Is there a 80-hr/post-call work hour rule for medical students?

[cw05]

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When I was a med student on the wards (03-05) we were told that such a rule didn't exist for med students and therefore stayed full days post-'call'. Just curious as the med students on my service leave early in the am before the interns when after nights they were 'on call'. Thanks in advance to any with insight as to what the actual rule is.

 

[goinsurg]

Our PD told us that it didn't apply to us either. I had a couple of hours of sleep every night, even when I was on call. The interns all made sure we had at least 2 hours of sleep at night, and I pretty much only did the post-op checkups and maybe 1 consult. Post-call, I've stayed in the hospital till around 6 pm once, but most of the time, as soon as the attending will realize that I was post-call they will tell me to go home.

 

[45408]

Well, the ACGME doesn't apply to students, since it's for residents. However, my school enforced a 30/80 hour rule.

 

[SLUser11]

When I was a med student on the wards (03-05) we were told that such a rule didn't exist for med students and therefore stayed full days post-'call'. Just curious as the med students on my service leave early in the am before the interns when after nights they were 'on call'. Thanks in advance to any with insight as to what the actual rule is.

We've discussed this in the past, and I've gone through the LCME website without a clear answer. I then tried to contact the LCME for an answer, and they never returned my email or phone calls.

What is in place by the LCME is a general recommendation that clerkship directors have a rule, but they don't say what the rule is...i.e. CDs should develop their own policies about work hours for students.

To answer your question, there's no clear cut student work hour restrictions with resultant penalties if violated (like there are with the ACGME).

For years, residents have said that the 80 hour rule doesn't apply to students without any actual research or basis other than that's what they heard from their resident when they were a student.

That being said, it's sort of a non-issue because 95% of medical students will still work way less hours than their residents. Most 120-hour medical student weeks are the result of "Med Student Math" that seems to amplify their actual clinical work time....and can often add in time spent in the library, etc.

Of course, there will be some obligatory students to come out of the wood work and disagree with me, but I've heard it all before and my opinion hasn't changed.

Overall, I think that while there's no official rule in place, it's generally a good idea to send the students home post-call, etc. Since we're training them to be a part of the team, we should treat them like part of the team, and give them the same benefits (albeit few) that we're given.

 

[Buzz Me]

As a student I didn't follow any 80-hour workweek/30-hour shift rules. But as a resident it seems that most med students aren't allowed to stay as long as the residents. I also agree with sending students home when nothing's going on and it's just not educational anymoer.

 

[Ronin2258]

Most of the places I have been since the resident rules came into effect in 2003 is that 3rd year students were sent out of the hospital no later than 11pm on weeknights due to mandatory classes that had to be attended during the rotations. The only exception was OB/GYN, which was overnight and home the next day at noon. On Friday and Saturday, overnight call on surgery was the rule. 4th year, we had hours on medicine and surgery more in line with residents, including post-call days.

As an intern/resident, I would boot the students out of the hospital as soon as things went quiet, which was around 9pm (and after dinner, since they ate with the call team.) Housing for the students was across the street, so they would be within walking distance to get back into the hospital if called. Practically, I would not call them back unless a case came about, as there were lectures the students had to attend. I would rather have them well-read, rested, and ready for the shelf exam than have them in the hospital twiddling their thumbs waiting for the next thing to hit the fan.

Under NO circumstances would I or the rest of the residents who had holiday call let the students pull call on a holiday (pulled them enough as a student before 2003.) There will be enough beatings on the holidays as a housestaff/attending; why start early?

 

[glade]

Anyone who babys a student is merely doing them a disservice. The point of rotating on service is to understand what that specialty is about. It's not going to kill anyone to take call during a holiday for *gasp* three months of their life. Sending a student home at 9 PM on overnight call is the height of ridiculousness. If I caught a resident doing that, I'd make them take extra call in return. No joke. Have fun being Mr. Nice Guy, hope you like being tired.

 

[deleted89854]

Our students are prohibited from showing up before 6am. They are therefore unable to see their patients prior to rounds or contribute much to the patient presentation. You'd think this would result in happier, well-rested students, but actually the opposite occurs. Turns out 1-1.5 hours of dumbly standing there while patients are examined and evaluated is much less engaging than examining and attempting to present the patient yourself. Without any kind of "ownership" of the patient or feeling of contribution, student learning and satisfaction drops tremendously.

