Lessons from Bad Rotations

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metabolite

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Currently I'm not enjoying my rotation very much. Right now I feel like I'm the only one who is experiencing this much stress with concerns over what my evaluatin will look like. However, if anyone else also has experienced a bad rotation and came up with some differentials for the cause (aside from mean residents and attendings, because we will have to deal with them from time to time) and how to better handle it next time (hopefully never again, but still), please feel free to add.

Lessons I have learned:
1. Stay chill for a day or two in the beginning of the rotation, to see if whether or not they want you to be excited about being there.
2. When you feel things going bad/ tensions from residents and attendings, take a deep breath, take a little bit less work load if you can, and make sure not to get overly nervous and flustered with presentation.
3. Spend less time working in admin stuff and more time on things you can show off - like presentation.
4. CHILL CHILL CHILL. Becoming upset, flustered or nervous not only takes you concentration away from studying and presenting appropriately, but also from how others feel and act around you, and vicious cycle can start!!!
5. If you made a mistake, just try not to do it again but do not freak out. Everyone makes a mistake whether or not they admit it, so stay calm and be careful.
 
Be at the rotation less but do more when you are there. If you are constantly hanging around doing problems in your review books (sitting in a corner with the attending and others working), you piss everybody off (including other students). It is just better to be active when you are there and then go home.
 
Hey, I did two weeks of heme-onc as a medical student and absolutely hated it. I survived by doing as little as I possibly could without malingering, staying as much away as possible without being AWOL, and making a huge effort to not see any more patients than the bare minimum.

Heme-onc is so complicated that it's not as if a third year medical student can make any meaningful contribution anyways. What exactly do you put on your assessment and plan on your daily note? Precise dosages for the patients CHOP therapy? A discussion of the probablilty of complete remission? I was happy to punt that one by writing "continue current care, will discuss with attending."

Not that a third year medical student can make any meaningful contribution on any rotations, you understand, just that you can do even less on some specialties.
 
2. When you feel things going bad/ tensions from residents and attendings, take a deep breath, take a little bit less work load if you can, and make sure not to get overly nervous and flustered with presentation.


Good Lord. We must have gone to medical school on different planets or maybe you are Canadian (which is kind of the same thing) but I thought everybody's goal on rotations, particularly those that you despise, was to make yourself as small a target as possible. How, precisely, can a know-nothing medical student (and we all are at that stage of our training) cause tension in the residents and attendings? If anything, a toolish medical student is a source of mirth, much needed comic relief, and somebody who they can laugh and joke about for months after you're gone.

There's a medical student here who was such a tool that we still talk about her three months later.
 
And I thank the Lord that I am done with formally presenting patients and all of that other trained monkey crap. Just another benefit of being in Emergency Medicine where we strive to be succint.

When I was at Duke last year I had to round on a medicine team. Listening to presentations from the medical students was like torture, especially when I was post-call. It's just exertional mid-chest pressure radiating to the right shoulder relieved by rest and nitroglycerine in a guy with a history of coronary artery disease. Let's not make a federal case over it. Nobody's going to make a decision without reading the chart so why waste time with the, "Patient has a family history of," or, "Patient was washing his dog when..."

Nobody talks like that in the real world.
 
Good Lord. We must have gone to medical school on different planets or maybe you are Canadian (which is kind of the same thing) but I thought everybody's goal on rotations, particularly those that you despise, was to make yourself as small a target as possible. How, precisely, can a know-nothing medical student (and we all are at that stage of our training) cause tension in the residents and attendings? If anything, a toolish medical student is a source of mirth, much needed comic relief, and somebody who they can laugh and joke about for months after you're gone.

There's a medical student here who was such a tool that we still talk about her three months later.

Panda Bear: I didn't mean that a med student causes tension among the resident and attendings - I meant sensing that they are unhappy about something that a student did or is doing, i.e. grabbing too many patients and thereby increasing their workload, rolling their eyes in front of senior resident (this one was not me, btw), etc etc... Your point is well taken in that it's better to be invisible rather than seem eager when you can sense that you are not a favorite.

