apologize for making me "do scut." I liked the possibility to feel like what I was doing meant something since so much stuff we do is fake [fake physicals, fake histories, etc etc]. I agree that for specific tasks like admits/discharges there are going to be some accidental, site specific aspects that aren't going to help the student but there are some essentials that the student needs to know as part of their clinical education. I will say, however, MS2 -> MS3 is a giant culture shock and I think a few days of just shadowing in my first IM clerkship to start off would have had me working more effectively the rest of the time instead of the slow learning by error.

When I start internship I'm going to give my students some "scut" but first I'm going to ask if they've done it before or know how to do it. I've never seen a point in wasting other peoples' precious time or putting patients in harm's way because a student needs to learn via trial by fire. I believe in the "see one-do one-teach one" and I think it applies to scut

Also, students can read in-house. I always brought a small book for my shelf exam to my clerkships so I can read on downtime. Some of mine had shelfs that were worth as much or more than my clinical evals, and covered a much wider range of disease than I saw on the floor.

 

[Dr.LeoSpaceman]

Stuff like holding the lidocaine I can see as work. But most of that is scut work. Work with no educational value that serves no purpose to the student, but only makes the doctors job easier. It is not my "job".

If you don't consider checking the board for a surgeon who busy with facebook to be scut work, then what is???

Here's the deal: Whether I decide to teach or not (as a resident), I'm going to get paid the same. I'm not going to get any added benefits, save for a plaque I might be able to put on my wall. But, I like to teach, and so I do it even though it takes time away from the 67 other things I'm trying to do. So no, I don't think it's wrong if I ask a med student to go grab something while I'm standing at the bedside because it's going to save me some time. That's the bargain: I'll enhance your educational experience if you pitch in and help me out.

Now, if you think you can be a better physician by reading for 12 hours a day, be my guest. Don't even show up, because that's a lot less hassle than you being there and acting disinterested or put upon when I ask for help. Of course, I think you'll find that medicine is a practical field, and reading will only get you so far.

I'm not sure when this "I should only do things that are educational" thing got started, but it's (pardon the language) bull****.

EDIT: I'll add, I think there's an underlying mentality that's part of the problem. Many students have stopped seeing themselves as part of "the team". They instead view themselves as a separate entity, above the daily grind of hospital life. It's only perpetuated by the changes in the culture of medical education. Millions of lectures and other obligations that remove students from the team dynamic. It's hard to incorporate students into this atmosphere when they're liable to be gone for half the day, with no idea when they might return. Medical school should be as much an apprenticeship as it is traditional "school". It's beyond the time for passive learning and standing on the sidelines. You want to learn, then get in there...which means the stupid, menial stuff as much as it does the educational stuff.

 

[Dwindlin]

Here's the deal: Whether I decide to teach or not (as a resident), I'm going to get paid the same. I'm not going to get any added benefits, save for a plaque I might be able to put on my wall. But, I like to teach, and so I do it even though it takes time away from the 67 other things I'm trying to do. So no, I don't think it's wrong if I ask a med student to go grab something while I'm standing at the bedside because it's going to save me some time. That's the bargain: I'll enhance your educational experience if you pitch in and help me out.

Now, if you think you can be a better physician by reading for 12 hours a day, be my guest. Don't even show up, because that's a lot less hassle than you being there and acting disinterested or put upon when I ask for help. Of course, I think you'll find that medicine is a practical field, and reading will only get you so far.

I'm not sure when this "I should only do things that are educational" thing got started, but it's (pardon the language) bull****.

EDIT: I'll add, I think there's an underlying mentality that's part of the problem. Many students have stopped seeing themselves as part of "the team". They instead view themselves as a separate entity, above the daily grind of hospital life. It's only perpetuated by the changes in the culture of medical education. Millions of lectures and other obligations that remove students from the team dynamic. It's hard to incorporate students into this atmosphere when they're liable to be gone for half the day, with no idea when they might return. Medical school should be as much an apprenticeship as it is traditional "school". It's beyond the time for passive learning and standing on the sidelines. You want to learn, then get in there...which means the stupid, menial stuff as much as it does the educational stuff.

Holy **** this made my day. Thank you.

 

[Bobblehead]

Of course, surgeons made you do scutwork constantly. Putting stuff in charts, rechecking some lab or exam thing they missed, getting tape, hold the lidocaine bottle upside down, going to check the board, finding nurse X and telling them about something. But I can't blame my school for that.

Welcome to, the rest of your professional life. If you don't think you'll end up doing these things when you're "done" I've got some really bad news for you.