Overnight call is optional, and students often go home around 9-10pm. Problem is, all the good trauma cases come in between 10pm and 4am. Students therefore see a great deal less operative trauma and develop a poor understanding of how trauma codes are run and how injuries are addressed, since the majority of cases during the day are elective gen surg.

 

[glade]

1-1.5 hours of dumbly standing there while patients are examined and evaluated

Yeah, our students are like cows who just wander around the hallways chewing cud listlessly as we herd them around the hospital with subtle kicks and nudges. One of these days I'm going to start branding them so that if they get lost someone will know to return them to the pen.

 

[goinsurg]

well just to be fair, we actually have to take a shelf exam after the rotation is over and still manage to do pretty much the same hours as residents. and the reason why med students are not more efficient is because there are jerks like you who demean our presence in the hospital.

I just hope I don't become a bitter ass like glade someday

 

[glade]

well just to be fair, we actually have to take a shelf exam after the rotation is over and still manage to do pretty much the same hours as residents. and the reason why med students are not more efficient is because there are jerks like you who demean our presence in the hospital.

I just hope I don't become a bitter ass like glade someday

Wow, remind me to be impressed that you take a shelf exam after the rotation is over. Maybe I should high-five you because us residents take exams DURING residency sometimes post-call. And as for you "doing pretty much the same hours" as residents, that's irrelevant since you do about 80% less work (which is completely appropriate, I'm just saying to compare your level of stress to that of a resident is laughable and you should refrain from doing so in public ever again).

And don't worry, you won't become a bitter ass like me. You'll probably be one of these nice residents who allows medical students to lounge around or sends them home. Which is fine, nobody said that my way is the right way. It just happens to be the smart way. Your way only teaches medical students that surgery is about going home at 9 PM on call or getting a good night's sleep. Then they're all confused and upset when it doesn't turn out that way in residency, which I've seen time and time again. Then they leave for some "lifestyle" specialty, which is also fine, but they could have not wasted everyone's time (including their own) in doing so. In other words, you wasted their entire life by babying them.

So that makes you a total non-bitter ass, which is NOT like me because I didn't waste their time. What you see with me is what you get. You know coming into it how it's going to be.

 

[goinsurg]

wow. it looks like you are gonna explode! you need to get laid soon

 

[glade]

OK, I'll visit your girlfriend again this weekend.

 

[goinsurg]

lol wow, I could've responded you mean your mother?? and then ........ I am just going to stop it here though.

Just relax man, you were a medical student at one point, and I know, everyone thinks that their life is tougher then anyone elses. For god's sake, whenever I talk with my cousins who are still in high school, I feel like their life couldn't get any worse. I can't speak for all medical students but I have to say, I didn't reach the potential I wanted during my rotations because our word has no weight! We just have to go over everything with the intern and then a senior resident who sometimes I feel are incompetent and don't even know what they are talking about. But whatever, it is what it is. And don't worry, I know what I am getting myself into, most applicants do. Trust me, if I had a nickle for everytime someone told me ... well you know where I am going with this.

So just chill and try not to degrade everyone who are lower on the food chain. Being bitter just makes you a worse person

 

[glade]

Just relax man, you were a medical student at one point, and I know, everyone thinks that their life is tougher then anyone elses. ...So just chill and try not to degrade everyone who are lower on the food chain. Being bitter just makes you a worse person

No, see, you're missing the point. Nobody is saying that medical students don't do stupid things. When I did my rotation, I did some fantastically bad things, none of which I'll disclose here. Nobody is saying "as a medical student, you should function as an attending." THAT would be stupid.

But to act like it's "inhumane" to have a medical student on call on a holiday is ridiculous. Or to be like "oh, we should let the medical students leave early on call because it's quiet." Hey, if it's so quiet, then who cares? They can sleep in the call room or watch television ...OMG, it's almost like prison!! THIS IS UNCONSTITUTIONAL! Maybe we should let medical students just stay at home three days a week because we're worried about being meanies. Our students constantly ask us if they "need" to be on call on weekends because they have stuff to do. No joke. What is this, kindergarten?

Even if a student doesn't want to do surgery, it's THREE MONTHS of their life. Their ENTIRE life. If you can't hack a surgery rotation for three months, there's something wrong with you.

 

[glade]

Oh, by the way, I just noticed this, but any medical student who thinks a senior resident is comparatively incompetent to them is usually either stupid or highly over-rates themselves. If you really are "goinsurg," then you'd better learn that fact quickly because people won't tolerate something like an intern who thinks they know more than the attending.

