Lazy teaching methods of residents/attendings

[High Roller]

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I don't know about that. A lot of the older attendings come from a time when medical school was very different (and a lot easier given that they didn't learn as much as we did b/c of scientific advancement) and it was the norm to suck up to everyone and it was encouraged. They absolutely LOVE being sucked up to and will often judge students based purely on that.

This is not to say those people are in the majority of course but they do exist. Usually everyone knows who those attendings are at the schools though. That's why our school intentionally installs a clerkship director who is younger and more up-to-date with the material (class of 2000 as opposed to class of 1980).

Great point, and its awesome it see proactive steps in changing the culture of not speaking up in medicine.

 

[quepatho]

I think (hope) I'm figuring out that there are some people you CAN ask anything from and some people you can't - you just have to figure out which are which.

I think the thing that I tend to ask about a lot are abbreviations (at least on ob/gyn), and while I could undoubtedly look them all up, I doubt that I could look up the relevant ones in a timely, efficient manner, and it's just so much easier if someone can just TELL you. I don't have a smartphone and being on the internet/on your phone all the time makes you look inattentive and uninterested anyway (no one knows what you're looking at anyway). By the next day it might just be too late to be relevant to the situation and/or you sometimes forget what you wanted to ask about.

I tend to agree on some level with the poster who said "you're PAYING for this."

You have to find a balance and stick to your guns as much as possible, I guess.

 

[dantt]

I tend to agree on some level with the poster who said "you're PAYING for this."

The problem is the resident/attendings are not getting paid for it.

 

[turkeyjerky]

The problem is the resident/attendings are not getting paid for it.

No. Both have teaching students as an expressed part of their duties. They might not get paid extra for it, but they do get paid.

 

[astrocreep96]

The problem is the resident/attendings are not getting paid for it.

At an academic hospital?

Right, and I'm not really paying tuition.

 

[ArcGurren]

The problem is the resident/attendings are not getting paid for it.

... Yes they are. It is part of a resident or an attending's duties at a teaching hospital to actually teach.

 

[45408]

Again, I'm here to learn, not to get points. It's beyond obnoxious when you go out of your way to be "that guy" by asking questions you have the answers to. It's also a waste of everyone's time.

I'm not saying you should just ask something that you know the entire answer to, at all. I would recommend asking questions that build off what you know, and if you don't know anything about it, go read about it first.

Don't get me wrong. I'm not advocating asking questions just to make yourself look good. That would be wasting people's time and people see right through that. But I think you should know the basics about something before you ask an expert. This not only increases your learning but some may argue even more importantly makes you look better.

Exactly. Ask an advanced question about a topic that you have a basic understanding of. Don't ask any basic questions (if you don't want them to give you the "Why don't you look it up?" answer).

 

[Perrotfish]

Don't get me wrong. I'm not advocating asking questions just to make yourself look good. That would be wasting people's time and people see right through that. But I think you should know the basics about something before you ask an expert.

Part of the issue is that the role of the residents and attendings in our education is poorly defined. Are they (as you imply) experts, from whom we seek expert advice when other sources fail? Or are they instead (like I think) teachers, from whom we should expect didactics and feedback on basic medical topics? You could make a good case for either viewpoint.

 

[MilkmanAl]

I'm not saying you should just ask something that you know the entire answer to, at all. I would recommend asking questions that build off what you know, and if you don't know anything about it, go read about it first.


Exactly. Ask an advanced question about a topic that you have a basic understanding of. Don't ask any basic questions (if you don't want them to give you the "Why don't you look it up?" answer).

I absolutely agree with this sentiment. You're not going to learn much if you don't have the foundation to understand the answer. However, that's a pretty significant difference from "the art of asking questions you already know the answer to," which may have just been poorly worded or something.

 

[dantt]

I absolutely agree with this sentiment. You're not going to learn much if you don't have the foundation to understand the answer. However, that's a pretty significant difference from "the art of asking questions you already know the answer to," which may have just been poorly worded or something.

I was being sarcastic. 😉

But there is some underlying truth. The right questions have to be asked at the right time. You always should be prepared with a well thought out answer to your own question (doesn't have to be correct but is a plus).