I'm sure you will find me pretty silly for saying that I really never thought of setting my goal in rotation to remain as small target as possible. I do admit that I was too idealistic in thinking that 3rd year was all about learning through clinical exposure, unlike first two years where we were confined to classroom memorizing lines after lines.
 
Panda Bear: I didn't mean that a med student causes tension among the resident and attendings - I meant sensing that they are unhappy about something that a student did or is doing, i.e. grabbing too many patients and thereby increasing their workload, rolling their eyes in front of senior resident (this one was not me, btw), etc etc... Your point is well taken in that it's better to be invisible rather than seem eager when you can sense that you are not a favorite.

I'm sure you will find me pretty silly for saying that I really never thought of setting my goal in rotation to remain as small target as possible. I do admit that I was too idealistic in thinking that 3rd year was all about learning through clinical exposure, unlike first two years where we were confined to classroom memorizing lines after lines.

I don't think you're silly at all. I was pretty motivated for some rotations (Emergency Medicine, Trauma Surgery) and tried to do a good job. But I didn't "skyline" myself either. I hated being asked to look something up and present it the next day so I stopped asking questions as this was usually the result. I also never volunteered for extra work and generally left, and quickly, when I was told I could go.

On that subject, residents laugh at medical students who, on being told they can go home, ask if there's anything else they can do and act guilty to be leaving. Fools. If I needed you I'd keep you here but I don't so you can go. I had to take one of my medical students aside and explain to him that while we appreciate his very real help on the service, when we say "go" we mean that he can go and it doesn't reflect poorly on him at all if he does. Telling him he can leave is not a loyalty test.

When my residents told me I could go, without actually sprinting away I moved out of their sight as fast as I could, usually taking the first stairs or hallway even if it was out of my way with the goal of putting as much architecture between me and the urge to ask me to do one more thing before I went home.

I don't understand how you can increase your residents workload by taking too many patients. I mean, you don't make the decision to admit patients.
 
...residents laugh at medical students who, on being told they can go home, ask if there's anything else they can do and act guilty to be leaving. Fools. If I needed you I'd keep you here but I don't so you can go. I had to take one of my medical students aside and explain to him that while we appreciate his very real help on the service, when we say "go" we mean that he can go and it doesn't reflect poorly on him at all if he does.


I do appreciate your honest comments from someone who has completed this tortuous medical education portion - it is helpful to know opinions from the other side. These are type of things that I learn during rotation and not at the Junior Orientation at med school... you see, we were told during clinical orientation NOT to look eager to go home, always ask if there is anything else we can do before we go.

What I meant about "increasing workload" - I know that my "help" at clinic is really residents spending time to teach me. I'm well aware that my taking history is slower than any of the residents or attendings, so by having me talk to patient, then present to them, and then going in together does take a lot longer time than if residents just went in and took care of the patients themselves. I try to help out with mindless things - like calling outside hospital for culture results/paperwork, which can mean staying on phone for up to 20-30 min at times, or filling out discharge sheets, which is pretty standard, organizing pre-printed prescription pads that were stacked in piles without any order whatsoever.. Regardless, I found that only thing really matters is to present in the format that is preferred in the specific site that I happened to be in, and knowing things that they happened to be pimping me on. Well, in this rotation anyway.
 
Panda Bear: btw, your blog is cool. I just might copy your idea and begin a blog on my clinical experience 🙂
 
We were also told by some fourth years to never seem to eager to go...aka when told to go, do not go and stay longer, until they tell you to go the second or third time...WTF? there are some many "unwritten/unheard of rules" that you get a glimpse of here and there...I wish someone would just be honest and tell it like it really is. God forbid we stopped being PC and get down to business.
 
We were also told by some fourth years to never seem to eager to go...aka when told to go, do not go and stay longer, until they tell you to go the second or third time...WTF? there are some many "unwritten/unheard of rules" that you get a glimpse of here and there...I wish someone would just be honest and tell it like it really is. God forbid we stopped being PC and get down to business.


Har har. When I tell my medical students to go, I mean for them to go. But I do appreciate their asking me if they can do anything else. It's not necessary to ask, of course, but I guess it's good manners. But some medical students ask several times which is annoying and just plain crazy. You will work plenty of hours once you get to intern year. No sense killing yourself as a medical student.
 