 

[ZagDoc]

At my institution, third years were allowed to be "post call" and scurry out of the hospital around 10 or 11am the next day after rounds and helping the 'tern a bit with floor work. Was nice... generally got at least an hour or two of sleep on call and a half day off. I think that's a fair system for third years.

As a sub-i, there was no such thing as "post-call" or "days off". Took call q4 and worked all but two days that month, which I think is a fair thing to do to sub-i's since by being a sub-i you are implying you plan to do as much in residency and its a good opportunity to give you "THE REAL DEAAALLLLLL" before it's "too late." Granted keeping that schedule for four weeks is nothing like doing it ad infinitum, but at least you got a better sense of how much you loved it.

 

[ESU_MD]

whats interesting is that there still exists a few hardcore programs (both in IM and surgery) where the medical students remain a part of the team and are necessary to help keep the meat moving through the system.

in these goldmines- the students are NEEDED and therefore more engaged with jobs. without responsibilty- no wonder half the students would rather just go home early. I've seen some hospitals that wont even allow the students to write a progress note!

 

[LucidSplash]

I've seen some hospitals that wont even allow the students to write a progress note!

Bingo. On one rotation, after a few days of watching my "progress notes" pile up in the corner of the team room without a single person ever looking at them (because we were supposed to write them but they were not allowed to go in the patient chart) guess what? I stopped writing them. No one noticed. Sorry, but I'm too old to do busy work for the sake of busy work if it contributes in no way, shape, or form to the team or patient care.

When we received an e-mail from the Dean reinforcing that we were not allowed to write notes for the chart, not even if they were cosigned by the residents or attendings, one of my fellow classmates paraphrased the e-mail as such:

"Dear Students,

You are now totally useless.

Love,

The Dean"

One of the reasons I particularly hated my medicine rotation was because there was so much sitting around and staring at the wall. With no actual responsibility, we simply sat there for hours on end waiting to be dismissed. We "read for the exam" a lot of the time, but there's only so much of that you can do in one stretch and quite frankly I could do that at home better than I could sitting in the team room. We couldn't wait to get out of there, not because we were lazy or disinterested but because we WEREN'T ALLOWED TO DO ANYTHING. Once I was sent to draw blood on a patient but the nurse caught wind of the fact that I was a student and paged my CHIEF to come supervise me because I wasn't "signed off to draw blood" by the nursing reqs.

 

[ACSurgeon]

Bingo. On one rotation, after a few days of watching my "progress notes" pile up in the corner of the team room without a single person ever looking at them (because we were supposed to write them but they were not allowed to go in the patient chart) guess what? I stopped writing them. No one noticed. Sorry, but I'm too old to do busy work for the sake of busy work if it contributes in no way, shape, or form to the team or patient care.

When we received an e-mail from the Dean reinforcing that we were not allowed to write notes for the chart, not even if they were cosigned by the residents or attendings, one of my fellow classmates paraphrased the e-mail as such:

"Dear Students,

You are now totally useless.

Love,

The Dean"

One of the reasons I particularly hated my medicine rotation was because there was so much sitting around and staring at the wall. With no actual responsibility, we simply sat there for hours on end waiting to be dismissed. We "read for the exam" a lot of the time, but there's only so much of that you can do in one stretch and quite frankly I could do that at home better than I could sitting in the team room. We couldn't wait to get out of there, not because we were lazy or disinterested but because we WEREN'T ALLOWED TO DO ANYTHING. Once I was sent to draw blood on a patient but the nurse caught wind of the fact that I was a student and paged my CHIEF to come supervise me because I wasn't "signed off to draw blood" by the nursing reqs.

One of my old school attendings told me "interns are the new medical students"... meaning students do not get to do anything these days (lines, IV's, etc) so they have to learn as interns.

Regarding the original question, if residents are restrained to 80 hrs of work per week (doing actual work), why would anyone in their right mind make a medical student stay for longer? Is there really any educational benefit? Our school had a 24/80 policy, and for each rotation eval, we were asked if said policy was reinforced "on average."

 

[OtoHNS]

Yeah, I would agree that medical students have become less and less useful because of new rules and regulations. When I was a med student on trauma surg in 2004 (at a county hospital), I typically wrote 10-12 progress notes daily which were just cosigned by the intern, wrote orders and forged the intern's signature (obviously I informed the team), took patients by myself to procedures/imaging studies, wrote out the H+P's during trauma codes while the residents were examining the patient, and lots of other stuff. The 2 other medical students on service and myself were an integral part of the team.
I think this has been lost to a large extent and I even noticed a significant change over the course of my residency. Now with computer notes and orders, it's basically impossible for a medical student to do anything useful for the service. I still tried to encourage students to write notes and think through the patient's plan, but many students seem more and more content to just sit around like a bump on a log. For students who were more enthusiastic, I did try to reward them by letting them suture, do a bit with the bovie, etc in the OR. Even though it is excruciating to watch most M3s try to suture...

