Leaving early

[Teufelhunden]

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Okay, my roommate comes home today and wants my opinion on the following:

He's on his MS-III Medicine rotation right now. Today at 2:00 his preceptor (a PGY2) tells him and the two other students to "hang out" until 5:30, at which time he'll round them up and do case discussions, or whatever. Okay, 5:00 rolls around, the preceptor has left for the day, and him and the other students are in a quagmire.

So, they call the intern, who tells them that he's swamped with 4 new pt admits, and that the students can stay on and help with the admits, or they can go home if they like.

Well, of course I told him that this was a no-brainer, and that he should have stayed. I told him that a large part of his evaluation would probably be based up his work ethic and enthusiasm. He replied that he thought that this intern wouldn't have any input on his evals cuz the intern would be leaving before the end of his rotation. I told him that the intern probably communicates with the residents and attendings, and that everyone will eventually know.

To add insult to injury, the other two students opted to stay.

Now, in my mind there is a plethora of reasons I would have stayed:

1) To be a teamplayer. The intern was swamped with the 4 new admits...the right thing to do would have been to stay and help.

1a) IMHO, people don't forget s*** like this. If I was that intern, and two students stayed to help while the other went home, I think I would remember that.

2) Because I'd think it would be a reflection of my work ethic, which I'm very proud of. My attitude on rotations is that I might not be the smartest, or be able to answer the most pimp questions, but I can out-work everyone around me.

3) Staying is an opportunity to learn. I wouldn't want to miss out on anything! Not to mention, tomorrow morning on morning rounds, he won't have a clue as to what's going on with these new patients.

Oh well, we're all different, I guess. Funny thing is...he didn't have any particular reason to come home. No hot date, no must-see TV...no...he just came home and went to bed (?)

Don't get me wrong, my roommate is a great guy...I just hate to sit by and watch as he commits professional suicide. Am I wrong?

 

[MI48104doc]

I agree with you.. as a fourth-year I have learned that whenever an attending says " you can leave if you want" you'd better stay for the sake of your evaluation, if not to learn something!

 

[doc05]

there was no reason to stay, except that the other students did, which would make him look bad. I wouldn't worry too much about the intern's evaluation. most are pretty cool, and if his intern is normal, he'll get a solid evaluation regardless.

 

[DOtobe]

Originally posted by MI48104doc
I agree with you.. as a fourth-year I have learned that whenever an attending says " you can leave if you want" you'd better stay for the sake of your evaluation, if not to learn something!

See, I've heard the opposite sometimes too. My FP attending told me "whenever your attending tells you you can go home, you might as well because there are plenty more attendings who will make you stay forever."

I'm always torn because a little part of me is always thinking, "Are they testing me to see what kind of worker I am?" when I am told I can go home. Or are they just saying there is nothing really left for me to do and I would just be in the way? I'm always afraid to leave, but so far when I have, it hasn't hurt my grade any. But this is only my third rotation, so who knows.

 

[prwunecom]

if my attending or a resident tells me to go home, i usually do. It is usually prefaced by them telling me that I will have plenty of time to put in long hours as a intern, so I should take advantage of my last year of being able to leave when there is still work to be done if I am told to do so. So far, I have high passed 3/4 of my rotations. I work hard when I'm there -- perhaps I have just had very understanding, kind attendings.....don't know

 

[gwyn779]

In general, if an attending or resident tells me to go home, I do. However, if given a choice and there are other students staying, I will stay to not look worse than them. On the other hand, I haven't had any other students on my service in several months, so this situation hasn't presented itself recently.

 

[GO_MEDPEDS]

"Commits professional suicide" may be just a little harsh when judging your roommate. I think it is a common misconception that every little thing you do is under constant scrutiny. Interns, residents, and staff are much to busy to keep a constant tab running of each time you answer a pimp question correctly, perform a procedure, stay late, etc. They deal more in generalities; was this a medical student who was generally inquisitive and intelligent, who generally was around when important medical decisions/procedures/interventions occurred, and were they generally good about interacting with the patients and ancillary staff. As a 4th year, I have been "consulted" concerning the peformance of 3rd years on a few of my rotations, and the resident/staff would always present their evaluations as a gestalt- this guy just never seemed interested in Medicine, this guy always seemed to upset his post-partum patients, etc. I never noticed these evaluations to come from one particular observation, rather they were a cummulative assessment made from watching a student continually make the same mistakes.