You can really do whatever you want. I just don't think ranting about it in a forum is all that helpful.

 

[Danlee07]

Unless the question was "what is ___", I don't really believe anything deserves a "look it up." I like the question teaching method since I do this as well, but the method is useless if it leads to a dead-end. but, this only can happen because the teacher can read the body language/eyes to see whether the student studied at all.

 

[deleted263296]

This example was mainly referring to situations where residents do things that are not immediately apparent. There are multiple ways to care for patients that are all correct and are not always amenable to looking it up on UpToDate. For example, asking residents their rationale for changing a pain regimen or adjusting fluids. This was not referring to questions like how does this drug work or whatever that are easily looked up on one's own.

 

[MilkmanAl]

I was being sarcastic. 😉

It doesn't come off as sarcasm when you go on to defend the point you made.

 

[ArcGurren]

It doesn't come off as sarcasm when you go on to defend the point you made.

Hence the claim of "sarcasm" probably being a defensive move 😉

But anyway... anyone else have good stories? They should be popping up aplenty now that the new interns are flooding in.

 

[Rollo]

This occurred in teaching round on one of the last days this past week...

Attending is going over pancreatitis and everybody is throwing out differentials. Somebody mentions medication-induced and the attending asks for which meds. A brand new intern on his second day is playing on his phone the entire time doing who knows what.

The interesting thing was that I saw my attending glaring over at the intern playing on his phone. Mind you, this is teaching round so it's common sense to not be on your phone or doing something else when you're in a small room with your superior(s). Anyway, the new intern mentions a drug. The attending disagrees.

The intern, with his balls of steel, DISAGREES with the attending and says, "It says right here in my phone..."

The attending explains that the incidence of pancreatitis from that particular drug is so rare that it isn't even worth mentioning because nobody in that room will ever see it.

Fast forward few minutes later, the genius intern is STILL playing on his phone. The attending is asking the group about something else (I forgot what he was asking). The group is throwing out answers.

The intern contributes. The attending disagrees. The intern says AGAIN, "Well on here it says that..."

The attending tells him, "Put that thing away. You've made it this far so I assume you know how to read. I want to see what you know already, not whether you can read information off of a phone."

 

[Acherona]

At an academic hospital?

Right, and I'm not really paying tuition.

Residents are basically paid by the government. The medical school is getting free labor anytime a resident teaches. The attendings appointed as clinical faculty of the med school should really bear the brunt of teaching, and if they aren't then you should complain. It is part of the medical educational culture that residents teach, but it is definitely not a primary responsibility (patient care and gaining expertise in our fields is). It's a messed up system but that's the way it works and med students who don't understand the mind-set of residents will get poor evaluations from them (i.e. students who sit there whining about how they aren't being taught rather than helping with clinical duties, which is the best learning anyways).

 

[fightingsaint]

I'm not saying you should just ask something that you know the entire answer to, at all. I would recommend asking questions that build off what you know, and if you don't know anything about it, go read about it first.


Exactly. Ask an advanced question about a topic that you have a basic understanding of. Don't ask any basic questions (if you don't want them to give you the "Why don't you look it up?" answer).

I completely agree. Residents have alot of other responsibilities, and some of us are better about taking the time to teach than others. Some med students are lazier than others about reading/preparing for cases. It goes both ways. As a side note, I guarantee your medical school is not paying us a dime to teach you. So we get none of your money...you may be paying someone, but it's not residents...and we are poorly reimbursed for the amount of other responsibilities we are given. You'll see for yourself in a few years. However, I do fully believe in teaching students and actually used to tend toward just telling them the answers (partly because I remembered what it was like to be a student) but then became frustrated later when they would repeat questions I had answered with a 10 minute mini-lecture weeks earlier that I clearly remembered. It doesn't stick as well when it's spoon fed to you and not ever quizzed under any pressure at all.

If you're on a surgical rotation, you have an advantage. Obtain the surgery schedule each week and read on the next day's cases. That avoids having to ask "basic" sounding questions. You will run into jackasses at all levels. It happens. Some med students and premeds are jackasses too. If you do the reading, it WILL show. Maybe not every single time, but it WILL show. I guarantee it. Unfortunately, in some ways, one of the most important things a med student can do is read on relevant topics. It will certainly help you ask more intelligent questions.