 

[glade]

many students seem more and more content to just sit around like a bump on a log. For students who were more enthusiastic, I did try to reward them by letting them suture, do a bit with the bovie, etc in the OR. Even though it is excruciating to watch most M3s try to suture...

Like I said, they're like cows that you herd around the hospital. Infrequently, there's a medical student that is good and I'll let them sew or tell them small pearls. For the rest of them, I don't.

 

[goinsurg]

..

 

[Winged Scapula]

Users are reminded to adhere to the Terms of Service agreement when posting. If you find another user troublesome, there is an "Ignore" feature available on your control panel for that user which will block their posts from view. Use of this feature is suggested over continued arguments.

 

[njbmd]

While the residency hour restrictions do not apply to medical students, LCME rules DO apply. It's my job as a teaching attending to make sure that every medical student who rotates on my service gets a good educational experience. To that end:

• All educational lectures are taped, recorded and available streaming for medical students who have stayed overnight on call.
• Medical students go home at 5:30AM post call without exception (they scrub out if doing a case).
• Medical students are not called for routine ward emergencies but are called for cases that go on overnight. If they are up and interested they can participate in ward work but they are not required to do this.
• Medical students on trauma call, are paged for Level 1 Traumas but not others trauma pages.
• Medical students are expected to pre-round with the intern (only on their patients) and scrub surgeries with the rest of the team.
• Interns do most of the floor work and can utilize medical students for procedure teaching if they, the intern) feel comfortable teaching a procedure (dressing changes, central lines and the like).

Finally, if a medical student is not on overnight call, they go home by 5PM on for the day. They generally come in at 5:30 AM and leave by 5PM. They are supposed to report to the intern for the most part but are not responsible for more than 2 patients on the service (writing notes). Their notes are co-signed by the intern and the chief resident. Interns get to the OR when all of the morning floor work is done. This is usually around 9AM or so. There are intern-level cases that are specifically scheduled for those times so that the PGY-1s can get the maximum amount of operating time. Students are required to do one half-day on the weekend either Saturday or Sunday (morning or evening 6 hours) unless they are on overnight call. This allows them to get more experience with ward work and to help the weekend intens/residents who may be covering more patients.

Medical students are not "extra" workers for the team but are students period. They are quizzed during cases and will prepare reports for team teaching and participate in all educational conferences. Some medical students are extremely efficient and make great contributions in terms of following their patients and learning materials. They are the ones who get Honors in the rotation. The ones who hide and don't contribute fail the rotation and most pass.

 

[SLUser11]

well just to be fair, we actually have to take a shelf exam after the rotation is over and still manage to do pretty much the same hours as residents.

It was tough not to cringe when I read this. The problem is that many medical students truly believe that they are doing all that we do (and more). Med Student Math in effect again.

lol wow, I could've responded you mean your mother?? and then ........ I am just going to stop it here though.

I know it's a TOS violation, so I'm not going to encourage it, but I have to say that I'm liking the significant increase in mom jokes on SDN over the last couple weeks.

Bingo. On one rotation, after a few days of watching my "progress notes" pile up in the corner of the team room without a single person ever looking at them .......When we received an e-mail from the Dean reinforcing that we were not allowed to write notes for the chart, not even if they were cosigned by the residents or attendings, one of my fellow classmates paraphrased the e-mail as such:

"Dear Students,

You are now totally useless.

Love,

The Dean"

Yeah, I would agree that medical students have become less and less useful because of new rules and regulations. When I was a med student on trauma surg in 2004 (at a county hospital), I typically wrote 10-12 progress notes daily which were just cosigned by the intern......

I still think it's funny that everyone puts so much weight into progress notes. Third year students feel like once they've written their note, they've completed their clinical duties for the day, and we talk about all the notes we had to write as students, etc.

I know that progress notes are important for documentation and legal reasons, but very little thought goes into most of them, and you could teach a monkey to write them. In general, they have very little to do with the process of treating and dispositioning patients. There's just so many other things that students need to learn besides how to write a SOAP note, and yet that is where the emphasis always lands....