1. You put stuff in charts as a doctor. That's how others know what you're thinking.
2. If you think checking on one patient's labs or exam thing is scut wait until you get to do an entire list of 18 patient and the buck stops with you.
3. I don't "check the board" in my specialty but I do end up surveying charts when I'm on.
4. In addition to getting tape/holding lidocaine you can collect all the stuff you need for a consult procedure, getting the consent, talking to the patient, holding the clipboard while they sign paperwork, etc. etc.
5. Finding the nurse is part of patient care. Once the nurse is on board with what you want to do to the patient the rest of your day/job is far easier.

 

[turkeyjerky]

Here's the deal: Whether I decide to teach or not (as a resident), I'm going to get paid the same. I'm not going to get any added benefits, save for a plaque I might be able to put on my wall. But, I like to teach, and so I do it even though it takes time away from the 67 other things I'm trying to do. So no, I don't think it's wrong if I ask a med student to go grab something while I'm standing at the bedside because it's going to save me some time. That's the bargain: I'll enhance your educational experience if you pitch in and help me out.

Now, if you think you can be a better physician by reading for 12 hours a day, be my guest. Don't even show up, because that's a lot less hassle than you being there and acting disinterested or put upon when I ask for help. Of course, I think you'll find that medicine is a practical field, and reading will only get you so far.

I'm not sure when this "I should only do things that are educational" thing got started, but it's (pardon the language) bull****.

EDIT: I'll add, I think there's an underlying mentality that's part of the problem. Many students have stopped seeing themselves as part of "the team". They instead view themselves as a separate entity, above the daily grind of hospital life. It's only perpetuated by the changes in the culture of medical education. Millions of lectures and other obligations that remove students from the team dynamic. It's hard to incorporate students into this atmosphere when they're liable to be gone for half the day, with no idea when they might return. Medical school should be as much an apprenticeship as it is traditional "school". It's beyond the time for passive learning and standing on the sidelines. You want to learn, then get in there...which means the stupid, menial stuff as much as it does the educational stuff.

Man, what a dick.

I'd be so much more appreciative of your "teaching" if it wasn't just pimping me on minutiae that I couldn't give two $hits about.

 

[LifetimeDoc]

Teaching should be about more than pimping and should include practical stuff (i.e how to survive and thrive in the hospital) and knowledge (procedures, management information, and facts). But truth be told, one of the ways I judge my students competancy is their knowledge of the minuatiae. It's not hard to read First Aid for Rotation X but if you really are putting your best foot forward I need to see that you went beyond that. obviously I look at other things beyond fund of knowledge but it does tell me a lot about students.

Yea; it tells you they are good memorizers.

 

[unsung]

Guys, scut work is infinitely less malignant than "fake work".

I'd rather hold the lidocaine bottle than go wake the patient up from a nap to do a "fake physical".

...Then present the findings to a physician who doesn't even know that patient. (Hence, no way of even verifying whether you DID the physical correctly, much less whether you've formed the right DDx based on said physical...)

Uh... I think that's worse than scut.

 

[Dr.LeoSpaceman]

Man, what a dick.

I'd be so much more appreciative of your "teaching" if it wasn't just pimping me on minutiae that I couldn't give two $hits about.

It's cool. I'm sure I'll be getting calls from you when someone's "belly hurts". No sense in overextending yourself--I'll just work it out myself.

 

[dilated]

Clerkship year must be one of the things my school has done right. It is mid April, and (other than surgery) I think I've only done scutwork once.

And even that was a resident who wanted me to help make his skeleton for the next mornings rounds. And he even apologized AND said please.

You're going to be in for a rough first day of internship when you don't know how to do anything in the hospital. Guess what: nobody's going to be impressed by your knowledge of Kayser-Fleischer rings.

Ironically, to the extent that medical school rewards busywork and interpersonal relationships over the chance to hoard more medical knowledge it's probably a better preparation. A lot of fresh residents seem very disappointed when they discover the "real world of medicine", which much like the "real world" in general places very little value on what you know. Welcome to the rest of your career, there will be no more AOA or gold stars for the awkward kid who rocks out on MCQs.

 

[PlutoBoy]

You're going to be in for a rough first day of internship when you don't know how to do anything in the hospital. Guess what: nobody's going to be impressed by your knowledge of Kayser-Fleischer rings.