I hear ya...and that is what ALL the residents have reiterated....you are NOT getting paid to be here..so if we tell you to go home then GO HOME.
 
After two days of agonizing with worries and paranoia, I have fully accepted whatever will be, will be... meanwhile, my list of "lessons" continue as I think over what I now call "A Series of Unfortunate Events"... please feel free to correct me if I state something wrong here...

1. School psychologists are not very helpful, esp when they have not gone through a medical school themselves. If there is really a big concern, better off talking to your academic dean - just make sure you stay calm and be coherent.

2. Don't show any signs of misery to your fellow med students because some of them are inherently senseless and say all sorts of stupid things in front of you, like "hey your intern told me that you are a kissa*s" in middle of hospital cafeteria. This is the dude who got in a trouble for reminding a senior resident that we are all paying $40,000 of tuition to be in these rotations (he was even more blunt than this).

3. As tempting as it could be, refrain from comparing how residents and attendings treat other students vs. how they treat you. Sometimes you are just not a favorite - maybe you root for a wrong team, maybe your hairdo isn't their style, whatever. Doing so only increases you paranoia and victimized feelings.

4. Bad days should end as bad days, not bad day and night, like I have been. But how do we grow thick skin if we don't have one to start with???
 
2. Don't show any signs of misery to your fellow med students because some of them are inherently senseless and say all sorts of stupid things in front of you, like "hey your intern told me that you are a kissa*s" in middle of hospital cafeteria. This is the dude who got in a trouble for reminding a senior resident that we are all paying $40,000 of tuition to be in these rotations (he was even more blunt than this).

There is nothing wrong with being blunt but if you're going to take this approach then you have to go whole hog. You do not have to be timid during clinical rotations, you just can't be wishy-washy, vacillating between bluntness and ass-kissing.

I did one rotation at the end of fourth year which I did not like and only did because it was mandatory. Without being surly or direspectful, I told the residents at the outset that I wasn't going to do call and I had no intention of hanging around after quitting time because they couldn't get the nerve to go home. I was perfectly polite but when they said I had to pull call I said "no," pointing out that if I'd just have to call them for everything which makes call as a medical student idiotic.

I suppose that if they had made an issue of it I would have given in but they didn't so I didn't. And while I again stress that I was perfectly correct, affable, and polite, when I was pimped by the attending or the residents and didn't know the answer I instantly said, "I don't know" and that was pretty much the end of it. The "and I don't care" was implied and understood. They stopped pimping me and I followed in respectful silence doing my assigned duties.

I was pretty tired of medical school by that point. I like being a resident a lot better. My attendings don't pimp us but use the Socratic method. There is a difference.
 
More lessons from the field ...

1) after quietly watching the dynamics of the rotation for a day or so, make sure you also have scoped out people who can be potentially friendly/helpful/people to just plain be yourself with, like nurses, pharmD's, social workers, cna's. Anyone who is a nice friendly person is a valuable asset when you're feeling disoriented as to your place on the service. Also works when you don't understand the tensions and weirdness that might be going on with unhappy residents/interns/attendings.

2) Be small, be soft. Be a sponge, soak things up. Say "thank you," when you get advice from an intern that sounds completely ******ed. Thank people who harsh on you, what are they trying to teach you? what can you learn from their comments?

3) Wear some sort of mental protective gear, like, pretend you're wearing a clear plastic raincoat. That way, if some sh^t comes at you, it sticks to the raincoat and not to you. Sounds nuts, but it works.

4) Never, ever take stuff personally.

5) If something seems weird, you're not sure if people are mad at you or just mad at everything and you're in the way - step back, detach and remember rule number 4. 😀

6) When in doubt, do nothing.

7) When in doubt, say nothing.

8) Try and learn from everything, and everyone.

9) Thank people who help you, interns/residents/attendings/cna's/nurses, etc.

11) Apologize if you do something inappropriate, or hurt someone.

