Making room for MS3s....

[smq123]

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I just started my 4th year sub-I...and I found out today that I may be getting an MS3 on my team in a week or so. That, by itself, is fine....but how do I act like an honors student sub-I, while still leaving something meaningful for the third year student to do?

I wouldn't want to make him/her come in and pre-round when I pre-round (it's a surgery sub-I, and that might be enough to make him/her quit school). But I remember being an MS3, and being really frustrated because there just wasn't anything left for me to do, once the sub-I started her rotation.

Any ideas?

 

[Blade28]

I just started my 4th year sub-I...and I found out today that I may be getting an MS3 on my team in a week or so. That, by itself, is fine....but how do I act like an honors student sub-I, while still leaving something meaningful for the third year student to do?

I wouldn't want to make him/her come in and pre-round when I pre-round (it's a surgery sub-I, and that might be enough to make him/her quit school). But I remember being an MS3, and being really frustrated because there just wasn't anything left for me to do, once the sub-I started her rotation.

Any ideas?

Are you expected to act as an intern?

Have your residents talked to you about their expectations for YOUR performance? (Are you expected to co-sign the MS-III's notes? write orders? talk to consults? etc.)

 

[smq123]

Are you expected to act as an intern?

Have your residents talked to you about their expectations for YOUR performance? (Are you expected to co-sign the MS-III's notes? write orders? talk to consults? etc.)

* I doubt that I'd co-sign the MS3's note. I've never seen a fourth year at my school do this...and it probably would not be encouraged in any case.

* Can't write orders - the computer doesn't accept them if it's from a student account. Even if I did, it wouldn't be anything new to the third years, who are also taught how to put in orders in the computer.

* We don't really accept consults on this service. Long story.

 

[Blade28]

* I doubt that I'd co-sign the MS3's note. I've never seen a fourth year at my school do this...and it probably would not be encouraged in any case.

* Can't write orders - the computer doesn't accept them if it's from a student account. Even if I did, it wouldn't be anything new to the third years, who are also taught how to put in orders in the computer.

* We don't really accept consults on this service. Long story.

Hmmm...looks like you've got your work cut out for you then, if you want to shine on this rotation!

Can you write preliminary orders anywhere? Or at least prepare some orders and show them to your intern/resident so they'll know that you're thinking?

Can you teach the MS-III stuff? Writing SOAP notes, basic pre-op/post-op orders, tying knots, suturing?

What about presentations? Are you expected to pick an interesting topic and present it to the team? Hand out interesting journal articles?

If you aren't expected to function as an "intern" then I'd just pre-round and make sure I wrote all my notes before the intern/resident...doesn't really matter if you "beat" the MS-III or not, as long as you beat the rest of your team.

 

[DrDre311]

If it were me, I'd just ambush the MS3. I mean that in the most literal sense of the word. Tell him/her to meet you at the nurses' station at a reasonable time (say 5:30) and act all nice about it; then hide behind the strategically positioned crash cart--when he/she walks up, all bleary-eyed and sleepy, just f***ing launch yourself, full speed, and form tackle the little bastard. Then scream incoherently about how he/she is a lazy piece of **** who better stay the hell out of your way. A kick to the junk while he/she is writhing in pain on the floor is optional but I think it personalizes the welcome nicely.

If the student ever gets pissy and acts as if he/she might report your tactics, just show him the 9 mm Glock you keep strapped to your hip and make the throat-cutting gesture with your hand (a la Ben Stiller in Happy Gilmore).

These perfectly acceptable tactics will ensure that things go smoothly for both of you during the month.

 

[NPR]

If the student ever gets pissy and acts as if he/she might report your tactics, just show him the 9 mm Glock you keep strapped to your hip and make the throat-cutting gesture with your hand (a la Ben Stiller in Happy Gilmore).

"You can trouble me for a warm glass of shut-the-he!!-up. Now, you will go to sleep or I will put you to sleep. Check out the name tag. You're in my world now, MS3."

In all seriousness, are people starting sub-I's already? I just started break today!