 

[Thanatos]

My students manage to do very little most days. We had paper charts where I went to school so as students we could write notes/orders and then have the intern sign them, but with everything being computerized they can't do too much.

Whats funny is when they sit around and complain about having nothing to do I usually tell them they can actually help the team by maintaining the patient list and putting all the vitals/labs for morning rounds, transporting patients to xray, or starting iv's/drawing blood. They then inform me that this is scut work and beneath them, and if I make them do it they will report me to the clerkship director. So I usually tell them to just sit there and complain about having nothing to do.

I enjoy teaching people about surgery but so many of my students make it such a chore that I don't do it as much. I'm happy to teach but I'm not a motivational speaker....I've gotten to the point where if the students aren't interested I just send them to the library.

 

[Winged Scapula]

I know it's a TOS violation, so I'm not going to encourage it, but I have to say that I'm liking the significant increase in mom jokes on SDN over the last couple weeks.

Since when is it a violation of the TOS to make mom jokes? As long as its about glade's mom, fair game. 😛

 

[LucidSplash]

I still think it's funny that everyone puts so much weight into progress notes. Third year students feel like once they've written their note, they've completed their clinical duties for the day, and we talk about all the notes we had to write as students, etc.

I know that progress notes are important for documentation and legal reasons, but very little thought goes into most of them, and you could teach a monkey to write them. In general, they have very little to do with the process of treating and dispositioning patients. There's just so many other things that students need to learn besides how to write a SOAP note, and yet that is where the emphasis always lands....

Well, in my case, my point was that there was so much we already weren't allowed to do at all or needed direct resident supervision to do (thus acting as a drain on team resources rather an asset) that the progress notes e-mail from the dean was really the last straw. It was especially bad on the medicine clerkship. But it affected surgery too. Prior to this we would round in the AM on surg and start all the progress notes leaving the A/P for rounding with the residents. But then were weren't technically even allowed to do that anymore. I frequently had trouble just being sent to remove staples or a JP as a 4th year sub-I because there were some that felt we had to be supervised for even these minor tasks.

 

[SocialistMD]

For what it is worth, I do think it is fair to have an 80-hour limit for students, though I think the mandate has to come from each individual school, as there is not any edict from any governing body to state that. That said, I do think a lot of schools have taken medical student input too far in terms of the work expectations.

The most popular theory on learning involves four stages; not knowing what you don't know (unconscious incompetence), knowing what you don't know (conscious incompetence), knowing what you know (conscious competence) and automaticity (unconscious competence). Med students don't know what they don't know, so it is difficult for them to appreciate what it takes to learn on clinical rotations until after they have been on them and are on the other side (as residents, where they progress from conscious incompetence to conscious competence).

The reason you hear nearly all residents complain about how little med students work has less to do with the "my life was harder" argument and more to do with the fact that, in retrospect and in looking at interns who come from programs that coddle vs programs that don't, those med students who have to "work harder" during clinical rotations are more prepared clinically (you don't learn to manage the minute-to-minute issues of patients from any book I've seen) and are less likely to leave residency, as they know what to expect. Many times it is the medical school administration that has implemented rules about expectations for students in terms of work, rounds, clinic, etc..., but that comes from feedback they've received over the years from medical students at the end of the rotation. As silly as it seems to me, most departments focus more on medical student satisfaction than medical student education and are willing to change expectations and curriculum to make life easier instead of encouraging education. Examples of going home at 9pm when "on-call" or not being allowed in the hospital until 6am illustrate this point. Hell, >50% of students at the medical school where I work receive honors on their surgical rotation, partly because of lowered expectations and partly because of straight grade inflation (because as good as our medical students are, 50% of them are not "honors material" in surgery). How valuable is that honors? The problem is, the perspective they are using in all of this curriculum and work change is that of the student, the one in the equation who knows the least about what is involved in valuable clinical education and the one who doesn't know what s/he is missing until it is too late.

 

[45408]

My students manage to do very little most days. We had paper charts where I went to school so as students we could write notes/orders and then have the intern sign them, but with everything being computerized they can't do too much.

I was actually most useful to my team on my medicine sub-I at the VA where all the records and orders are in the computer, because I could enter all my orders. My senior still had to approve them, but he said that after he reviewed the admission/discharge orders on a few of my patients, he stopped reading them because he trusted me to do what we had discussed. I didn't write a single paper order as an M3, and the only paper orders I wrote as an M4 were post-op admission orders.

