Liking 3rd year

[45408]

it sucks and i've grown really tired of my classmates lying about how much they enjoy it

I had a month of general surgery at a community hospital that was truly awesome (and the main reason I went into surgery). Most of M3 wasn't too bad in most regards. I was never jealous of the M1/M2s when I walked past them studying in the library, but I was jealous of them when my alarm went off at 5am.

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[45408]

I think a huge issue with many medical students is that a lot of them have never had "real" jobs (like in a for profit company with a boss - not research). Thus they don't have much experience in working with others, being in charge of others, getting b*tched at, etc. That's just how it is. Time to grow up.

Agreed.

Having done shift work at a hospital... I am 99.99% positive 3rd year med students have no idea how much they have it made, when compared to "real jobs" in the "real world." Whining about q4 call on peds rotation? Think about the nurse doing rotating shift with overnight shifts (staying up entire night, certainly no call room to relax in) every 4 days... permanently.

What standard nurse position has any kind of work schedule that is nearly as bad as Q4 call?

I really disliked 4th year. Don't get me wrong, the free time was great, but that was a bad way to spend 45k. If I borrowed that money for a TRUE vaccation, I would have had a much better time. Also, as a 4th year, you're doing a lot of the same stuff you did as a 3rd year (more surgery, more medicine, with a couple of unique electives). Nonetheless, the student role had gotten really old for me. I hated interns acting like they were boss (come on, we're 1 year a part for crying out loud). I especially hated my notes/orders not counting for anything. I am ready to be done, and seem to spend all my time on rotations day dreaming of graduation.

I feel your pain. It should not have cost anywhere near as much as it did.

 

[Jolie South]

If I got the chance to do MS3 over again, I would ABSOLUTELY tell every single rotation that that was my career choice right upfront (and then act interested the rest of the rotation).

During surgery my collegue and I were asked what we wanted to go into by an attending. I said ophtho, the response I got was "isn't that really competitive?" My collegue said "surgery" (even though he meant orthopedic surgery) and her response was "I wish you told me that sooner! I would have taken you under my wing" - and then she then let him suture in her cases/close. I was never allowed to do anything in her case.

In OB/GYN I actually asked point-blank if I could have the chance to have my hands on a baby to catch it, because it was really interesting and I probably won't get another opportunity ever again. I was told no, we typically don't let students do that unless they indicate they're specifically interested in OB/GYN. I was told the same thing in clinic when I asked if I could see patients on my own to do a Hx and PE.

That sounds like a school-specific problem. My school tells us we have to deliver 4 babies, suture, do I&Ds, insert a NG tube and they must be signed off to complete the rotation. That being said, if you ask to do something or ask to help do something, people will tend to include you. I never lied about my interests, but I still take the opportunity to learn everything that I can about different specialties. I think people respect that, especially if you take ownership of your patients and ask relevant questions. Also, if you make a resident's life easier, they have more time on their hands to teach you and let you do things.

As far as the post about being enthusiastic about DM and HTN in FM clinic, I have actually finished my FM rotation. I looked at each patient as a chance to improve on counseling skills and management. I mean I doubt that you can intuitively know all the nuances of diabetic and HTN management from just seeing a couple of patients.

 

[45408]

In residency you will be at an institution for more than one month. So YES, you will be able to say what you think. You will know all the attendings personally, and can give opinions that people will actually listen to and do something about it. As a 3rd year medical student who will be at a service for only a month, you have NO say on anything and pretty are at the whim of whatever the residents or attendings want you to do.

Good one!

 

[45408]

I could learn everything taught to me in 3rd year with about 4-5 weeks of moderate studying. It is perhaps the most inefficient system possible for learning medicine.

Don't get me wrong, it used to work back when med students actually did stuff 20-30 years ago - and not "did stuff" like put in one easy IV while the resident looked over your shoulder, but actually had real responsibilities and contributions to make. Now we've got the worst of both worlds: on the job training without the job.

Fine, you get to see and occasionally do some cool stuff, but I'm not trying to be a medical tourist. You're basically expendable/interchangeable at the hospital, yet keep hours like the place would fall apart without you. If being useless doesn't bother you, the utter waste of time should.