 

[MSKalltheway]

If it were me, I'd just ambush the MS3. I mean that in the most literal sense of the word. Tell him/her to meet you at the nurses' station at a reasonable time (say 5:30) and act all nice about it; then hide behind the strategically positioned crash cart--when he/she walks up, all bleary-eyed and sleepy, just f***ing launch yourself, full speed, and form tackle the little bastard. Then scream incoherently about how he/she is a lazy piece of **** who better stay the hell out of your way. A kick to the junk while he/she is writhing in pain on the floor is optional but I think it personalizes the welcome nicely.

Dude, what are you? Terry Tate, Med School Linebacker?

If the student ever gets pissy and acts as if he/she might report your tactics, just show him the 9 mm Glock you keep strapped to your hip and make the throat-cutting gesture with your hand (a la Ben Stiller in Happy Gilmore).

Nah man, if you're talkin' Happy Gilmore, go Bob Barker. He'd break one off on all of 'em and then go impregnate his beauties.

 

[NPR]

Nah man, if you're talkin' Happy Gilmore, go Bob Barker. He'd break one off on all of 'em and then go impregnate his beauties.

"The price is wrong, b!tch"

Fantastic movie. A classic for the ages.

 

[Law2Doc]

If it were me, I'd just ambush the MS3. I mean that in the most literal sense of the word. Tell him/her to meet you at the nurses' station at a reasonable time (say 5:30) and act all nice about it; then hide behind the strategically positioned crash cart--when he/she walks up, all bleary-eyed and sleepy, just f***ing launch yourself, full speed, and form tackle the little bastard. Then scream incoherently about how he/she is a lazy piece of **** who better stay the hell out of your way. A kick to the junk while he/she is writhing in pain on the floor is optional but I think it personalizes the welcome nicely.

If the student ever gets pissy and acts as if he/she might report your tactics, just show him the 9 mm Glock you keep strapped to your hip and make the throat-cutting gesture with your hand (a la Ben Stiller in Happy Gilmore).

These perfectly acceptable tactics will ensure that things go smoothly for both of you during the month.

I like this approach. But if you want to go less cro-magnon, divide up the patients and have them get you the numbers off the nursing charts.

 

[Ypo.]

Aren't there enough patients for the MS III to follow several on her/his own?
If yes, then I would say you shouldn't have a problem. If no, then you might have to work something out. I'd recommend talking to the residents about how to make sure you both get a good experience.

 

[elr1983]

Again, I'm also wondering about the patient assignments at your school....I did a surgery rotation where there were 2 sub-i's on our team (one of which was a crazy psycho visiting student gunning for a spot here), and there were always plenty of patients for us all to carry our own. (Generally 2-4 for the MS3, 6+ for sub-i's, depending on complexity.) Does everyone on your team share patients?

I think if you all get assigned your own patients, this shouldn't be a big deal....just extend the same courtesy to the new MS3's as you did to your classmates last year (assuming, of course, you're not one of those people who treats their classmates like crap 🙂).

Maybe you can explain how your system works?

 

[smq123]

Can you write preliminary orders anywhere? Or at least prepare some orders and show them to your intern/resident so they'll know that you're thinking?

Can you teach the MS-III stuff? Writing SOAP notes, basic pre-op/post-op orders, tying knots, suturing?

What about presentations? Are you expected to pick an interesting topic and present it to the team? Hand out interesting journal articles?

If you aren't expected to function as an "intern" then I'd just pre-round and make sure I wrote all my notes before the intern/resident...doesn't really matter if you "beat" the MS-III or not, as long as you beat the rest of your team.

I'll explain it to you later....don't want to write out a lot of (mostly) irrelevant stuff.

If the student ever gets pissy and acts as if he/she might report your tactics, just show him the 9 mm Glock you keep strapped to your hip and make the throat-cutting gesture with your hand (a la Ben Stiller in Happy Gilmore).

I'll smack my pager against my palm threateningly a few times....just to get the message across.

In all seriousness, are people starting sub-I's already? I just started break today!

First day of sub-I? Today.

First case presentation of 4th year? Tomorrow.

First night of trauma call? Thursday.

Time I'll be in to round tomorrow? 3:30 AM.