12) Work with classmates as colleagues, try and not be one up on them. You just look like a sneak and it reflects poorly on you. If a classmates cuts you and does it to you, "turn the other cheek." Be bigger than that, and you'll feel better.

13) Take good care of yourself. 😉
 
http://www.apor.org/html/how_to_swim_with_sharks.htm

HOW TO SWIM WITH SHARKS: A PRIMER
Voltaire Cousteau

Forward

Actually, nobody wants to swim with sharks. It is not an acknowledged sport and it is neither enjoyable nor exhilarating. These instructions are written primarily for the benefit of those, who, by virtue of their occupation, find they must swim and find that the water is infested with sharks.

It is of obvious importance to learn that the waters are shark infested before commencing to swim. It is safe to say that this initial determination has already been made. If the waters were infested, the naïve swimmer is by now probably beyond help; at the very least, he has doubtless lost any interest in learning how to swim with sharks.

Finally, swimming with sharks is like any other skill: It cannot be learned from books alone; the novice must practice in order to develop the skill. The following rules simply set forth the fundamental principles which, if followed will make it possible to survive while becoming expert through practice.

Rules

1. Assume all unidentified fish are sharks. Not all sharks look like sharks, and some fish that are not sharks sometimes act like sharks. Unless you have witnessed docile behavior in the presence of shed blood on more than one occasion, it is best to assume an unknown species is a shark. Inexperienced swimmers have been badly mangled by assuming that docile behavior in the absence of blood indicates that the fish is not a shark.
2. Do not bleed. It is a cardinal principle that if you are injured, either by accident or by intent, you must not bleed. Experience shows that bleeding prompts an even more aggressive attack and will often provoke the participation of sharks that are uninvolved or, as noted above, are usually docile.
3. Admittedly, it is difficult not to bleed when injured. Indeed, at first this may seem impossible. Diligent practice, however, will permit the experienced swimmer to sustain a serious laceration without bleeding and without even exhibiting any loss of composure. This hemostatic reflect can, in part, be conditioned, but there may be constitutional aspects as well. Those who cannot learn to control their bleeding should not attempt to swim with sharks, for the peril is too great.

The control of bleeding has a positive protective element for the swimmer. The shark will be confused as to whether or not his attack has injured you and confusion is to the swimmer's advantage. On the other hand, the shark may know he has injured you and be puzzled as to why you do not bleed or show distress. This also has a profound effect on sharks. They begin to question their own potency or, alternatively, believe the swimmer to have supernatural powers.

4. Counter any aggression promptly. Sharks rarely attack a swimmer without warning. Usually there is some tentative, exploratory aggressive action. It is important that the swimmer recognize that this behavior is a prelude to an attack and takes prompt and vigorous remedial action. The appropriate countermove is a sharp blow to the nose. Almost invariably this will prevent a full-scale attack, for it makes it clear that you understand the shark's intention and are prepared to use whatever force is necessary to repel aggressive actions.
5. Some swimmers mistakenly believe that an ingratiating attitude will dispel an attack under these circumstances. This is not correct; such a response provokes a shark attack. Those who hold this erroneous view can usually be identified by their missing limb.
6. Get out of the water if someone is bleeding. If a swimmer (or shark) has been injured and is bleeding, get out of the water promptly. The presence of blood and the thrashing of water will elicit aggressive behavior even in the most docile of sharks. This latter group, poorly skilled in attacking, often behaves irrationally and may attack uninvolved swimmers and sharks. Some are so inept that, in the confusion, they injure themselves.
7. No useful purpose is served in attempting to rescue the injured swimmer. He either will or will not survive the attack, and your intervention cannot protect him once blood has been shed. Those who survive such an attack rarely venture to swim with sharks again, an attitude which is readily understandable.

The lack of effective countermeasures to a fully developed shark attack emphasizes the importance of the earlier rules.