That being said, there are certainly some mistakes what will stick out and, in my opinion, are "committing professional suicide." Outright lying, disrespect, or intentional neglect are mistakes that one only makes once.

In this particular case with your roommate, I don't think anyone can fault him for deciding to relax at home. The resident was no longer present, and the intern may or may not appreciate having students hanging around. If you are determined to stay, preface this with something that you want to accomplish by staying (i.e. staying to do procedures, to follow-up a certain condition, finish some discharge summaries, etc.), and then leave promptly when this is accomplished. No one wants a student hanging around that he/she needs to "babysit," and this is especially true if there are several of you sticking around because no one wants to be the "slacker" who went home early.


GO_MEDPEDS

 

[Teufelhunden]

Goof points. And I agree that "professional suicide" was a little overblown. Anyway, thanks for sharing your experience.

I think, in the end it's frustrating for us new MS-IIIs because no one really sits down and tells us what the expections are.

For me, I'm gonna err on the side of staying whenever possible...make the residents have to kick me out. I just don't EVER want an eval saying that I wasn't enthusiastic, hardworking, teamplayer, etc.

 

[8744]

When my attending or resident tells me I can go, I quickly put as many stairs, doors, and buildings in between me and them as I can. I'll take the first stairs I come to or the first open elevator door even if it isn't going my way.

The 30 seconds after dismissal is statistically the most dangerous time when you are still in their minds and they might think of something at the last minute which needs to be done.

But before that I maintain a good attitude and do my duty cheerfully and willingly.

Still, it would be unusual for one of our residents to tell us to stay "if we wanted to." If they did I would take it at face value and leave, if I wanted to. No sense reading to much into it.

I'm doing medicine right now. My residents are pretty cool. As long as we get all of our work done early they will not keep us hanging around doing nothing until 6:30PM "just because."

See some of my other threads, but I have a "real life" and appreciate having some extra study time which does not cut into normal family time.

But I think you cannot go wrong adopting Teufel's philosophy.

 

[8744]

Oh, and in every group I've been in we all agree whether we're going to leave or stay in situations where we have an option. Like whether we go back to the clinics after a lectures which ends at 4:00PM.

This under the theory that we don't want to make each other look bad. And we usually opt to slack, by the way. My group started third year with surgery, did OB-Gyn, and are now on medicine. We're getting a little worn out if you know what I mean.

 

[DOtobe]

Wow, Panda, that sucks to do surgery - ob/gyn - medicine. I see why you would be tired.

I was lucky enough to start off really easy with psych and family practice, and now I am in medicine. Surgery is next, which is very frightening to me

 

[c diddy]

the strange transition into the clinical years has quickely given me the understanding that there is no way to try and predict whether attending/resident/intern offers to leave are for real, or a test. i've come to the conclusion that our clinical evaluations are much more dependent on luck or on the mood of the evaluator than anything else. my first rotation i new nothing (my impression based on my interactions with the residents/attendings), and wound up with honors clinically. my next rotation was the opposite. clinically i was great, in terms of knowledge (had the right answers at the right times), work ethic, relationship with coworkers, etc, and i wound up with a very mediocre eval. whereas years 1-2 and boards are objective, from here on out it's very much a matter of luck. a kid who was on my current rotation before me would show up an hour before anyone was even supposed to be in the hospital, stay later than all students, try his damndest (sp?) to make an excellent impression, and he wound up irritating the hell out of the residents. if he had done that on my obgyn rotation, he would have been crowned the best student of the year. my advice- try to get along with everyone and feel everyone out. if they seem like rotten residents that might set you up, stay late. if you can tell they're cool and not out to test you every second, go home and chill.

 

[huktonfonix]

decent advice. However, my personal philosophy is just work hard and if you're told to leave come to a concensus or just leave. People like the aforementioned student who came in really early stayed really late, etc... probably spent a lot of time with his nose stuck up the resident's butts. This tends to annoy a lot of people. These are not stupid people. Wouldn't you be able to tell if someone was trying to kiss your ass 24/7 and wouldn't it get annoying really fast? That being said, a lot of third year is random luck and a lot of the asskissers do tend to get honors while other harder working, smarter people won't. Can't be helped so its really pointless to try and please everyone.

 

[Tazmaniac]

😀 😀 😀

In a year or two, we won't have the luxury of torturing ourselves with the possibility of going home or not going home.