Yep...this sub-I has definitely started! 🙁

 

[smq123]

Again, I'm also wondering about the patient assignments at your school....I did a surgery rotation where there were 2 sub-i's on our team (one of which was a crazy psycho visiting student gunning for a spot here), and there were always plenty of patients for us all to carry our own. (Generally 2-4 for the MS3, 6+ for sub-i's, depending on complexity.) Does everyone on your team share patients?

I think if you all get assigned your own patients, this shouldn't be a big deal....just extend the same courtesy to the new MS3's as you did to your classmates last year (assuming, of course, you're not one of those people who treats their classmates like crap 🙂).

Maybe you can explain how your system works?

Sure.

Last year, on outpatient psych, there were two sub-Is. I was BEGGING for patients. There were literally not enough to go around at this site.

On OB, when I did a week of MFM, there were about a dozen patients...again, I didn't round on a single one. The sub-Is saw them all.

On this particular surgery service, there are usually less than a dozen patients - but most of them are in the ICU. Now, there will be two sub-Is on this service. Traditionally, the sub-Is got there first, before the intern, and pre-rounded on all the patients. So, by the time the intern got there at 4:30 AM, all the patients had been seen.

I can't really imagine suggesting to a brand-new MS3 that she/he ought to come in at 3:30, just for the chance to write a SOAP note and see a patient. And I'm NOT going to do that crappy thing where the MS3 writes out a SOAP note that will never see the inside of the chart. That's just stupid.

There are only two attendings on this service. One sub-I scrubs in with one, the other sub-I scrubs in with the other. There's no room for MS3s if this happens.

I'm not really sure how they're going to put in their day.

If the MS3 WANTS to come in at 4:00 and see one of the few floor patients, then that's fine. I just feel bad making an MS3 come in at 4 AM, knowing that they're not going to have much else to do for the rest of the day.

This particular service was designed to be run by a chief, an intern, and 2-3 students who are at the same level as each other. And that's kind of it.

 

[TheMightyAngus]

Time I'll be in to round tomorrow? 3:30 AM.

3:30am? This seems really excessive. What time do you guys actually round?

 

[smq123]

3:30am? This seems really excessive. What time do you guys actually round?

The intern's been coming in at 4 to see all the patients by herself, and not finishing by the time the chief is ready at 6. So, if she has to cosign all my notes, then I figure that 3:30 is a good time to try tomorrow.

It'll be different when the other sub-I starts in a few days. (For a variety of reasons, I needed to start early.)

 

[diosa428]

3:30am? This seems really excessive. What time do you guys actually round?

Yeah, seriously. I guess the intern pre-rounds before rounds with the resident? Our interns and residents always round together.

Anyway, to the OP: I think it's nice of you to take the MS3 into account, but really, you need this grade, and you really need to put yourself first. Find out expectations for you. If you're worried about the MS3, feel free to ask what they're supposed to do, but I would not give up part of my workload to the MS3 if it will make you look like you're doing less than the other sub-I. If they're really interested in surgery, they'll come in at 3:30 am and suck it up. If they're not, oh well. Lots of things about third year suck, and they'll have to deal. If you have free time, you could always try to be nice and teach them things.

 

[smq123]

Anyway, to the OP: I think it's nice of you to take the MS3 into account, but really, you need this grade, and you really need to put yourself first. Find out expectations for you. If you're worried about the MS3, feel free to ask what they're supposed to do, but I would not give up part of my workload to the MS3 if it will make you look like you're doing less than the other sub-I. If they're really interested in surgery, they'll come in at 3:30 am and suck it up. If they're not, oh well. Lots of things about third year suck, and they'll have to deal. If you have free time, you could always try to be nice and teach them things.

Hmmm.

Thanks for the advice. Point taken. I was trying to see if there was a happy middle-ground, but I don't think that there is.

Thanks!

 

[Law2Doc]

If they're really interested in surgery, they'll come in at 3:30 am and suck it up. If they're not, oh well. Lots of things about third year suck, and they'll have to deal.

If they're really really into surgery, they should come in at 3:00 so they've already gotten the numbers and woken up the patients before you get there at 3:30. Everyone knows the third year's most important job is to wake up the patients so the residents and attendings don't look like the bad guys when they come in later in the am. If the third years expect to saunter into the wards at 4-5 like normal human beings, scr3w em.