I really think it depends on your learning style. My average exam scores were pretty much right in the middle of the curve as an M1/M2, but as soon as we hit M3, I improved significantly. On quite a few shelf exams, I would stop and think "Well, what did we do when we had the patient with DKA/cellulitis/pneumonia/etc?" and then I would pick the right answer. Maybe I'm much more of a hands-on learner than most - I am going into surgery - but it was pretty efficient for me.

What would be the MOST efficient way to learn medicine?

I think that dealing with patients (or any non-standardized entity) is relatively inefficient, and you really have to do a few dozen H&Ps on drunk/delirious/demented patients before you're remotely proficient at it. I'd rather be learning it with back-up support than on my own.

And yes, I know that you are an exception. You are down there on the wards making things happen and pulling for your "team." Well guess what, absolutely no one is impressed by the 3 seconds you saved grabbing the chart for the intern, because it'll never overcome the countless minutes consumed by your overly exacting H&P presentation during morning rounds, or the shameless desperation of the med student "independent presentation" on topic X no one cares about or will be paying attention to. You are in the way. And that is why 3rd year sucks.

I'm not saying I made a difference on the team (except as a sub-I), but I sure learned a lot.

It's also quite clear that some of you should be whining about the terrible M3 year at YOUR school, but you're just wrong to assume it's like that everywhere.

No I think the truth is that medical school education/curriculum needs to be severely revamped.

Certainly at your school.

you didn't intubate anyone, deliver a single baby, or even start an IV? That's not a systems problem - that's a school-specific problem. It can also be a student-specific problem. If you don't ask to do stuff, people usually won't go out of their way to find you to do it.

Agreed. Even without a solid EMR system, I'd still like note writing better than anything the first two years have to offer. At least it's learning how to slap together a solid H&P in a reasonable amount of time.

No kidding. You may have all evening to draft up a lovely H&P for your assignment on a medicine rotation, but when I'm on call for multiple surgery services, the H&Ps start coming fast and furious. You would very quickly become "that intern" if you showed up and didn't behave like someone who had already done 500 H&Ps.

 

[xanthomondo]

It's also quite clear that some of you should be whining about the terrible M3 year at YOUR school, but you're just wrong to assume it's like that everywhere.


Certainly at your school.

you didn't intubate anyone, deliver a single baby, or even start an IV? That's not a systems problem - that's a school-specific problem. It can also be a student-specific problem. If you don't ask to do stuff, people usually won't go out of their way to find you to do it.

The only problem with continually blaming it on the individual school is that 1. we're sent out to many, many different clinical sites which makes it pretty hard to standardize and 2. those clinical sites often include students from other schools who were having the identical issues that I was having.

I guess I've just been unlucky so far with most of my clinical rotation locations?

 

[CardiacIntensivist]

The only problem with continually blaming it on the individual school is that 1. we're sent out to many, many different clinical sites which makes it pretty hard to standardize and 2. those clinical sites often include students from other schools who were having the identical issues that I was having.

I guess I've just been unlucky so far with most of my clinical rotation locations?

Dude, I think so...I'm confused by how little you've got to do. I've never been to a single hospital where nurses didn't love me for volunteering to do their procedures. e.x. I've done literally hundreds of IVs, so much that they allow me to do the RESUS ones since I'm quick enough. I've only experienced hesitation when it was a procedure that required an MD (paracentesis, thoracentesis, spinals, epidurals etc) but I've still had enough solo opportunities to know how to do them on an uncomplicated patient. I guess I've just had awesome residents? But then again, I think this is where bringing the enthusiasm and A-game comes in to play. And I didn't have to hump anyone's leg for these opportunities.

 

[Dwindlin]

The only problem with continually blaming it on the individual school is that 1. we're sent out to many, many different clinical sites which makes it pretty hard to standardize and 2. those clinical sites often include students from other schools who were having the identical issues that I was having.

I guess I've just been unlucky so far with most of my clinical rotation locations?

I don't know if it's luck, but I can tell you I have done everything on your list, accept deliver a baby, as a 2nd year here at my program.