Ironically, to the extent that medical school rewards busywork and interpersonal relationships over the chance to hoard more medical knowledge it's probably a better preparation. A lot of fresh residents seem very disappointed when they discover the "real world of medicine", which much like the "real world" in general places very little value on what you know. Welcome to the rest of your career, there will be no more AOA or gold stars for the awkward kid who rocks out on MCQs.

I guess you didn´t rock your exams

 

[dilated]

I guess you didn´t rock your exams

I'm a resident in a surgical subspecialty, so you may rest assured I did just fine. It didn't make the transition to intern year one bit easier, as I went to a well regarded medical school that also coddled us from any practical experience at the daily life of a resident.

 

[Dr.LeoSpaceman]

I'm a resident in a surgical subspecialty, so you may rest assured I did just fine. It didn't make the transition to intern year one bit easier, as I went to a well regarded medical school that also coddled us from any practical experience at the daily life of a resident.

Exactly. The assumption is that you're going to show up and have some baseline fund of knowledge. But few people are going to be in awe of your encyclopedic recall of facts. What they will be impressed by is your ability to execute plans on your patients in a timely manner, with the minimum of "Wait, what do I do?" phone calls. This has more to do with "scutwork" that it does knowledge you learned on the shelf.

You learn quickly that senior residents have forgotten how to do some of the day-to-day gruntwork in the hospital (how this order needs to be put in, what person needs to be called, how to set up extended care after discharge). That's the glory of being a senior. They are simply going to tell you "Hey, get this done."

 

[Perrotfish]

You're going to be in for a rough first day of internship when you don't know how to do anything in the hospital. Guess what: nobody's going to be impressed by your knowledge of Kayser-Fleischer rings..

Ironically, to the extent that medical school rewards busywork and interpersonal relationships over the chance to hoard more medical knowledge it's probably a better preparation. A lot of fresh residents seem very disappointed when they discover the "real world of medicine", which much like the "real world" in general places very little value on what you know. Welcome to the rest of your career, there will be no more AOA or gold stars for the awkward kid who rocks out on MCQs

I feel like I've heard his argument many times before, just... from midlevels. Placing a low value on understaning medicine and a high value on knowing how a hospital operates is sort of the central to the arguments from NPs who want to be primary providers. I'm surprised to hear from a surgeon who puts such a low value on formal education.

In any event I disagree with you. I don't think you learn how to be an efficient physician from doing scut work. What you do learn is the ins and outs of the hospital you happen to be rotating in, but that's not the least bit helpful on day one of your Intern year unless you're one of the lucky few that matches where you rotated. All that time you spent learning how to work the DOS based computer system, or where the nurses like to hide the charts, or which supply closets to run to for which supplies gets flushed the second you match somewhere else. On day one of your Intern year you'll be every bit as useless as everyone else.

 

[DrKnowLittle]

Here's the deal: Whether I decide to teach or not (as a resident), I'm going to get paid the same. I'm not going to get any added benefits, save for a plaque I might be able to put on my wall. But, I like to teach, and so I do it even though it takes time away from the 67 other things I'm trying to do. So no, I don't think it's wrong if I ask a med student to go grab something while I'm standing at the bedside because it's going to save me some time. That's the bargain: I'll enhance your educational experience if you pitch in and help me out.

Now, if you think you can be a better physician by reading for 12 hours a day, be my guest. Don't even show up, because that's a lot less hassle than you being there and acting disinterested or put upon when I ask for help. Of course, I think you'll find that medicine is a practical field, and reading will only get you so far.

I'm not sure when this "I should only do things that are educational" thing got started, but it's (pardon the language) bull****.

EDIT: I'll add, I think there's an underlying mentality that's part of the problem. Many students have stopped seeing themselves as part of "the team". They instead view themselves as a separate entity, above the daily grind of hospital life. It's only perpetuated by the changes in the culture of medical education. Millions of lectures and other obligations that remove students from the team dynamic. It's hard to incorporate students into this atmosphere when they're liable to be gone for half the day, with no idea when they might return. Medical school should be as much an apprenticeship as it is traditional "school". It's beyond the time for passive learning and standing on the sidelines. You want to learn, then get in there...which means the stupid, menial stuff as much as it does the educational stuff.

THIS. IS. AWESOME.

I've found the more I've just embraced doing things for the team and asking "how can I help?" instead of "is there anything else you want me to do?" the more I've learned. I've been given greater and greater responsibility, felt more like a contributing member, and had the opportunity to participate in and perform procedures. Also, I've made some great mentors, people who've given me advice about making transition to residency smoother, more efficient, etc.