 

[elr1983]

Sure.

Last year, on outpatient psych, there were two sub-Is. I was BEGGING for patients. There were literally not enough to go around at this site.

On OB, when I did a week of MFM, there were about a dozen patients...again, I didn't round on a single one. The sub-Is saw them all.

On this particular surgery service, there are usually less than a dozen patients - but most of them are in the ICU. Now, there will be two sub-Is on this service. Traditionally, the sub-Is got there first, before the intern, and pre-rounded on all the patients. So, by the time the intern got there at 4:30 AM, all the patients had been seen.

I can't really imagine suggesting to a brand-new MS3 that she/he ought to come in at 3:30, just for the chance to write a SOAP note and see a patient. And I'm NOT going to do that crappy thing where the MS3 writes out a SOAP note that will never see the inside of the chart. That's just stupid.

There are only two attendings on this service. One sub-I scrubs in with one, the other sub-I scrubs in with the other. There's no room for MS3s if this happens.

I'm not really sure how they're going to put in their day.

If the MS3 WANTS to come in at 4:00 and see one of the few floor patients, then that's fine. I just feel bad making an MS3 come in at 4 AM, knowing that they're not going to have much else to do for the rest of the day.

This particular service was designed to be run by a chief, an intern, and 2-3 students who are at the same level as each other. And that's kind of it.

Oiy, that sucks. Very different from my program, but it sounds like you'll get some OR time, which was definitely not the case for the sub-i's here. (They were definitely supposed to act like interns, as in do floor work all day for the occasional chance to scrub in.)

Anyway. First of all, if I were you, I'd let the upper level resident/attending explain to the MS3's what their role is and what's expected of them, since they are the ones actually responsible for their experience and their evaluation, I'm assuming. (Or are you supposed to be overseeing them? The sub-i's at my hospital never did anything like that, so maybe I'm wrong.) Plus, you're still a med student too, and your education is just as important as theirs. 🙂

Second, if the interns/sub-i's are coming in that early to round, I'd expect as an MS3 to also come in that early....that's how it worked on my rotation, anyhow. I'd generally get to the hospital around 4 because attending rounds started at 6 sharp and before that, we "pre-rounded" with our senior to practice our presentations, prep for pimping, etc. So really, I don't think them coming in at 4 is unreasonable...not particularly educational, perhaps. But, even if they only each get one floor patient to present, that's one more note/presentation than they've done before, so it's probably worth it. Unless only the intern/sub-i's get to present...

Third, I guess the chief probably scrubs with the attendings too? Does the intern get to scrub? (If not, then the sub-i's get to first assist?! That's awesome!!!!! I am officially green with envy. 🙂) Then maybe the MS3 could scrub w/ the attending who the chief isn't scrubbed with? Or scrub the afternoon cases when one of the 4 of you is post? Anyway, I probably shouldn't make such suggestions when I don't really know about your service/rotation...

Most of all, what's up with your school?! That blows being a student on a service and having no patients...is that common? Sounds like maybe they need to re-evaluate where they're sending you guys...

 

[Ashers]

I'd agree with going over expectations with your residents for you and the M3s.

One of the months I was on surgery, my team had a sub-I. She was told that the M3s got first pick of the surgeries, so we gave her the ones with the resident we didn't like, or the ones we knew would be extra-long (she asked for it by being lazy when the M3s did most of the work). However, we all showed up to round at the same time (0330-0400) -- depending on how many patients each person had.

The main difference with the sub-I was that she took over night call, and we didn't. She was also beyond lazy, and the team's PA and I had to make her call schedule because she wouldn't be on call unless someone told her when to do it. She also told the fellow when asked if she wanted to suture, that, "I'm an M4; I don't suture."

She didn't do any teaching or anything, she just showed up, rounded on her patients, and stayed over night some nights.

 

[NPR]

First day of sub-I? Today.

First case presentation of 4th year? Tomorrow.

First night of trauma call? Thursday.

Time I'll be in to round tomorrow? 3:30 AM.

Yep...this sub-I has definitely started! 🙁

😱

I'll be sure to enjoy the break between 3rd and 4th year to the fullest then (3 glorious weeks!)