 

[unsung]

Agreed.


What standard nurse position has any kind of work schedule that is nearly as bad as Q4 call?


I feel your pain. It should not have cost anywhere near as much as it did.

Dude. Nurses work hard. Try 3 overnights, 1 day off, then 3 evening shifts, 1 day off, back to overnights x4, 1 day off, 3 day shifts, 1 overnight, 2 off, 2 overnights...

Etc. (This was a psych floor, btw.)

During the overnights, I saw the residents pop in, admit a pt, and pop out. During busy overnights, maybe resident would admit 4 or 5 off our floor. I have no doubt being on call is tough. But the schedule at our dept for the residents seemed a lot nicer than the ones for the nursing staff. At least the resident has a call room.. we were required to be up entire night, and round every 15 min. Be alert for "danger"... you just never know what these folks will do- to themselves or you. No snoozing there.

But what really killed me wasn't actually the amount of time spent awake overnight. It was the rotating shift!

We had no control over our schedule. And the way our scheduling worked, it often generated random ones like the example I gave above. Just when your body starts to acclimate to 2 overnights, you get put on 5 day shifts in a row. And the day off you get after overnight is mostly spent sleeping. Then there are those 1 or 2 days off in betw 2 huge chunks of overnights... and it's like, what's the pt? If I try to stay up during the day & do stuff, I'll just make myself super tired for next work shift.

Unless you wanted to work for 20 yrs, then you get some control over scheduling, such as putting in a request not to be scheduled to work New Year's Eve. (Assuming they're not short on staff that day, and there are ppl w/ less seniority below you...).

So yeah. I definitely gained a lot of appreciation for how hard nursing & support staff during that time. BE NICE TO THE NURSING STAFF!

 

[nlax30]

The resident may have a call room but chances are he may already been there for 12+ hours is just now starting an overnight call shift.

And even though you just see him pop in to do an admit they usually have to cover more patients than just the ones on their specific team.

Not saying nurses don't work hard, I know they do. But I don't think you'd get a lot of sympathy from residents when it comes to crazy schedules and hours spent working.

 

[45408]

Dude. Nurses work hard. Try 3 overnights, 1 day off, then 3 evening shifts, 1 day off, back to overnights x4, 1 day off, 3 day shifts, 1 overnight, 2 off, 2 overnights...

Etc. (This was a psych floor, btw.)

That is far and away the exception. If those are 8 hour shifts, that's already 48 hours/week, and if they're 12 hour shifts, then that's 72 hours/week. There are VERY few nursing managers who are going to be allowed to pay out that much overtime. My wife and mom are nurses - I'm pretty close to the field. My wife worked ~4 shifts/week, days and PMs only (even when she was just starting). Overtime wages were unbelievably good. She'd get $50 just to come in, then all the dividends and 1.5x regular wage, and she'd make $240 just for coming in from 7p-11p. Some of it was not hard work either - chart review or being a patient sitter for a confused patient.

During the overnights, I saw the residents pop in, admit a pt, and pop out. During busy overnights, maybe resident would admit 4 or 5 off our floor. I have no doubt being on call is tough. But the schedule at our dept for the residents seemed a lot nicer than the ones for the nursing staff. At least the resident has a call room.. we were required to be up entire night, and round every 15 min. Be alert for "danger"... you just never know what these folks will do- to themselves or you. No snoozing there.

The nurses have 8-12 hour shifts. The residents have up to 30 hour shifts. Nurses would have call rooms too if they worked 30 hours every third or fourth night. Plus, psychiatry is definitely one of the easier residencies out there.

We had no control over our schedule. And the way our scheduling worked, it often generated random ones like the example I gave above. Just when your body starts to acclimate to 2 overnights, you get put on 5 day shifts in a row. And the day off you get after overnight is mostly spent sleeping. Then there are those 1 or 2 days off in betw 2 huge chunks of overnights... and it's like, what's the pt? If I try to stay up during the day & do stuff, I'll just make myself super tired for next work shift.

I know a lot of nurses at a lot of hospitals, and I don't know anyone who routinely gets shifted from days to nights. That's fairly abnormal.