Whats funny is when they sit around and complain about having nothing to do I usually tell them they can actually help the team by maintaining the patient list and putting all the vitals/labs for morning rounds, transporting patients to xray, or starting iv's/drawing blood. They then inform me that this is scut work and beneath them, and if I make them do it they will report me to the clerkship director. So I usually tell them to just sit there and complain about having nothing to do.

Uh, transporting patients to x-ray? What a completely useless task for a student. That's the definition of scut. At least starting IVs and drawing blood at least a handful of times is a useful skill. "Maintaining the list" can be useful if the students are familiar with most/all of the patients, but when I was a student, some of my classmates were responsible for maintaining lists on patients they didn't even know.

 

[glade]

Since when is it a violation of the TOS to make mom jokes? As long as its about glade's mom, fair game. 😛

I'm in the process of creating an analysis of "yo momma" usage B.G. (before glade) and A.G., aka "when SDN started getting hilarious." I got bored before I completed the study, but I can assure you there was an exponential increase.

 

[glade]

Medical students are not "extra" workers for the team but are students period.

Yeah, except there are GLARING flaws in this argument.

1) Working leads to learning. When "just" working, people learn what to do, how to assess patients, they become comfortable with the system, they discover what a specialty is "really about." I'm not sure how one can separate working from learning, especially since that's what all of residency is. In fact, if residents behaved like students and were like, "sorry, I'm here to learn" then there would be an uproar of outrage because all of the slack-ass attendings who are used to residents doing all of their work would discover that they had to do some work.

1a.) If students are not "extra" workers, then neither are residents. Residents aren't there to transport patients, do blood draws, get reports from other hospitals, make phone calls, or any of that bullcrap. That's the attending's job, right? Oh, no? Heaven forbid the attending break a nail trying to track down a pathology report that isn't directly handed to them or conveniently discussed with them directly and which they won't disclose to residents because "the residents should know."

2) In contrast, students may be there to learn, but residents ARE NOT THERE TO TEACH. A lot of attendings say that it is the "duty" of residents to pass knowledge along to students. Uh, no. It is the duty of the TEACHING ATTENDING to teach. If the attending doesn't do it, it does not therefore fall to residents to serve as their stand-in or proxy, which is the attitude of most "teaching" attendings. Therefore, before any attending lectures anyone about "how to treat students," one should ask them "why is ANYONE treating them in any way, when YOU are the one responsible for directing and taking care of them?"

3) Going back to the first few posts, expecting students to take call on a holiday or actually be on call overnight doesn't constitute "abuse." And if it does, then it constitutes the same abuse for residents. I don't recall anyone making a legitimate or sane argument for residents having to work on weekends or holidays if students don't, simply because one has graduated medical school and the other hasn't. Suddenly, since someone is a resident it's TOTALLY OK to beat them down and treat them in any way you want, but if they're a medical student it's like "OMG, OMG, did I not tell you how wonderful you are today?? OMG, I'm so sorry!!!"

 

[OtoHNS]

I still think it's funny that everyone puts so much weight into progress notes. Third year students feel like once they've written their note, they've completed their clinical duties for the day, and we talk about all the notes we had to write as students, etc.

I know that progress notes are important for documentation and legal reasons, but very little thought goes into most of them, and you could teach a monkey to write them. In general, they have very little to do with the process of treating and dispositioning patients. There's just so many other things that students need to learn besides how to write a SOAP note, and yet that is where the emphasis always lands....

There's some truth to this for sure. However, I do think that learning to write a concise well organized progress note that says what's important and leaves out what's unimportant is a useful skill for medical students to learn. If nothing else, it will train them to think like a physician.

I never minded writing notes and doing scut as a student, especially on busy services like trauma, because the work had to get done and I could help by doing some of it. Now, though, even if a student does write a note, the resident or intern will have to write another whole one anyway.

The problem now is with computer records, most SOAP notes are just a bunch of cut and pasted lists of problems, medication, ROS, etc with a few lines about what is actually going on with the patient. You can definitely write a bunch of "notes" now that say absolutely nothing about what is actually happening with the patient.

 

[45408]

3) Going back to the first few posts, expecting students to take call on a holiday or actually be on call overnight doesn't constitute "abuse." And if it does, then it constitutes the same abuse for residents. I don't recall anyone making a legitimate or sane argument for residents having to work on weekends or holidays if students don't, simply because one has graduated medical school and the other hasn't.

I'm basically making $80-90,000 more per year than a med student, and the attendings have another digit in front of that. It assuages the pain of being on call for a holiday. Working a holiday is rather lame, because there aren't any scheduled operations, and people are specifically going to avoid going to the ER for some piddly complaint since they'd rather get smashed and eat turkey (and then come into the ER the next day). But someone has to be there, so I show up.