All the while thanking my lucky stars I'm doing a medicine sub-I

I assume those brutal hours mean you're doing a surgery sub-I?

 

[Ashers]

😱

I'll be sure to enjoy the break between 3rd and 4th year to the fullest then (3 glorious weeks!)

All the while thanking my lucky stars I'm doing a medicine sub-I

I assume those brutal hours mean you're doing a surgery sub-I?

You get a break between M3 and M4 year? We ended our rotations on 27 June and the school officially started rotations on 1 July -- 3 whole days off for the majority of my class.

 

[UCLAstudent]

You get a break between M3 and M4 year? We ended our rotations on 27 June and the school officially started rotations on 1 July -- 3 whole days off for the majority of my class.

We don't get a break, either --- end MS3 on July 3 and start MS4 on July 7.

 

[elr1983]

We don't get a break, either --- end MS3 on July 3 and start MS4 on July 7.

Bummer....we get this whole week off. And it sounds like the OP's school gets vacation too, but s/he had to start a few days early.

 

[Samoa]

She also told the fellow when asked if she wanted to suture, that, "I'm an M4; I don't suture."

Wow, does she not actually want to be a surgeon? If not, what the hell is she doing on a surgery sub-I?

 

[Anka]

Wow, does she not actually want to be a surgeon? If not, what the hell is she doing on a surgery sub-I?

Maybe at one of those schools where everyone has to do a surgery sub I regardless of future career plans? Who knows. Even if you don't want to do surgery, you figure you'd prefer to sew skin rather than watching the other guy do it.

SMQ, I gotta agree with the advice you've received so far about you needing to do well in the subI. If you can, figure out a way to teach the M3, and/or get them involved, but you need to do your job as a subI without fail -- at my school, even if the M3 'forgot' to get numbers on a particular patient they were assigned, it was the M4's 'fault' if numbers weren't readily available on rounds. This resulted in some duplication of labor, but ultimately for everyone's benefit.

Anka

 

[yaah]

Why don't you just share the work? Have them come in the same time as you, split the pre-rounding. Then take time afterwards and meet together and go over everything so you're on the same page about everyone. If you try to "compete" then you are both going to look bad. If you work together and help each other out I suspect the residents (if they have any brain) will notice and think even more highly of you then if you did it all on your own. There is no point system.

 

[smq123]

Why don't you just share the work? Have them come in the same time as you, split the pre-rounding. Then take time afterwards and meet together and go over everything so you're on the same page about everyone. If you try to "compete" then you are both going to look bad. If you work together and help each other out I suspect the residents (if they have any brain) will notice and think even more highly of you then if you did it all on your own. There is no point system.

My initial point was that I felt like I was a bit ambivalent having brand-new third years, on their first rotation, come in at 3 AM to see a couple patients...and then not have any cases to scrub into later that day.

In any case, I've decided how I'm going to approach it. I'll just throw the suggestion out there that the third year come in at 4 AM to see a few patients. If they balk, then that's fine - they can come in at 5 and see one patient. And either way, I'll print up the OR schedule for services that have fewer students on them, and let them figure out which cases they want to watch.

 

[yaah]

3am? Sheesh. Those poor patients. I had almost forgotten how inhumane prerounding is. I don't remember ever coming in at 3am though. 4am maybe.

 

[smq123]

3am? Sheesh. Those poor patients. I had almost forgotten how inhumane prerounding is. I don't remember ever coming in at 3am though. 4am maybe.

I don't think I've woken up a patient yet on this service. Many of our patients are in the SICU - and it's impossible to sleep in the SICU (between beeping monitors, honking vents, and the never ending smell of c. diff diarrhea). The ones on the floor are in too much pain to sleep - since those PCAs of course don't push themselves while the patient sleeps. 🙁

 

[Ashers]

Wow, does she not actually want to be a surgeon? If not, what the hell is she doing on a surgery sub-I?

We're required to do a surgical and medicine sub-I no matter what we're going into. I've got my med sub-I in February (good since it's shorter).

That girl went into family med. Weird thing was she had said she wanted to get better at suturing at the start of her rotation since she'll have to in family practice.