I've made more appointments for a resident's, or another student's, patient than I'm willing to admit and I've done lots of "menial" tasks that are still pertinent to getting the job done for the team, but I think I've learned a whole lot more from being proactive in that manner.

 

[smq123]

I feel like I've heard his argument many times before, just... from midlevels. Placing a low value on understaning medicine and a high value on knowing how a hospital operates is sort of the central to the arguments from NPs who want to be primary providers. I'm surprised to hear from a surgeon who puts such a low value on formal education.

In any event I disagree with you. I don't think you learn how to be an efficient physician from doing scut work. What you do learn is the ins and outs of the hospital you happen to be rotating in, but that's not the least bit helpful on day one of your Intern year unless you're one of the lucky few that matches where you rotated. All that time you spent learning how to work the DOS based computer system, or where the nurses like to hide the charts, or which supply closets to run to for which supplies gets flushed the second you match somewhere else. On day one of your Intern year you'll be every bit as useless as everyone else.

So what, in your mind, qualifies as scut?

Furthermore, the point of MS3 and MS4 is not how to teach you how to be an "efficient physician," the point is to practice TAKING CARE OF PATIENTS. And for the 6 weeks that you are rotating on that service, those ARE your patients, and you should do your part in taking care of them. Now, that may involve looking up lab results, putting their notes in the chart, checking with the nurse to see when they are due back from CT scan, suturing up their lac, etc. It may seem menial, but that's the nature of patient care. Learn to deal with it.

As a resident, I do stuff that you guys seem to consider scut. I print out lab results on patients who aren't mine, to help out my fellow resident. I hold lidocaine bottles for other residents when assisting them in an office procedure. I see patients for them when they are running behind. When my fellow residents are running behind, I get supplies for them. Yes, even as the service chief, I still run to "fetch tape and 4x4s."

I do all these things not because I get graded or evaluated, but because these are OUR patients and I will do what I need to do to make sure that these patients get the care that they need. Whether that's doing a procedure on them, changing a dressing, running to get them an emesis basin, getting them a cup of water, etc., it's not scut, it's patient care, whether the med students seem to think so or not.

In any event I disagree with you. I don't think you learn how to be an efficient physician from doing scut work. What you do learn is the ins and outs of the hospital you happen to be rotating in, but that's not the least bit helpful on day one of your Intern year unless you're one of the lucky few that matches where you rotated. All that time you spent learning how to work the DOS based computer system, or where the nurses like to hide the charts, or which supply closets to run to for which supplies gets flushed the second you match somewhere else. On day one of your Intern year you'll be every bit as useless as everyone else.

So, by your logic, you shouldn't do any of this stuff as a resident, either, because you'll move on to a different hospital on your next rotation. So why bother learning the ins and outs of the hospital you happen to be rotating at as a resident (and you WILL cover different hospitals as a resident), because you'll move on to another hospital in a few weeks anyways?

 

[Doctor4Life1769]

.

 

[babel]

it's not scut, it's patient care, whether the med students seem to think so or not.

Exactly.

The rotations that I loved the most as a medical student were the ones where they kept me involved in patient care - whether that was assisting on a procedure, looking up records/labs, scheduling follow-up appointments, calling consults etc. None of that felt like "scut" to me. I never had any intention of staying at my home program for residency, but there are general principles that underlie all of these tasks that I knew would be helpful for when I start residency, so I never resented doing those things - I actually felt excited that they trusted me enough to allow me to try.

What I did resent as a medical student was being kept around to do nothing - the rotations where they didn't trust me enough to give me any sort of task, and yet didn't have the decency to let me go home, so I just sat in a corner of work room trying to study - that drove me nuts.

 

[Substance]

, it's not scut, it's patient care,

Ah, the old cliche - I was waiting for someone to use it!

A student's duty is to learn medicine. A resident's duty is to apply it to patient care and make far-reaching decisions.

First I think we need to define scut.

Scut as I define it is anything an uneducated ancillary worker has been hired to do. Anything the ward clerk, janitor, porter, food services, phlebotomist, EKG tech, etc. has in their job description is never the responsibility of the student or resident(outside of the urgent situations, of course). Nursing, though I consider it a well-educated profession, is never the responsibility of the physician unless again it is an urgent situation.

SMQ123, lots of things you've described, like charting and lac suturing, and not just looking up but evaluating lab work, isn't scut. There is medical expertise required for those things. Those are part of the job, and are expected of a physician, and most importantly cannot be done by anyone else!