If someone senior than you offers you the chance to go home, take it and get out of their hair. You can be just as an unsightly burden too.

If you feel helpful and want to help the intern with 4 patients, offer right up and there to do one H & P, finish it efficiently, then go home. Invite the other students.

If you don't feel helpful, just leave. Invite the other students.

The best evaluations come when you're just doing things efficiently and not really thinking about how you look. Hard to do, but the philosophy comes in handy at awkward moments. I personally like hard work until 4pm or 9pm on short calls.

-Todd MS-IV USC

 

[prwunecom]

Todd, good points........glad to hear someone who thinks like me.....😉

 

[hosskp1]

I just happenend to click on this discussion by accident and let me tell you. this was a serious point in medical school. I am an intern (transitional year) now and can not stand the do-gooder medical student who thinks that sucking up and staying late is the way to go. I do not fault someone for staying late voluntarily- they may have interest and they may want to learn. Some of the students I am in charge of have finished their work early and then went over to the radiology, orthopedics, PMR and anesthesiology department for the rest of the day. I did not fault them for that. Some just wanted to get to the gym early, others just wanted to get their reading done. I personally would never sell someone out for leaving early, some of my intern colleagues might. The problem I have with the story is the two medical students who stayed late and left the other guy out to dry. MAny times evaluations are based on whether the guy liked you not on any substance. I remember getting better evaluations than people who had stayed late, just because the evaluator liked me better.

 

[Airborne]

Interesting post?

Really, I think one must think what they would do in their superior?s position ? I do believe that if an intern needs your help ? ie they have 4 full-on admits, they will ask. If they are routine admits, that you have seen before and will see time and time again ? and that their going over it with you detracts from their own time management, then heed their advice and leave. Trust me on this.

Perhaps a good way to approach this would be ? What are the 4 pts admitting diagnoses? If you have seen them, then as a student, you really would be better spent reviewing them ? if you have not, mention that you?d be keen to see this presentation and take the initiative to at least get a H&P.

Now your situation is a little unique, as multiple students are involved. I have always been one to invite fellow students to co-interview fun admissions, if circumstances allow. You can work it out between yourselves who is ?1st? ? in the end, as long as it is congenial, you all come out ahead. Remember that teamwork is big in the scheme of medicine ? and in the short term any evaluation that you are worried about. Indeed, at least where I go to school ? it seems that the people who are most team oriented and least me oriented fare best in the evaluation process.

Now we all worry about how we look in our peers perceptions ? Medicine in general perpetuates this ? for good reasons as in the end, the perceptions of patients in the end drive your practice ( I was once told that when you are an attending, your patients come to you based on 3 things, in this order: affability, availability and ability ? as all will assume you know your stuff.)

Is it wrong to leave when the opportunity arises?

Clearly, that depends on the circumstances, and quite honestly on the impression you have made earlier in your rotation. If you are independent enough to take charge (within reason) of the situation and give a clear and concise synopsis of what is _really_ going on, then yes, by all means stay. If you are one that asks too many questions at really the wrong time, then by all means leave. The problem is, that unfortunately, the latter often thinks of themselves as the former. In the end, time will tell.

Regardless, in the situation describe by the OP, I would simply have asked what the admissions were for, admitted those with processes I have not seen, and if I had seen them before, gone home, had a good meal, spent time with my partner, and looked up the diseases as to be in touch with current management for morning rounds.

As a side note, I would mention ANY and ALL insight to the intern and keep my mouth shut if I did not actually admit the patient. If you did not admit them, they are not yours and belong the whomever did (I take that back, I would mention it to whoever did the admitting, even if it was another MS) ?

If it is praise you are looking after, I have mentioned MANY times in my own reports with patients that other students have commented on privately to me ?on the side? that ?blah blah blah, St. Dr. Bob (we really don?t say St. Dr., but you get my drift) and I talked and he mentions an interesting point that perhaps we should consider X in the case of Mr JD ? I agree and feel it would contribute to his management and disposition?.? ? In the end you both come out ahead in this approach, methinks.

Best of luck with 3rd year ? I?m currently struggling with interviews!

With kind regards,

Airborne

 

[Teufelhunden]

Wow...thanks for the insightful replies, everyone. I have to admit that I'm a bit shocked at the overwhelming support for leaving early when given the chance.

In all my previous professional experiences, ranging from the Marines to Corporate America, the answer was always to stay and work. Everywhere I've been, those that showed up early and stayed late were recognized as 'team players' and duly rewarded.