 

[Acherona]

3am? Sheesh. Those poor patients. I had almost forgotten how inhumane prerounding is. I don't remember ever coming in at 3am though. 4am maybe.

omg. 4am. We started at 6 or 6:30 in surg and I thought that was bad. if i ever get hospitalized on a surgery ward i'm refusing to answer if I've passed gas at 4am by a sniveling third year. refuse. will feign death if necessary.

 

[NPR]

omg. 4am. We started at 6 or 6:30 in surg and I thought that was bad. if i ever get hospitalized on a surgery ward i'm refusing to answer if I've passed gas at 4am by a sniveling third year. refuse. will feign death if necessary.

Wow that's awful. The earliest I ever showed up for work was 5AM.

I remember my classmate and I showed up for work at 4AM on our first day of OBGYN as per the advice of older students. In an attempt to make the rotation less abusive to all, the residents promised to dock our grade 10 points if we ever showed up that early again. (Not a great rotation, but some awesome residents 😛)

 

[DrDre311]

Only reason to show up that early is if you're actually rounding with the team at 5 or you're INSANELY slow.

 

[NPR]

Only reason to show up that early is if you're actually rounding with the team at 5 or you're INSANELY slow.

Med students preround at 5

Interns preround at 5:15

Senior resident prerounds at 5:30

Team rounds at 5:45

Ugh. Bad memories.

 

[Ashers]

Med students preround at 5

Interns preround at 5:15

Senior resident prerounds at 5:30

Team rounds at 5:45

Ugh. Bad memories.

CT surgery we were told not to show up before 6AM. I liked that, then I switched to a gen surg service where we started team rounds at 5AM on busy days. When I had 5 or more patients to see, I'd get to the hospital before 4 to preround.

 

[smq123]

Only reason to show up that early is if you're actually rounding with the team at 5 or you're INSANELY slow.

We round at 6.

A lot of our patients are in the ICU. It takes me longer to write something on them, just because they have so much stuff going on.

All other patients tend to have a lot of drains (JP and CVIR), all of which have lately seemed to require maintenance. That's the one thing I would like to get faster with - taking care of drains a little faster.

 

[DrDre311]

We round at 6.

A lot of our patients are in the ICU. It takes me longer to write something on them, just because they have so much stuff going on.

All other patients tend to have a lot of drains (JP and CVIR), all of which have lately seemed to require maintenance. That's the one thing I would like to get faster with - taking care of drains a little faster.

Unit patients definitely take more time, especially if you really try to get a grasp on critical care and what's really going on with the patient.

Unfortunately first as a student and later as a tern I always felt that people cared more about getting things done quickly than doing them well. I've got more time now that I'm not responsible for as much scut but it can still be tough to take care of problematic issues in a timely fashion.

 

[beastmaster]

What a bunch of slackers.

I come at 2am to pre-round on the entire hospital.

 

[SoCuteMD]

My initial point was that I felt like I was a bit ambivalent having brand-new third years, on their first rotation, come in at 3 AM to see a couple patients...and then not have any cases to scrub into later that day.

In any case, I've decided how I'm going to approach it. I'll just throw the suggestion out there that the third year come in at 4 AM to see a few patients. If they balk, then that's fine - they can come in at 5 and see one patient. And either way, I'll print up the OR schedule for services that have fewer students on them, and let them figure out which cases they want to watch.

FWIW, I'd be kind of pissed off if I were an MS3 and a sub-i took it upon herself to tell me that I had to go to another service to "watch" cases. This is their learning opportunity and their tuition money, too. If the attendings want to decide that the med students should go elsewhere and that they only want sub-interns scrubbing in then I guess that's their prerogative - but if I were the MS3 on that rotation I'd certainly have something to say about it.

 

[smq123]

FWIW, I'd be kind of pissed off if I were an MS3 and a sub-i took it upon herself to tell me that I had to go to another service to "watch" cases. This is their learning opportunity and their tuition money, too. If the attendings want to decide that the med students should go elsewhere and that they only want sub-interns scrubbing in then I guess that's their prerogative - but if I were the MS3 on that rotation I'd certainly have something to say about it.

No, I agree with you on that.

Unfortunately, that's the way it works on this service. There just aren't two ways about it.