As a resident I've done - and am doing - my share of scut. The difference is that I'm being paid to do it, whereas medical students are paying for learning. If there was an ancillary worker available who could do the scut just fine, I'd order them to get off their butts and get to work, much to their chagrin. The medical students on my teams would never do scut.

And to the above resident who thinks its some sort of bargain to teach medical students if and only if they help you out, you are forgetting that it is in your job description to teach regardless of conditions. Otherwise you're failing at a part of your job.

 

[Perrotfish]

So what, in your mind, qualifies as scut?

Furthermore, the point of MS3 and MS4 is not how to teach you how to be an "efficient physician," the point is to practice TAKING CARE OF PATIENTS. And for the 6 weeks that you are rotating on that service, those ARE your patients, and you should do your part in taking care of them. Now, that may involve looking up lab results, putting their notes in the chart, checking with the nurse to see when they are due back from CT scan, suturing up their lac, etc. It may seem menial, but that's the nature of patient care. Learn to deal with it.

Scut is work that doesn't teach me skills I can carry into my future career, and which wastes time I could otherwise use to learn about my profession. Some examples:

Suturing: A procedural skill I need to learn. This is not scut (and is normally considered a reward for good behavior)

Gathering up charts on rounds: Not scut. It isn't educational, but by decreasing the length of rounds it saves me time to learn, rather than costing me time.

Fetching things for my attending or dropping his note: Almost always scut. It wastes my time and if you need experience to learn how to put something in a 3 ring binder I don't know what to say.

Checking on labs (most commonly: get the vitals out of the ICU chart): Situational. The main question is, when I get the labs, what do I do with them? Do I put them in a SOAP note, interpret them in my plan, and then get quizzed on them? Not scut. Am I just getting vitals on a patient I'm not following to hand mutely to my Resident? Definitely scut.

As a resident, I do stuff that you guys seem to consider scut. I print out lab results on patients who aren't mine, to help out my fellow resident. I hold lidocaine bottles for other residents when assisting them in an office procedure. I see patients for them when they are running behind. When my fellow residents are running behind, I get supplies for them. Yes, even as the service chief, I still run to "fetch tape and 4x4s."

I do all these things not because I get graded or evaluated, but because these are OUR patients and I will do what I need to do to make sure that these patients get the care that they need. Whether that's doing a procedure on them, changing a dressing, running to get them an emesis basin, getting them a cup of water, etc., it's not scut, it's patient care, whether the med students seem to think so or not.


So, by your logic, you shouldn't do any of this stuff as a resident, either, because you'll move on to a different hospital on your next rotation. So why bother learning the ins and outs of the hospital you happen to be rotating at as a resident (and you WILL cover different hospitals as a resident), because you'll move on to another hospital in a few weeks anyways?

Now here you basically asking why it's wrong for medical students to do scut and it's fine for physicians to do it. The reason is pretty simple: medical students are customers, paying to learn medicine in the most efficent way possible. Physicians are employees, paid to practice medicine. Asking why medical students don't see the value in scut is like asking why customers in a restaurant never expect to wash their own dishes. The entire reason that we pay (a fortune) for this education is the because, at least the theory goes, that a formal program focused on our education is more efficient at teaching us than mere on the job training. If we replace the reading and classes with scut then we're just suckers paying to work.

BTW to be fair I am perfectly aware that residents are also there to learn, as well as to work, and yes I do think that a corollary to the argument that medical students should do no scut is that residents, with their Journeyman status, should do less scut than attendings, but I'm aware that's not how the world works and the fact that the world is stupid once is not a good reason for it to be stupid twice.

 

[Dr.LeoSpaceman]

Nursing is never the responsibility of the physician unless again it is an urgent situation.
...
If there was an ancillary worker available who could do the scut just fine, I'd order them to get off their butts and get to work, much to their chagrin.

You must be a ward favorite.

Note to all future residents: The cliche that nurses can make your life much easier or much more difficult is not a lie. If you act like your above doing "nursing work", get ready to be paged at all times for stupid stuff just out of spite. Or to be ambushed by new information they "forgot" to mention in front of your seniors.

At this point, I've made friends with many different ancillary staff, and it wasn't by telling them they're lazy and need to start doing some work. The benefit is that when I really need something (a PICC line to get someone discharged, someone to get squeezed into the MRI queue, etc.), they're happy to help.