I now get to work any and all holidays from here on out, but my education would have gained 0.01% by being on call over a holiday.

 

[glade]

I'm basically making $80-90,000 more per year than a med student, and the attendings have another digit in front of that. It assuages the pain of being on call for a holiday. Working a holiday is rather lame, because there aren't any scheduled operations, and people are specifically going to avoid going to the ER for some piddly complaint since they'd rather get smashed and eat turkey (and then come into the ER the next day). But someone has to be there, so I show up.

I now get to work any and all holidays from here on out, but my education would have gained 0.01% by being on call over a holiday.

So we make money, big deal. We've all heard that line: "you're paid to be here, medical students are paying for the pleasure of being educated." Sounds nice, but being "paid" is irrelevant to residency. Sure, you're drawing a salary, but relative to the hours worked or the amount of done within those hours, you're grossly underpaid.

And if we're paid to "assuage the pain of being on call for a holiday," then why are the attendings paid more than me when they're not in the hospital? It's not about "responsibility level," either, which people like to say, because let's say you decided to totally eff around during a call. It's not like the attendings would tolerate that and go "it's OK, it's OK, ultimately I'm the one responsible for the patient so I'll take over." The implication of residency is "I'm responsible, but if you make a mistake we'll fire you, we're just saying, don't worry about that or think about it or anything."

And if being on call is about "education," then why don't attendings cover the hospital on holidays and weekends when "nothing is going on" (and believe me, I completely agree with your statements about patients avoiding the hospital on holidays)?

And why can't residents go "hey, I'll give back a pro-rated part of my salary and not come in on holidays and weekends"? Hey, how about I make half as much and decide when I feel like coming in and we'll call it a draw?

And even if we're paid for "the pain," isn't it the case that students take massively less call than residents? (Note: if they don't where you are, don't tell me, I'd make fun of your program for the rest of eternity.)

I seriously can't believe we're sitting here arguing about the fact that A SINGLE MEDICAL STUDENT has to take ONE CALL their whole life on a holiday. Recall that within any given three month period, there is an average of less than one holiday per month. And if their rotation falls on such a holiday, they don't ALL stay on call. ONE guy draws the crap stick. And if they don't want to ever do surgery again, that's the ONLY call they'll ever have taken EVER for surgery in their entire life on a holiday. Someone give me some Kleenex and dry my eyes because I don't think I've cried this much since I accidentally saw Lady Gaga's face and almost killed myself.

 

[Samoa]

My approach has always been that, at whatever level I am, my job is to learn how to do the job of the person at the next level of training. For example, as a 3rd year and sub-I, my job was to learn how to be an intern. As an intern, to learn the PGY-2's job, etc.

I'm pretty sure that viewpoint came from my school, rather than myself. So although my school did insist that our hours conform to resident work-hour standards, the goal was to function at the skill and knowledge level of an intern. So it was explicitly stated that any task an intern would be expected to do was fair game to ask of us.

 

[glade]

function at the skill and knowledge level of an intern

So after you attained that in the first ten minutes of the rotation, what did you do for the rest of the time?

 

[45408]

I seriously can't believe we're sitting here arguing about the fact that A SINGLE MEDICAL STUDENT has to take ONE CALL their whole life on a holiday.

I can't believe it either. I thought we were talking about multiple calls on multiple rotations on their way to a residency with hundreds of chances to be on call.

 

[glade]

Wow, multiple calls. The students where I'm at average about four calls per month, most of them with no weekend call, so I can totally see where you're coming from and this doesn't seem like some lame-ass argument at all. You convinced me now, sir. Bravo!

 

[45408]

No, no, your n=1 has convinced ME!

 

[Thanatos]

I was actually most useful to my team on my medicine sub-I at the VA where all the records and orders are in the computer, because I could enter all my orders. My senior still had to approve them, but he said that after he reviewed the admission/discharge orders on a few of my patients, he stopped reading them because he trusted me to do what we had discussed. I didn't write a single paper order as an M3, and the only paper orders I wrote as an M4 were post-op admission orders.