I guess I feel I'm getting conflicting messages. On one hand, I keep being told that work ethic is key, yet I'm supposed to 'split' whenever given the option (?)

So far, every time I've been given a choice to leave or stay, I've chosen to stay. I feel it, at least, confers enthusiasm (?) I do agree with many posters, though...in that as MS-IIIs, we don't have a heck of a lot to offer in many situations, and are often more of a hindrance than anything.

Interesting points of view, though, everyone....thanks for posting.

 

[ItsGavinC]

I'm obviously not a med student, but I think the crux of this thread is something that is applicable to many aspects of life.

I, personally, cannot stand people who beat around the bush and refuse to lay it out on the line, or tell it like it is.

Because of this, I am in full agreeance with those who stated that the student should leave if given the opportunity.

My thinking is that if the senior really needs the help or sees a good learning experience at hand, then he should state so, without throwing in any options of leaving early.

Therefore, if leaving early is an option, I'd get out of there quickly. If the senior is disappointed in that, then that is their problem.

Of course, that is probably easier said than done, especially when things such as evaluations come into the mix.

 

[md03]

Tough situation.

As an intern, it's my opinion that there's not a whole lot a 3rd year student can do to help with 4 admits in the evening right now. Let's say I sent the students to write H&P's, I still have to go see the pt and write some comment on the H&P and correct any mistakes the students made. Plus generally students are still pretty slow writing H&P's right now, so I might actually wind up waiting for the student to finish. Students might be able to do things like pull up lab vaules and radiology reports, and some of the better ones can get a set of admit orders started. But still I have to check whatever they do carefully.

Having said that, I would be very appreciative of the fact that students want to help.

The problem with the scenario you described is that all of the students didn't act in unity. That runs the risk of making one look bad (or others look like gunners). I remember times as a student when, for example, we had to travel from one clinical site back to the school for a lecture and arrived only to find the lecture was cancelled. We would all stay at school and relax until the cancelled lecture would have been over. (even when this happened in surgery and I wanted to go back right away cuz I loved surgery, I always went with the majority so at least we were unified). But if, individually I was told to "stay if you want" as a student I would have stayed, no matter what. As a resident I'd opt to go home (unless there was some very rare case going on). Problem with being a student is that a lot can depend on your GPA, and it's nearly impossible to predict what your evaluation will be. As a resident, generally you have to be pretty bad for your contract not to be renewed.

I hope that I never put students in such an akward position. Having said that, if I found students in that situaion, I'd probably think a little less of the student who opted to go home. Would it affect my evauation? Probably not much, unless that student had significant deficiencies in other areas as well.

And don't kid yourselves. Unless we only spend a week with a student, we usually do have to evaluate them.

 

[Teufelhunden]

Originally posted by grouptherapy
BE THE FIRST ONE IN AND THE LAST ONE OUT. come in on weekends and days off to work.

The above was posted on another thread; however, I wanted to post it here to make the point that advice on this issue is inconsistant, to say the least. On this thread alone, the advice has ranged from one extreme to the other.

So, it looks like I'm going to err on the side of always-stay-when-given-the-option.

 

[rrreagan]

One learns the most as a student in structured settings such as those on morning Medicine rounds.

Do a good job of managing existing floor patients and you will be in good shape.

While you <b>can</b> indeed learn something by admitting new patients, this is not really the student's role.

When I'm an intern admitting patients, the last thing I'd want is students hovering around or shadowing me around.

 

[mamadoc]

for crying out loud do NOT do this:

BE THE FIRST ONE IN AND THE LAST ONE OUT. come in on weekends and days off to work.

Now, getting in early enough to get your notes done, your lab values collected, and your thoughts in order about the plan for the day is all good. But DO NOT show up on your days off. And if someone tells you to go - do not wait to see if they change their minds. GO.

Someone else pointed this out: while an MS-III can do a lot of stuff to help the interns and residents, the student does also *create* work to some extent. A PGY-2 can do the entire H&P on an ER admit quicker than she can talk to the med student about it, and some nights that is just what she is going to want to do - get it done and get outta there.

In my experience the interns and residents generally take seriously their responsibility to teach the medical students. Sometimes I have been quite sure that the reason they told us to go ahead and leave was because they really needed a break from that teaching.

So don't be a tool and be hanging around when you've been told to go. Be grateful, say thanks, and don't let the door hit you on the a$$ on the way out.