8. Use anticipatory retaliation. A constant danger to the skilled swimmer is that the sharks will forget that he is skilled and may attack in error. Some sharks have notoriously poor memories in this regard. This memory loss can be prevented by a program of anticipatory retaliation. The skilled swimmer should engage in these activities periodically and the periods should be less than the memory span of the shark. Thus, it is not possible to state fixed intervals. The procedure may need to be repeated frequently with forgetful sharks and need be done only once for sharks with total recall.
9. The procedure is essentially the same as described under rule 3: a sharp blow to the nose. Here, however, the blow is unexpected and serves to remind the shark that you are both alert and unafraid. Swimmers should care not to injure the shark and draw blood during this exercise for two reasons: First, sharks often bleed profusely, and this leads to the chaotic situation described under rule 4. Second, if swimmers act in this fashion, it may not be possible to distinguish swimmers from sharks. Indeed, renegade swimmers are far worse than sharks, for none of the rules or measures described here is effective in controlling their aggressive behavior.
10. Disorganized and organized attack. Usually sharks are sufficiently self-centered that they do not act in concert against a swimmer. This lack of organization greatly reduces the risk of swimming among sharks. However, upon occasion the sharks may launch a coordinated attack upon a swimmer or even upon one of their number. While the latter event is of no particular concern to swimmer, it is essential that one know how to handle an organized shark attack directed against a swimmer.

The proper strategy is diversion. Sharks can be diverted from their organized attack in one of two ways. First, sharks as a group, are prone to internal dissension. An experienced swimmer can divert an organized attack by introducing something, often minor or trivial, which sets the sharks to fighting among themselves. Usually by the time the internal conflict is settled the sharks cannot even recall what they were setting about to do, much less get organized to do it.

A second mechanism of diversion is to introduce something that so enrages the members of the group that they begin to lash out in all directions, even attacking inanimate objects in their fury.

What should be introduced? Unfortunately, different things prompt internal dissension of blind fury in different groups of sharks. Here one must be experienced in dealing with a given group of sharks, for what enrages one group will pass unnoted by another.

It is scarcely necessary to state that it is unethical for a swimmer under attack by a group of sharks to counter the attack by diverting them to another swimmer. It is, however, common to see this done by novice swimmers and by sharks when under concerted attack.

*Little is known about the author, who died in Paris in 1812. He may have been a descendant of Francois Voltaire and an ancestor of Jacques Cousteau. Apparently this essay was written for sponge divers. Because it may have broader implications, it was translated from the French by Richard J. Johns, an obscure French scholar and Massey Professor and director of the Department of Biomedical Engineering, The Johns Hopkins University and Hospital, 720 Rutland Avenue, Baltimore, Maryland 21203.

Perspectives in Biology and Medicine 1987; 30: 486-489.

We thank University of Chicago Press for permission to reprint this article.
 
I was perfectly polite but when they said I had to pull call I said "no," pointing out that if I'd just have to call them for everything which makes call as a medical student idiotic.

You are my new hero.
 
Sadly, sometime during this rotation I remembered that the reason why I hesitated for so many years before coming back to school was because I was dreading jumping into "the water infested with sharks"...

Hang in there amigo, we're routing for ya 🙂

4) Never, ever take stuff personally.

5) If something seems weird, you're not sure if people are mad at you or just mad at everything and you're in the way - step back, detach and remember rule number 4.

Solid advice. I like it! I'll try to continue to be a sponge. :laugh:
 
Way to go with the shark article!! Flying low under the radar is key only in those rotations which you care nothing about. The ones that interest you however, you should be calculated in your actions. Does a future internist need to know how to do a Whipple? No. Likewise the surgeons among us don't need the myriad of rheumatic manifestations. So blow off the the people that aren't going to like you anyway and focus on what YOU like.
 
On that subject, residents laugh at medical students who, on being told they can go home, ask if there's anything else they can do and act guilty to be leaving. Fools. If I needed you I'd keep you here but I don't so you can go. I had to take one of my medical students aside and explain to him that while we appreciate his very real help on the service, when we say "go" we mean that he can go and it doesn't reflect poorly on him at all if he does. Telling him he can leave is not a loyalty test.
.