 

[astrocreep96]

Residents are basically paid by the government. The medical school is getting free labor anytime a resident teaches. The attendings appointed as clinical faculty of the med school should really bear the brunt of teaching, and if they aren't then you should complain. It is part of the medical educational culture that residents teach, but it is definitely not a primary responsibility (patient care and gaining expertise in our fields is). It's a messed up system but that's the way it works and med students who don't understand the mind-set of residents will get poor evaluations from them (i.e. students who sit there whining about how they aren't being taught rather than helping with clinical duties, which is the best learning anyways).

I'm not saying it is the resident's primary responsibility and I'm not asking for a powerpoint presentation each morning.

While I'm helping with clinical duties, however, I think it is reasonable for residents to throw me a bone and try and fill me in on what they're doing - ask questions to gauge my understanding, pimp, whatever...I don't particularly care. At least some fundamental component of communication is appreciated.

 

[myhandsarecold]

Student to doctor: "Why did we do X for patient A?"

Doctor to student: pauses, "Why did we do X for patient A?"

Student: "I don't know." Thinks, that's why I just asked you...

Doctor: "Look it up."

Next patient... Student wonders why they did Y for patient B but decides he'll just look it up instead of asking.

Evaluation: "Student doesn't ask questions."

you usually find this info in the admit H&P and from reading through books. I never ask this question unless I'm trying to figure out why they, for example, picked a conservative approach versus, say, surgery or whatever. it does seem lazy to just be expected to be told of the answer when you could answer the question by going to the chart

 

[WanderingDave]

On a number of occasions, I've been pimped by residents and answered, cheerfully and without missing a beat, "I'll look that up and get back to you," and had them throw back in my face, "You should know that by now." I always attrbited them playing this card to them purposely wanting to make me squirm, and feeling that my response didn't show enough shame. But reading this thread makes me wonder if there's not a laziness element in this response -- they don't want to remember to have to quiz me again.

 

[ArcGurren]

On a number of occasions, I've been pimped by residents and answered, cheerfully and without missing a beat, "I'll look that up and get back to you," and had them throw back in my face, "You should know that by now." I always attrbited them playing this card to them purposely wanting to make me squirm, and feeling that my response didn't show enough shame. But reading this thread makes me wonder if there's not a laziness element in this response -- they don't want to remember to have to quiz me again.

Lol I wonder how people are supposed to figure out what they "should know by now". Like if I'm on peds I don't expect to go into the rotation knowing the full vaccination schedule by heart... I doubt they do themselves. More likely the residents are just in a bad mood and tired.

 

[KnuxNole]

I feel that way in OB/GYN, where the attending thinks we know everything about labor and delivery whereas I probably wouldn't know what to do when the baby comes expect tell the lady to push and let the baby fall into a basket!

 

[WanderingDave]

Lol I wonder how people are supposed to figure out what they "should know by now". Like if I'm on peds I don't expect to go into the rotation knowing the full vaccination schedule by heart... I doubt they do themselves. More likely the residents are just in a bad mood and tired.

The most recent incident of this that I can remember was being pimped by a resident about how to correct hypomagnesemia in an ICU patient on TPN. I've never once been given a lecture on fluids and electrolyte replacement, if you can believe this, but I'm perfectly willing to learn it. Trouble is, this resident was a PGY5 and about to graduate, pretty much a sociopath, and really didn't like me from day one.

 

[DuxburyPembroke]

On a number of occasions, I've been pimped by residents and answered, cheerfully and without missing a beat, "I'll look that up and get back to you," and had them throw back in my face, "You should know that by now." I always attrbited them playing this card to them purposely wanting to make me squirm, and feeling that my response didn't show enough shame. But reading this thread makes me wonder if there's not a laziness element in this response -- they don't want to remember to have to quiz me again.

I'm only on my second rotation, but when I say "I'll read about it tonight," they usually seem satisfied. The residents never ask me later, but I've had a couple of attendings ask me a day or two later, randomly or at lunch or something. Fortunately I really have read about it by the time they ask me again!