Furthermore, the person running the service is the head of the department. I can't imagine that many sub-Is (many of whom have already decided to enter surgical subspecialties) would be happy about giving up their chance to get face time/OR time with the chair. After all, it is THEIR tuition as well.

And MS3s in the past DID say something about it - to the point where it was decided that, in the future, MS3s would not be assigned to this service along with two MS4s.

However....this arrangement might not always be possible. Our school (somewhat stupidly) expanded too fast too quickly, and trying to find places to put 3rd years has become something of an issue. This is the school's fault, not the service's fault and certainly not my fault.

So while your self-righteous indignation is duly noted 🙄, this is unfortunately how it is. And I would rather that a 4th year went over the surgery schedule with me, rather than say "Okay, seeya!" and run off to the OR. (Especially since, when I started 3rd year, I barely knew where the OR was!)

 

[SoCuteMD]

No, I agree with you on that.

Unfortunately, that's the way it works on this service. There just aren't two ways about it.

Furthermore, the person running the service is the head of the department. I can't imagine that many sub-Is (many of whom have already decided to enter surgical subspecialties) would be happy about giving up their chance to get face time/OR time with the chair. After all, it is THEIR tuition as well.

And MS3s in the past DID say something about it - to the point where it was decided that, in the future, MS3s would not be assigned to this service along with two MS4s.

However....this arrangement might not always be possible. Our school (somewhat stupidly) expanded too fast too quickly, and trying to find places to put 3rd years has become something of an issue. This is the school's fault, not the service's fault and certainly not my fault.

So while your self-righteous indignation is duly noted 🙄, this is unfortunately how it is. And I would rather that a 4th year went over the surgery schedule with me, rather than say "Okay, seeya!" and run off to the OR. (Especially since, when I started 3rd year, I barely knew where the OR was!)

Wow...you seem really upset with my take on the issue. I guess it'll be up to the MS3s to stick up for themselves, which is a bit unfortunate since MS3s on their first rotation tend to be very very reluctant to do so. You are right that it's not your fault that your school has created this situation. At my school it also wouldn't be your job to tell an MS3 when/where she couldn't scrub in.

If it were me, I'd share the face time - at least in a token gesture. That's what the sub-I's on my current rotation have done and it's worked really well.

 

[smq123]

Wow...you seem really upset with my take on the issue. I guess it'll be up to the MS3s to stick up for themselves, which is a bit unfortunate since MS3s on their first rotation tend to be very very reluctant to do so. You are right that it's not your fault that your school has created this situation. At my school it also wouldn't be your job to tell an MS3 when/where she couldn't scrub in.

If it were me, I'd share the face time - at least in a token gesture. That's what the sub-I's on my current rotation have done and it's worked really well.

Well, when you use phrases like "the sub-I took it upon herself," indicating that I'm overstepping my boundaries (when, in fact, I am not - this is what sub-Is are supposed to do, at least at my school), then yeah, I'm going to get a little pissed. Sorry, but that's how your wording came across.

I'm glad that you'd share the face time. I wouldn't, and the other sub-I on my team probably wouldn't be all that willing to either. Seeing as there aren't all that many other opportunities to interact with the chairman of the department, OR time is the only time that we really have.

Please don't extrapolate what you think I should be doing based on what YOUR school and YOUR rotation have been like. I'm trying to think of the best options that will work in the structure that I've been given.

 

[SoCuteMD]

Well, when you use phrases like "the sub-I took it upon herself," indicating that I'm overstepping my boundaries (when, in fact, I am not - this is what sub-Is are supposed to do, at least at my school), then yeah, I'm going to get a little pissed. Sorry, but that's how your wording came across.

I'm glad that you'd share the face time. I wouldn't, and the other sub-I on my team probably wouldn't be all that willing to either. Seeing as there aren't all that many other opportunities to interact with the chairman of the department, OR time is the only time that we really have.

Please don't extrapolate what you think I should be doing based on what YOUR school and YOUR rotation have been like. I'm trying to think of the best options that will work in the structure that I've been given.

You asked for advice. I gave my $0.02 on the matter. There's really no need to get so upset over the fact that my take on the issue differs from yours. I didn't realize that sub-i's had a supervisory role over MS3s - that wasn't something you made clear in your earlier posts.