Now here you basically asking why it's wrong for medical students to do scut and it's fine for physicians to do it. The reason is pretty simple: medical students are customers, paying to learn medicine in the most efficent way possible. Physicians are employees, paid to practice medicine. Asking why medical students don't see the value in scut is like asking why customers in a restaurant never expect to wash their own dishes. The entire reason that we pay (a fortune) for this education is the because, at least the theory goes, that a formal program focused on our education is more efficient at teaching us than mere on the job training. If we replace the reading and classes with scut then we're just suckers paying to work.

You're not a "customer". The idea of a person (or their family) paying training fees as part of an apprenticeship agreement is something that goes back hundreds of years, and is not limited to medicine. The second two years are absolutely on the job training, and it's pretty obvious when you show up as an intern who treated medical school that way. And yes, classes and reading would be more efficient at teaching you how to be a doctor if you never had to actually touch a patient and simply had to take tests. For those interested in radiology or pathology, it may work out just fine. For everyone else, the practical aspect of "see one, do one, teach one" is absolutely part of it.

 

[gutonc]

You must be a ward favorite.

Note to all future residents: The cliche that nurses can make your life much easier or much more difficult is not a lie. If you act like your above doing "nursing work", get ready to be paged at all times for stupid stuff just out of spite. Or to be ambushed by new information they "forgot" to mention in front of your seniors.

At this point, I've made friends with many different ancillary staff, and it wasn't by telling them they're lazy and need to start doing some work. The benefit is that when I really need something (a PICC line to get someone discharged, someone to get squeezed into the MRI queue, etc.), they're happy to help.

What FaytIND said.

I agree that you shouldn't have to do a nurse's job (nor an RTs, nor the phlebotomists, nor the social workers, nor etc, etc) but that doesn't mean you shouldn't make it easier for them to do their job or jump in and help out when the shiz it hitting the fan in one way or another. Quite honestly, just being nice to the nurses and checking in with them routinely (not frequently, just routinely) will go a long way to making your life easier, not just in residency but in practice if you wind up doing any inpatient work.

As a very practical example, I moonlight on our BMT service, as do many of my Hem/Onc colleagues. One of them is a complete dickwad to all the nurses and ancillary staff (I have heard this from him, them and 3rd party observers). He complains constantly about the BS FYI pages he gets at 3am when he's working. I OTOH am generally nice to the (not stupid) nurses and, as a result, am usually allowed to sleep from ~1-6am unless there's an admit or a code.

Being nice to people you work with isn't scut, it's common decency.

 

[Substance]

What FaytIND said.

I agree that you shouldn't have to do a nurse's job (nor an RTs, nor the phlebotomists, nor the social workers, nor etc, etc) but that doesn't mean you shouldn't make it easier for them to do their job or jump in and help out when the shiz it hitting the fan in one way or another. Quite honestly, just being nice to the nurses and checking in with them routinely (not frequently, just routinely) will go a long way to making your life easier, not just in residency but in practice if you wind up doing any inpatient work.



Being nice to people you work with isn't scut, it's common decency.

I totally agree! I know my tone sounded a bit harsh, but in reality I'm more diplomatic. Writer's creative license. That's it. Yeah...

If things are getting out of hand then it definitely is the responsibility of the resident to pitch in and get things done. As for the medical student, not really. But if things are going down the tubes and help is needed, a socially astute medical student will help out when the time is needed for their assistance.

In regards to scut, an example I have encountered time and time again is setting up outpatient appointments with a patient's family doctor or outside specialist on discharge. I write an order in the chart for the ward clerk to do just that(find the doctor's number, go through the automated service, wait, wait some more, and then set the appointment up) because it is a waste of my time to do that. It is a waste of a medical student's time to do that as well. Zero educational benefit.

It wasn't clear in my note above, and I apologize for that, but I do not consider nursing to be uneducated ancillary work. Nurses are well-educated in nursing and provide a valuable service to patients. Perhaps I'll go back and edit it...

 

[LifetimeDoc]

On rounds today, I saw a couple residents looking over a chart. A third year passed me with a Mt. Dew in one hand and a single-serving box of pizza in the other. He greeted his senior residents, and handed one of them the drink and pizza. I guess scutwork is part of your education! LOL

I don't believe a lot of things that people call "scutwork" are really that bad (like writing notes, getting labs, helping with a procedure). But some residents don't feel it's their responsibility to teach those students who do try to be a part of the team and help out "on the little things". The relationship is two-way.