Although I can appreciate the amusement at the foolish medical student who just WON'T go home when told, I am wondering if it EVER occurs to a resident that maybe the medical student WANTS to stay because he/she thinks it's interesting and wants to see more cases.
I often stay just because this is the only time in my life when I can follow new admissions for my own pleasure (and absolute lack of responsibility), not because it's work and I don't have a choice. And when the well meaning resident tells me to go home, I almost hate disappointing (and bewildering) them by explaining my position. I mean, are residents so far away from the perspective that sometimes it can be interesting to stay longer? Is that so 'out there' incomprehensible?
 
3) Wear some sort of mental protective gear, like, pretend you're wearing a clear plastic raincoat. That way, if some sh^t comes at you, it sticks to the raincoat and not to you. Sounds nuts, but it works.
...
6) When in doubt, do nothing.
7) When in doubt, say nothing.

These were the thought I left my home with this morning (after praying to God to carry me through another day), and hey, it worked!!! Thanks!!!
 
The "never be late for ANYTHING" advice from those "self-help books" is not helpful and will just add undue stress. No matter how hard you try, you will be late for something.
 
Paws gives fantastic advice...

And I tend to also agree with Zuwie. All these absolutes and extremes: "NEVER be late" and "know EVERYTHING about your patients" are, in my opinion, unreasonable. Now, that's not a prescription for mediocrity. If you want to stand out, rarely be late and know your patients well.

I think the most important lesson for 3rd/4th year and LIFE itself (and the gist of Paws' post reflects this theme) is to have a good attitude. You'll feel better, and so will everyone else. Roll with the punches and don't take yourself too seriously. Ironically, medical education from the get go conditions you to do just the opposite. But bad attitudes, hard-core gunnerism, and general negativity isn't a good way to succeed even if you're Osler himself.

Happy Halloween! 😀
 
Paws gives fantastic advice...

😳

Thanks guys! Sometimes stuff in third year makes me doubt myself and my senses, and particularly my instincts - which I really need to help me. Gunner classmates, indifferent residents, anxious interns, bored attendings ... and evaluations where you're like: "who are you talking about here?" It is a real test to one's emotional strength, I think. In the bigger world, I feel pretty happy and well adjusted, but on some of the wards I start to feel like I am a freak or suddenly a social misfit. 😕 Such a pressure cooker. I am really working on building up my outside support system, and taking good, good care of myself mentally and emotionally. You're definitely not alone, Metab! And the shark thing is totally right on ...
 
The "never be late for ANYTHING" advice from those "self-help books" is not helpful and will just add undue stress. No matter how hard you try, you will be late for something.

Ha! Reminds me of my surgery consultant. He told us you can never be late for his ward round. Either you're early or absent. And he enforced it. If you arrived after him he'd run you off the ward. Aww good times good times
 
I don't think you're silly at all. I was pretty motivated for some rotations (Emergency Medicine, Trauma Surgery) and tried to do a good job. But I didn't "skyline" myself either. I hated being asked to look something up and present it the next day so I stopped asking questions as this was usually the result. I also never volunteered for extra work and generally left, and quickly, when I was told I could go.

On that subject, residents laugh at medical students who, on being told they can go home, ask if there's anything else they can do and act guilty to be leaving. Fools. If I needed you I'd keep you here but I don't so you can go. I had to take one of my medical students aside and explain to him that while we appreciate his very real help on the service, when we say "go" we mean that he can go and it doesn't reflect poorly on him at all if he does. Telling him he can leave is not a loyalty test.

When my residents told me I could go, without actually sprinting away I moved out of their sight as fast as I could, usually taking the first stairs or hallway even if it was out of my way with the goal of putting as much architecture between me and the urge to ask me to do one more thing before I went home.

I don't understand how you can increase your residents workload by taking too many patients. I mean, you don't make the decision to admit patients.


At the risk of angering the almighty Panda, who I greatly respect and who is one of the consistently best posters on SDN and who has an informative blog:

You failed to match, so is it possible that some of these behaviors as a 3rd/4th year contributed to that?
 
...You failed to match, so is it possible that some of these behaviors as a 3rd/4th year contributed to that?