 

[MilkmanAl]

I know a lot of nurses at a lot of hospitals, and I don't know anyone who routinely gets shifted from days to nights. That's fairly abnormal.

In fact, the nurses I know who've tried to change their shift (from night to day or vice versa) have found it extremely difficult to do so.

 

[VoiceofReason]

it gargles my baaaaaaalllllllzzzzz

 

[officedepot]

so here's the thing I've learned about 3rd year thus far... you are not needed.

I think that's the thing that bothers me the most. I for the most part like being there but when it comes right down to it residents and attendings do not need your help at all. A resident told me today - in good conversation (she is very nice) - that "with all due respect, nobody remembers who you [speaking of any generic medical student] are. Nobody remembers your name the day you leave. So don't go around expecting people to like and know you because they won't".

This kinda stuff just makes it hit home. With a real job you actually perform a service that is needed that could possibly be done but you are more than competent to deal with the issue. The same is not true for medical students. We are there to learn but as such we also find ourselves in the way whether we realize it or not. That's somewhat disheartening if you ask me.

It is what it is though. It's not like things were different for residents when they were students afterall. Part of being able to learn and enjoy rotations as much as possible does fall into the medical student's lap - i.e. they have to take some initiative. However, in some rotations that just isn't really possible - e.g. ward services that have long term patient care and little new admissions - in that getting to examine patients, present, write notes, and have more direct involvement is difficult just based on the dynamics of the rotation service itself. Makes it difficult sometimes to derive full enjoyment, esp if you seem to only be shadowing most of the time to no fault of the student (sometimes there just isn't any work that needs to be done for the student -> leads to being bored and have to study instead of learn clinical patient care).

 

[DanZeccola]

so here's the thing I've learned about 3rd year thus far... you are not needed.

I think that's the thing that bothers me the most. I for the most part like being there but when it comes right down to it residents and attendings do not need your help at all. A resident told me today - in good conversation (she is very nice) - that "with all due respect, nobody remembers who you [speaking of any generic medical student] are. Nobody remembers your name the day you leave. So don't go around expecting people to like and know you because they won't".

This kinda stuff just makes it hit home. With a real job you actually perform a service that is needed that could possibly be done but you are more than competent to deal with the issue. The same is not true for medical students. We are there to learn but as such we also find ourselves in the way whether we realize it or not. That's somewhat disheartening if you ask me.

It is what it is though. It's not like things were different for residents when they were students afterall. Part of being able to learn and enjoy rotations as much as possible does fall into the medical student's lap - i.e. they have to take some initiative. However, in some rotations that just isn't really possible - e.g. ward services that have long term patient care and little new admissions - in that getting to examine patients, present, write notes, and have more direct involvement is difficult just based on the dynamics of the rotation service itself. Makes it difficult sometimes to derive full enjoyment, esp if you seem to only be shadowing most of the time to no fault of the student (sometimes there just isn't any work that needs to be done for the student -> leads to being bored and have to study instead of learn clinical patient care).

That's funny, my Surgery IOR introduces the rotation by saying. "You [medical students], are basically useless in the hospital. We don't need you, patients don't need you. You are here not to do work, but to learn". I kind of love this attitude, it cuts through the BS and sets an expectation that we can live up to. Surgery at my school is one of the most loved rotations in third year for this reason. We don't write that many notes, we don't do that much scut, we just scrub and get the **** pimped out of us. It's great!

 

[unsung]

That is far and away the exception. If those are 8 hour shifts, that's already 48 hours/week, and if they're 12 hour shifts, then that's 72 hours/week. There are VERY few nursing managers who are going to be allowed to pay out that much overtime. My wife and mom are nurses - I'm pretty close to the field. My wife worked ~4 shifts/week, days and PMs only (even when she was just starting). Overtime wages were unbelievably good. She'd get $50 just to come in, then all the dividends and 1.5x regular wage, and she'd make $240 just for coming in from 7p-11p. Some of it was not hard work either - chart review or being a patient sitter for a confused patient.


The nurses have 8-12 hour shifts. The residents have up to 30 hour shifts. Nurses would have call rooms too if they worked 30 hours every third or fourth night. Plus, psychiatry is definitely one of the easier residencies out there.