 

[Top Gun]

Now here you basically asking why it's wrong for medical students to do scut and it's fine for physicians to do it. The reason is pretty simple: medical students are customers, paying to learn medicine in the most efficent way possible. Physicians are employees, paid to practice medicine. Asking why medical students don't see the value in scut is like asking why customers in a restaurant never expect to wash their own dishes. The entire reason that we pay (a fortune) for this education is the because, at least the theory goes, that a formal program focused on our education is more efficient at teaching us than mere on the job training. If we replace the reading and classes with scut then we're just suckers paying to work.

BTW to be fair I am perfectly aware that residents are also there to learn, as well as to work, and yes I do think that a corollary to the argument that medical students should do no scut is that residents, with their Journeyman status, should do less scut than attendings, but I'm aware that's not how the world works and the fact that the world is stupid once is not a good reason for it to be stupid twice.

Good lord.

Yes, education should be your primary goal as a med student. No one is saying that you should replace the reading and classes. You can read either when you go home or during down time on the wards. Go to whatever lectures you have during the day, by all means.

As a resident, I try to teach my students as much as I can. But that does not mean they just sit in a corner and read. There are certain task which I do not consider scut work and which do have educational value: i.e. doing H&P's, writing progress notes... But guess what, not every task I give a student to do is about their education or learning. Its about taking care of the patients. Isn't that what you're here to learn to do?

No, I don't need a student to help me out with scutwork. But if you are willing to lend a hand even with non-educational tasks, that shows me that you are willing to be an active part of the team and do your part to help care for the patient, even if that means running specimens down to the lab so we can get the results faster and get appropriate treatment initiated. If you whine and complain that a task I give you has no teaching value, then that shows me two things:

1.) You're not a team player

2.) You have an attitude of entitlement

And guess what. You come into residency with this kind of attitude, you won't survive. Other residents and I have to do all kinds of menial tasks with no educational value to ensure the patient gets appropriate care. You might argue whether this is appropriate. I mean, as residents, aren't we there to learn too? But its not about us. And its not about you either.

 

[Mattchiavelli]

As a resident, I try to teach my students as much as I can. But that does not mean they just sit in a corner and read. There are certain task which I do not consider scut work and which do have educational value: i.e. doing H&P's

I think this is one of the best examples of differing definitions of "scut" causing arguments. H&Ps are the cornerstone of our profession, are really important, and practice does make perfect- however I've seen myself improve far more when someone above me helped make it a learning experience by observing, offering feedback, setting expectations, allowing the student to observe their exam etc. I wouldn't say they were scut. Doing an H&P that will never be read or verified is I think worse than scut because it sends the message that an H&P is really just some bullcrap no one cares about.

To the opposite, what I as a student consider scut is the stuff that ideally would be done by someone with less specialized training... IE scheduling outpt appointments- why is anyone with any postgraduate training sitting on hold with a PCP when they could be functioning at a level appropriate for their training? Some residents use it as a kind of hazing ritual but they generally have a more pervasive assholism about them.

 

[DrKnowLittle]

You guys keep talking about someone making appointments for you or this mythical thing called a ward clerk... Is this commonplace? I thought I worked in a pretty modern workplace where there were plenty of ancillary staff to do things the medical staff order (except for orthostatics...) but at our hospital, the students are the clerks of that ward and if you don't make the appointments, no one else is going to do it for you. Are we really behind or do we also need to hire someone at minimum wage on each ward to sit around waiting to make appointments?

 

[DocDanny]

Here's the deal: Whether I decide to teach or not (as a resident), I'm going to get paid the same. I'm not going to get any added benefits, save for a plaque I might be able to put on my wall. But, I like to teach, and so I do it even though it takes time away from the 67 other things I'm trying to do. So no, I don't think it's wrong if I ask a med student to go grab something while I'm standing at the bedside because it's going to save me some time. That's the bargain: I'll enhance your educational experience if you pitch in and help me out.

But the thing is, the education never happened. The surgery program at this hospital was awful at teaching. We couldn't write notes, couldn't see patients, most attendings refused to give lectures, and some surgeons wouldn't want us to ask questions during surgery. It was 9 weeks of shadowing.

I don't mind doing someone a favor. That isn't what I consider scut work. But to get nothing out of it, and having this happen chronically, is what I consider scut work. It is DETRIMENTAL to learning.

I don't want to just read. I love rounding, and my evaluations for my professionalism and attitude have always been much better than my test scores.

 

[DocDanny]

Welcome to, the rest of your professional life. If you don't think you'll end up doing these things when you're "done" I've got some really bad news for you.