Lots of luck to you and the MS3s on this rotation.

 

[DoctorFunk]

Please don't extrapolate what you think I should be doing based on what YOUR school and YOUR rotation have been like. I'm trying to think of the best options that will work in the structure that I've been given.

I think it's poor form to ask for advice and then become indignant when said advice doesn't match up with your current actions or plan of attack for the rotation. Do you feel guilty about the ramifications of your career aspirations on the M3's experience? I understand time to impress the surgery chair in the OR is valuable, but can you honestly say you would be ok with the impression they would have of you and your ability to be a team player if they were reading what you wrote in this thread?

Then again, if I were waking up at 3 AM every day, I would probably be ripping heads off here on SDN.

 

[Agent Splat]

I think it's poor form to ask for advice and then become indignant when said advice doesn't match up with your current actions or plan of attack for the rotation. Do you feel guilty about the ramifications of your career aspirations on the M3's experience? I understand time to impress the surgery chair in the OR is valuable, but can you honestly say you would be ok with the impression they would have of you and your ability to be a team player if they were reading what you wrote in this thread?

Then again, if I were waking up at 3 AM every day, I would probably be ripping heads off here on SDN.

That's why I got up at 3:30am on surgery. I only eviscerated a few people. All heads were spared.

 

[smq123]

I think it's poor form to ask for advice and then become indignant when said advice doesn't match up with your current actions or plan of attack for the rotation. Do you feel guilty about the ramifications of your career aspirations on the M3's experience? I understand time to impress the surgery chair in the OR is valuable, but can you honestly say you would be ok with the impression they would have of you and your ability to be a team player if they were reading what you wrote in this thread?

But I'd said that I'd already decided on a plan of action. No longer really looking for advice anymore. Plus, it's moot - no third years on our team as of yet.

Do I feel guilty? Sure...which is why I agreed with the decision by the clerkship coordinator to not put MS3s on this rotation. At this point in the year, do they know enough to impress the attendings? What have they really lost, even if they do want to do surgery as a career? Not much.

The team knows about my ability to be a team player. What I'm saying is not a shocker to them or any other student at this school, frankly. The way that this rotation tended to pan out for MS3s who were put on the team with 2 sub-Is is pretty well known.

 

[DrDre311]

But I'd said that I'd already decided on a plan of action. No longer really looking for advice anymore. Plus, it's moot - no third years on our team as of yet.

Do I feel guilty? Sure...which is why I agreed with the decision by the clerkship coordinator to not put MS3s on this rotation. At this point in the year, do they know enough to impress the attendings? What have they really lost, even if they do want to do surgery as a career? Not much.

The team knows about my ability to be a team player. What I'm saying is not a shocker to them or any other student at this school, frankly. The way that this rotation tended to pan out for MS3s who were put on the team with 2 sub-Is is pretty well known.

My advice to any MS3's starting any surgery rotation is that if you're told to page Dre with plastic surgery...trust him completely. Trust whatever he says...there will be no ambush, no unrelenting pimpfests about useless trivia...yeah, that's the ticket. It'll be fun.

 

[Ashers]

My advice to any MS3's starting any surgery rotation is that if you're told to page Dre with plastic surgery...trust him completely. Trust whatever he says...there will be no ambush, no unrelenting pimpfests about useless trivia...yeah, that's the ticket. It'll be fun.

I got pimped about nematodal parasites during a plastic surgery by the attending. It was weird.

 

[indo]

I just started my 4th year sub-I...and I found out today that I may be getting an MS3 on my team in a week or so. That, by itself, is fine....but how do I act like an honors student sub-I, while still leaving something meaningful for the third year student to do?

I wouldn't want to make him/her come in and pre-round when I pre-round (it's a surgery sub-I, and that might be enough to make him/her quit school). But I remember being an MS3, and being really frustrated because there just wasn't anything left for me to do, once the sub-I started her rotation.

Any ideas?

Teach the 3rd year everything you know. I'd bet some time somebody who writes your evaluations will ask the ms3 for their opinion on your abilities as a teacher and team player. Plus, once you get the ms3 up to speed (sorta) you'll be much more productive as a team.