Probably. But if they wanted me to stick around, all they had to do was say, "Student Doctor Bear, we need you stay later." Why make it into some kind of game where you get points for pretending to be enthusiastic? I know this is how the game of medical school is played but this is ridiculous because we're adults and shouldn't have to play games for a career. I assure you that almost everybody wants to go home as early as possible and absolutely nobody likes marathon rounds except your attending. Also, everybody, and I mean everybody, hates waiting for the attending to get off his ass so the team can round and get out at a decent time. It's just that most residents are too scared to call him to task for his rude behavior. The one guy in your team who is not a kiss-ass and shows his displeasure will get the worst evaluation but is probably the best person on the team.

On the other hand I got pretty good evaluations on most rotations, the worse thing ever said about me was by an OB-Gyn resident who gave me low scores because I was "too enthusiastic."

Figure that one out. Actually, it means that evaluations are so subjective that it is impossible to please everyone without becoming a chameleon. As Brother Stox points out on his blog, Med School Hell (the link is on my blog), gunner or slacker, the odds are that your evaluation will seem totally arbritrary unless you are a super-gunner or a super slacker.
 
At the risk of angering the almighty Panda, who I greatly respect and who is one of the consistently best posters on SDN and who has an informative blog:

You failed to match, so is it possible that some of these behaviors as a 3rd/4th year contributed to that?

AmoryBlaine: This thread has been very helpful in keeping my sanity together through what seemed like a rotation from hell. Please don't turn this into one of those threads that end up with people attacking each other. I've got enough of that everyday of the past 6 weeks.

As far as the bad rotation goes... if you keep positive attitude, occasionally you just might be rewarded! At last I had decided not to do/talk/ask too much, then last week had been crazy busy. I came to a conclusion that I am a black cloud and I will always be working my a** off and still be unappreciated. Then today, my attending thanked us (3rd yrs) for the hard work and let us go early with a promise of very nice evaluations.

Now, back to reality... If anyone has any suggestions on how I should explain some of the negative comments that may end up on my final eval (which is not yet available) please let me know...
 
AmoryBlaine: This thread has been very helpful in keeping my sanity together through what seemed like a rotation from hell. Please don't turn this into one of those threads that end up with people attacking each other. I've got enough of that everyday of the past 6 weeks.

I wouldn't have asked the question if I didn't think Panda could answer it thoughtfully - and guess what? I was right.

It's just an internet forum. Sheesh.
 
I am coming to believe that no matter *what* you do at times....there is a TON of subjectivity going on in third year. Aside from the shelf exam the rest is ALL subjective. It is also extremely hard (at least at my school) where you rotate through some services every week to get evals that truly can reflect what you did. In some cases we are with a particular team only for five days and out of those five days some half days are spent in other areas getting didactic lectures....the best advice someone gave me was to do what is best for your patients. Trying to impress attendings/residents is sometimes a futile act. These folks can run the gamut of attitudes from highly stressed out to mildly enthusiastic. Everything is team dependant and person dependant. It is truly amazing how hard "most" medical students actually do work and try to be on top of things yet not ALL get super uber clerkship grades. I have yet to meet the "lazy" or "uninterested" medical student.
 
I realize that it's a waste of time trying to figure out which one of the horrible people I've worked with totally screwed me over - because it's screwing my head!!!

I never realized how valuable the degree of M.D. is until this rotation though. It's painful getting there, but it will be worth it when I'm finally there. Hopefully I won't have to post a thread on "Lessons from Bad Residency Team"...
 
Actually, it means that evaluations are so subjective that it is impossible to please everyone without becoming a chameleon.

Reminds me of my inpatient peds rotation when we had only five or six patients during the entire time on the service with five residents, two subIs and three M3s. I managed to carry two of these patients and my senior told me in the evaluation that I wasn't "aggressive enough in picking up patients." Apparently I was supposed to bite and claw the residents and other students so they give me their patients. Either that or go out on the street, find some healthy kids, make them sick and drag them to the hospital.
 
Here's another persepctive from a 4th year student.

Simply being present in the clerkship does not guarantee you a good education. I totally respect Panda's views on this, and it's one way to get through medical school with as little impact on personal life as possible. You can leave when they tell you, do your part well and without making waves, absorb all that you can, and put some boundaries on how long you're willing to stay. However, I feel that it's worth the effort to do more. When else can we see all of this stuff without being burdened by paperwork and the responsibility of making real decisions? I feel like I need to learn as much as possible now, because in a few months I'll need to make some decisions on my own.