I know a lot of nurses at a lot of hospitals, and I don't know anyone who routinely gets shifted from days to nights. That's fairly abnormal.

You're right, it's kind of an extreme example. More benign schedule might be 4 days, break, then 4 overnights. But a string of something like that definitely can happen when beds are full & the floors are under-staffed.

Basically, when ppl call in sick (either nurse or MHW), guess who gets to pull "doubles"? Just when you think you're almost done with the shift, the manager calls down looking for ppl to stay on. And sometimes the person who fills in for the overnight has already worked day & evening shifts... so 24-hr "triple". True, not 30 hrs. And there's definite 1.5x pay for the extra hrs.

Mainly the schedule is so wonky 'cuz when a staff does call in sick, it throws everything off. The person who fills in who does the "double" or "triple" that involves an overnight has to get that next day shift off... Another thing that happens is a pt getting put on 1:1 precautions-- suddenly need a MHW there all the time! Including overnight shift, watching the pt & making sure the pt doesn't die... incl standing within arm's length while pt uses restroom. Good times.

So... lot of things on psych floor that affect staffing needs. Consequently, you can see how easily & frequently schedules change. The lack of stability was the hardest thing. Physically obviously tough on the body to switch sleeping all the time... but also more so mentally, 'cuz you never know for sure what you're going to get.

I guess I really shouldn't generalize about nursing, since psych nursing has some unique aspects to it. lol But really, my own personal experience was as a MHW... and that in some ways is tougher than the nursing, 'cuz the nurses (SOME, not all) liked to relegate all the scut work to us. Any & all poop, pee duties (whereas in other depts w/o such staff, I assume they have to do it themselves)... my most memorable duty involved assisting a patient in the shower & a large amount of feces. I won't go into any more details.

Med students: That's why you should enjoy your 3rd year.

 

[unsung]

In fact, the nurses I know who've tried to change their shift (from night to day or vice versa) have found it extremely difficult to do so.

It is verrrrry hard. I would recommend to everyone to avoid rotating shifts like the plague. It really effed up my sleep patterns, and for quite a while after I quit the job, even.

And just when I started becoming a "normal" sleeper again, I got in med school.

 

[officedepot]

That's funny, my Surgery IOR introduces the rotation by saying. "You [medical students], are basically useless in the hospital. We don't need you, patients don't need you. You are here not to do work, but to learn". I kind of love this attitude, it cuts through the BS and sets an expectation that we can live up to. Surgery at my school is one of the most loved rotations in third year for this reason. We don't write that many notes, we don't do that much scut, we just scrub and get the **** pimped out of us. It's great!

interesting to see the different attitudes people take to the same comments. I mean I think it is most important to learn the ins and outs of diseases, eliciting symptoms, diagnosing, etc. However, it is also important to learn how to do the other aspect of being a resident and that's writing notes, following up, etc. I know it's different at every school and every rotation. But I don't think having to write one or two notes a day is too overwhelming for any student and then having a resident look over/modify that notes adds too much time, if any, to their day's work.

I also don't see things of a similar nature as scut work. I don't see placing IVs, drawing blood etc. as scut work because it's stuff all docs should know how to do - not just writing an order for one. It's just part of a whole compentecy of issues... yeah it is by far the most important for us to learn the material overall, but we do need to learn how to be competent physicians is all aspects and having clerkship directors, residents, etc tell you that all medical students are useless is NOT helpful at all. I mean why is any one particular resident necessary? Is there not some other resident who could do the work? Same goes for any one attending. There's always someone else. It's an entire team atmosphere and keeping that flowing I feel is important and it's not helpful to explain to a person that they are not needed at all.

I honestly think it all plays into an ego lots of docs have and this heirarchy of "power" that never seems to go away. I don't dislike the heirarchy at all to be honest but an attending shouldn't feel like he/she has the power to berate and belittle a student or resident just because they are the attending. It's part of being a decent person. It's also why other people in the hospital in other professions (nurses, social workers, etc) can have negative views of doctors as a group and this is overall not helpful to patient care.