1. You put stuff in charts as a doctor. That's how others know what you're thinking.
2. If you think checking on one patient's labs or exam thing is scut wait until you get to do an entire list of 18 patient and the buck stops with you.
3. I don't "check the board" in my specialty but I do end up surveying charts when I'm on.
4. In addition to getting tape/holding lidocaine you can collect all the stuff you need for a consult procedure, getting the consent, talking to the patient, holding the clipboard while they sign paperwork, etc. etc.
5. Finding the nurse is part of patient care. Once the nurse is on board with what you want to do to the patient the rest of your day/job is far easier.

1. I'm not talking about putting MY notes in a chart. I'm talking about putting a resident's note in a chart on another floor which they either forgot/ hadn't finished at the time.
2. Checking labs on patients you don't know and that the resident WON'T go over is scut.
5. I know nurses are important to talk to. And I don't consider anything done on rounds to be scut. But if I have to go track down a nurse who I've never even met before to get back something or ask a question (and once again, the patient isn't mine) I consider that scut.

 

[TruthMD]

Some of these posts by student are funny as hell. I don't know which elite school u went to but I really hope for u and me that we don't end up on my team. As an intern or a resident I expect a student to double my work (as told in house of god the book).

Ps. As a student, the residents where nice to me and I gladly offered to help them, yes even with getting them lunch, and they did the same for me).

 

[dpmd]

On rounds today, I saw a couple residents looking over a chart. A third year passed me with a Mt. Dew in one hand and a single-serving box of pizza in the other. He greeted his senior residents, and handed one of them the drink and pizza. I guess scutwork is part of your education! LOL

You didn't give enough information. For all I know the student volunteered to grab food for the resident because they just finished taking care of some sick person in the unit or finished a long case and missed lunch (with the student having already eaten his, but the resident had too much other work to do to break away). In that case I would say it is just a matter of being a team player. Or maybe the guy is sucking up because that is how that resident decides which student gets to do stuff (not cool). Or maybe the resident requires the students to get food all the time (also not cool). Or maybe the student got the morning off for some personal thing and that was the tradeoff (somewhat sketchy but if agreeable to both, who cares)

Seeing consults, writing notes, getting labs, getting the chart so you can present the patient (with the ability to look at your note if needed)-not scut. Doing the residents laundry, picking up their dry cleaning, walking their dog-outside of the usual discussion of scut/not scut, generally inappropriate. Putting away notes, filling labs in on previously written notes, getting the radiology reads on a bunch of patients, preparing discharge paperwork, putting in add on slips in the OR, calling consults, filling out forms for lab/rad/interventional orders, filling out pre-op packets, gathering all the charts for work rounds, writing orders (that get signed by the resident), gathering supplies-considered scut by many but all things I have asked students to do (and have done as a student). I consider it part of learning how to function as a team. The actual details of how to fill in form X, and where to find supply Y aren't what is important. It is the process of figuring out how to get things done which is helpful as you begin in new environments (as a resident and later as well). It is also stuff that is important to keep the team running and taking care of patients. If done with the right attitude (and appropriate support) it can be very educational. Example-filling out the form for a biopsy: student A is pissed because they feel they shouldn't have to do this bull****. They fill out name, medical record number, and the test as they heard it worded then just dump it in radiology. The intern or resident checks on things later, sees it isn't done right, fixes it, and never mentions it to anybody since they figure the student didn't care. Student B takes it as a learning opportunity. Fills out all the boxes they can figure out then asks the folks in radiology if things look ok, they notice something missing/wrong that gets fixed then ask a question the student doesn't know the answer to (let's say they ask if they wanted CT or ultrasound guided), student B calls the intern/resident to check and is told the answer (and ideally is given the explanation why as well-if not they can look up the answer later and if they don't find one can ask someone). Student B is happy because they know what is going on, intern/resident is happy because things are set up, and patient is happy because they get their test done. Which is better? I suppose someone will tell me Student C who was in the lounge reading from whatever they had in their pocket while the intern/resident filled out the form is best off.

 

[LifetimeDoc]

That's just one example and I'm not going to write a chapter like you did above. I agree that all of the stuff that you list is being part of the team. But many residents dole out the menial work and leave the student out of the important stuff like writing admit orders, dictations, assisting with procedures, explaining the assessment and plan. They just have you mindlessly gather labs, get the coffee, pre write vitals, then tell you to go read or go home because they don't have time to teach. It's supposed to be a team and you listed someone helping with the scut that also got to help and learn about the actual management part and cool stuff. But in reality, the student only is given the mindless stuff and then told to take a hike.

 

[TruthMD]

.....