So, if a resident told me I could go I would ask if there's anything else I could do, then leave if he/she said no. I would spend call nights doing my write-ups in the team room instead of at home, I volunteered as often as possible for new patients, or to help with or do procedures, etc. Parts of 3rd year definitely sucked, but it's an amazing experience as well... might as well take advantage of it.
 
Your fellow students can really make or break a rotation. Even if you have the coolest residents on earth, being on a rotation with a bunch of gunners is a miserable experience (and by gunners, I mean people who try to look good at your expense. I don't mean people who just work hard.) Similarly, a cool group of students can make even the suckiest of residents tolerable.
 
Fang, I think that for the "most" part all medical students do what you have stated. Of course we are all here to learn and get the most out of every rotation but lets get real....we also need the evals for the letter from the Dean and to get a good residency spot. The problem is that often times after being there for your team, busting your arse, reading, etc...you still do not get the results that you truly deserve and *that* is what is so sucky about third year.
 
Fang, I think that for the "most" part all medical students do what you have stated. Of course we are all here to learn and get the most out of every rotation but lets get real....we also need the evals for the letter from the Dean and to get a good residency spot. The problem is that often times after being there for your team, busting your arse, reading, etc...you still do not get the results that you truly deserve and *that* is what is so sucky about third year.

I agree with you-- sometimes even if you do everything right and try hard, you can still get screwed by one evaluator, and that really sucks. At my school at least, most of the students are really trying hard, "busting arse", and are generally great to work with. However, there is another 30% or so (and I think different people do this on different rotations) who are just sliding along waiting for the rotation to be over. If you haven't met them yet, just wait till Jan/Feb. And, you hear these same people bragging about how they skipped call nights on surgery without being caught, or left psych at 3 pm every day. I think it has to do with how interested they are in the rotation and what else they have going on outside of medical school, but it gets old, especially if you did all your call nights and stayed till 8 every day on psych. (Note: if you want to complain here, go for it, that's what this forum is for... I'm talking about individuals who I *know* are doing the absolute minimum to get by, and think that's totally OK.)

My only point is that apart from the grading issue, this is truely an excellent opportunity to learn. So, while solving the frustration and demoralization we all feel by refusing to take call or something else might be the right answer in some situations, another option is to do what you can to stay engaged and motivated and learn everything you can.
 
I agree, we will see what happens come January...at my school the class size is so small that there is truly limited exposure to students. For the most part we are the only student on a particular team.
 
Although I can appreciate the amusement at the foolish medical student who just WON'T go home when told, I am wondering if it EVER occurs to a resident that maybe the medical student WANTS to stay because he/she thinks it's interesting and wants to see more cases.
I often stay just because this is the only time in my life when I can follow new admissions for my own pleasure (and absolute lack of responsibility), not because it's work and I don't have a choice. And when the well meaning resident tells me to go home, I almost hate disappointing (and bewildering) them by explaining my position. I mean, are residents so far away from the perspective that sometimes it can be interesting to stay longer? Is that so 'out there' incomprehensible?

I know what you mean! Once, a patient we just closed was bleeding liters out of his chest tbe and had to be emergently reopened at 8pm to save his life, and my team was like, "oh, you can go, no sense staying". WTF? I straight up said, "I want to SEE this!". Can't see why that's wrong. Hanging out doing nothing on the other hand....
 
sometimes even if you do everything right and try hard, you can still get screwed by one evaluator, and that really sucks.

This is totally true. I really got screwed over and received unfair mid-block evaluation. Looking back, I think if I didn't worry about it so much I wouldn't have had such a harsh following few weeks - things don't go well when you are constantly walking on eggshell, if you know what I mean. I'm not sure what I can do at this point, except to be glad that this horrible rotation is over. I take what I can out of this rotation - many of the lessons listed on this thread - but still this was one nasty rotation and I hope I never have similar experience again. Yes, I'm complaining.
 
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