Uh, transporting patients to x-ray? What a completely useless task for a student. That's the definition of scut. At least starting IVs and drawing blood at least a handful of times is a useful skill. "Maintaining the list" can be useful if the students are familiar with most/all of the patients, but when I was a student, some of my classmates were responsible for maintaining lists on patients they didn't even know.

unless you work at some nice hospital, if your patient needs an xray you have to take that patient to the place where the radiation actually passes through their body. You either want to help out your patient/resident/team or you don't. Its not educational, but somebody has to do it. As a student I did stuff like that because it was something I could actually do to ease the burden on the residents. They rewarded me by teaching me stuff and let me do more in the OR than my classmates who pissed and moaned about "scut." In life sometimes things just work out like that I guess....

 

[glade]

No, no, your n=1 has convinced ME!

n = 1? OK, I'll call your bluff. I invite everyone on here to post the grueling call schedule that is routinely taken by your Surgery medical students. I'm sure I'm going to be so shocked and stunned that I may never recover and my priaprasm may even spontaneously resolve. It'll be like "The Jungle" where I suddenly realize the terrifying and deplorable conditions of our medical schools, where students are worked until they literally drop by the wayside and are instantly cannibalized by the survivors, who also stop to pick over their pocket books, pens, and the infrequently-but-highly-prized otoscope.

 

[Samoa]

So after you attained that in the first ten minutes of the rotation, what did you do for the rest of the time?

I honestly do not remember. I wrote a bunch of notes, that the intern then had to completely rewrite or it didn't count. Changed a lot of dressings, pulled out a lot of tubes, stood in awkward positions holding retractors without any view of the surgical field. Listened to ancient attendings explain their particular brand of surgical voodoo. That sort of thing.

There were six of us, so we took overnight call q6, regardless of weekends and holidays. I stuck around post call a few times when there was an interesting case, even though we were supposed to go home.

It was about as old-school as it gets, these days. But I don't feel like I learned much, because I got assigned to the slacker services (not my choice at all).

 

[glade]

Changed a lot of dressings, pulled out a lot of tubes, stood in awkward positions holding retractors without any view of the surgical field. Listened to ancient attendings explain their particular brand of surgical voodoo.

...and then all of a sudden residency ended.

 

[Winged Scapula]

n = 1? OK, I'll call your bluff. I invite everyone on here to post the grueling call schedule that is routinely taken by your Surgery medical students.

Schedule for students during my residency: on call approximately q7; could leave at 10 pm if "nothing going on"

Schedule for students at a local program: no call at all, no pre-rounding, no rounding on weekends (unless some mean attending like me makes them); surgery rotation is a joke

 

[ESU_MD]

half of the time they dont even show up.

once we gave a student the equivalent of a "low pass" and the student complainted to the dean who in turn complained to the PD and coerced us into changing the grade!

 

[ESU_MD]

another irony- some of the best students I ever worked with on surgical rotations with had no interest in going into surgery!
they were just there to learn as much as possible to be good doctors.

strangely enough, the ones who are interested in surgery can get very consumed with internal political issues and lose sight of their ultimate goal.

 

[glade]

Holy crap, I thought I was the only one who had students that didn't show up. You'll pass by the resident lounge and they're sitting there watching television and they're so brazen about not doing work that they don't even move or flinch. That's the great part: they don't even realize how pathetic they are. And then later they're like "uh ...since I'm here every day, doesn't that mean we get to not come in on the weekend??" It's getting near the end of the current rotation and the best part is that these *****s are trying to suddenly look all great to create some good "end impression." I don't know what's worse, the fact that they think I'm that easily swayed or the fact that this consists of them going "can I do anything for you, sir? Can I do anything for you, sir?" every five seconds. That's even worse because any GOOD medical student wouldn't have to ask, but I guess if the only thing you know about surgery is which channel ESPN is on, that's your idea of "good."

I'd at least be more happy to interact with them if some of them were decent looking women, but they're all hags. Also, one of them apparently spends all of her time in the bathroom caking on extra makeup. She frickin' comes to work wearing mascara, lipstick, and eye-liner. I wish she'd come to work with a paper bag on her head and a sock in her mouth, but she hasn't fulfilled my fantasy yet.

 

[45408]

unless you work at some nice hospital, if your patient needs an xray you have to take that patient to the place where the radiation actually passes through their body. You either want to help out your patient/resident/team or you don't. Its not educational, but somebody has to do it. As a student I did stuff like that because it was something I could actually do to ease the burden on the residents. They rewarded me by teaching me stuff and let me do more in the OR than my classmates who pissed and moaned about "scut." In life sometimes things just work out like that I guess....

"Some nice hospital"? I've worked at close to a dozen hospitals, and every single one had patient transporters, including the VA, inner city dive hospitals, and the nice posh ones.