med students making interns look stupid

[microscp2]

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When I was a medical student, it was well known that you don't do that, currently, will have a sub-I that is not interested in our FM program, she wants to do Dermatology, and she is trying to impress, making the intern look bad. How would you guys approach this situation? She knows that the attending is the one that will evaluate her.

 

[MedicineDoc]

When I was a medical student, it was well known that you don't do that, currently, will have a sub-I that is not interested in our FM program, she wants to do Dermatology, and she is trying to impress, making the intern look bad. How would you guys approach this situation? She knows that the attending is the one that will evaluate her.

Study more. If you try to learn every chance you get while you're on and a little at home you will incrementally and almost inperceptably rise to the top. No one really cares how much that potential derm resident knows but by the time you graduate one or more of the worst interns will have risen to the top of their class. All she is doing is helping you lift the bar for yourself.

 

[lowbudget]

Who cares? Let the med student have her hey day and wish her luck in derm. Anyone can act like a know-it-all when you're not truly responsible for the care of a patient. She will one day become an intern and there will be a med student who makes her look bad. Welcome to life. Study harder.

If anything, turn a negative into a positive. Help her succeed. Tell her that you're impressed with her performance thus far and give her more responsibilities, more patients, more presentations, and more latitude in directing a patient's care. When she hits a road block, teach her.

Put another way, there is nothing to gain if you try to destroy her. There is so much to gain for you, for her, for the team when you do the opposite.

 

[microscp2]

Study more. If you try to learn every chance you get while you're on and a little at home you will incrementally and almost inperceptably rise to the top. No one really cares how much that potential derm resident knows but by the time you graduate one or more of the worst interns will have risen to the top of their class. All she is doing is helping you lift the bar for yourself.

I had the feeling people will think is about knowledge, is not that. Let me give you an example. I just started at the ward 2 days ago, the student has been there already for 3 weeks. I inherited an HIV patient from the other intern, that had a biopsy for kaposi sarcoma that was confirmed positive over a week ago. We are not even discussing that at rounds. Out of the blue, she started telling me in front of everybody with a tone and attitude ," have you told the patient about the implication of having kaposi sarcoma, does he understand that once is in the skin, the possibility to spread to other parts of the body is high......." I am like why I have to bring that up now, the results has been out for over a week, has been given by the attending and the other intern,I hope, you guys were here rounding with them, why you did not bring that up last week ?
Another example, same day. Had a very busy day, had 2 admissions in top of all the patients ( I am an Intern so carrying 6 out of the 8 patients in the team, she is carrying one) so forgot to do a mini mental in a patient that came with hypoglycemia. She was like " Well, do you know how to do a mini mental status? " I responded OMG! of course I know how to do a mini mental status, I just finished medical school last year . I am in my early 40's so am thinking she is just thinking I finished school long time ago or something.

 

[Reductio]

I had the feeling people will think is about knowledge, is not that. Let me give you an example. I just started at the ward 2 days ago, the student has been there already for 3 weeks. I inherited an HIV patient from the other intern, that had a biopsy for kaposi sarcoma that was confirmed positive over a week ago. We are not even discussing that at rounds. Out of the blue, she started telling me in front of everybody with a tone and attitude ," have you told the patient about the implication of having kaposi sarcoma, does he understand that once is in the skin, the possibility to spread to other parts of the body is high......." I am like why I have to bring that up now, the results has been out for over a week, has been given by the attending and the other intern,I hope, you guys were here rounding with them, why you did not bring that up last week ?
Another example, same day. Had a very busy day, had 2 admissions in top of all the patients ( I am an Intern so carrying 6 out of the 8 patients in the team, she is carrying one) so forgot to do a mini mental in a patient that came with hypoglycemia. She was like " Well, do you know how to do a mini mental status? " I responded OMG! of course I know how to do a mini mental status, I just finished medical school last year . I am in my early 40's so am thinking she is just thinking I finished school long time ago or something.

Given that...

Hows the relationship of the team with the Attending? Can you safely have a discussion with the attending?

If not, have a talk with your team. Maybe you can get everyone on the same page. Then when she has an outburst, you can TACTFULLY reply appropriately. Im sure its hard to think straight in when she does make a comment like that, but there IS an appropriate and constructive response....

"There's a right time for everything, once he is stable, and we have a plan, we can discuss the management of the sarcoma with him. And, it isnt our responsibility to list out every single complication in detail with him all at once. Especially with serious things, we take one step at a time, and allow the patient to absorb the info at his own pace. "

or in the second situation...

"Yes I do"

Third option - since the teams opinion may or may not matter, and since her opinion of you DOESN'T matter, there really isnt anything wrong with commenting on her professionalism. She is a student after all, shes meant to get feedback. The only reason shes gotten this far with this attitude is because she's never been called out on it. Consider it a favor.

 

[MedicineDoc]

I would not make the mistake of assuming she knows what she is talking about. Oftentimes the people who ALWAYS act as if they know exactly what they are talking about bluff others into thinking they are on top of the game when really they may be winging it to a large degree. Especially a med student. I verify even attending statements that strike me as new info or different than my understanding. You could have said well so and so you know that kaposi sarcoma has become much less prevalent and severe with HARRT therapy and we don't want to inappropriately alarm the patient. I think that a short presentation on the reduced incidence and severity of ks with modern HIV therapy would be a good way for you to help the team learn more about ks and it's implicatons.. Read on it yourself and call her on the inaccuracies when she presents. If you she teaches you something you win if she messes it up Oh well.... Either way let it roll off your back. It doesnt matter its just a distraction. As for the mms exam. I would say that we usually let the medical students help us with thAt. We'd appreciate it if you could get that done for us. I have found that running is a good way to clear your mind of ridiculous crap like this.

 

[Reductio]

I would not make the mistake of assuming she knows what she is talking about. Oftentimes the people who ALWAYS act as if they know exactly what they are talking about bluff others into thinking they are on top of the game when really they may be winging it to a large degree. Especially a med student. I verify even attending statements that strike me as new info or different than my understanding. You could have said well so and so you know that kaposi sarcoma has become much less prevalent and severe with HARRT therapy and we don't want to inappropriately alarm the patient. I think that a short presentation on the reduced incidence and severity of ks with modern HIV therapy would be a good way for you to help the team learn more about ks and it's implicatons.. Read on it yourself and call her on the inaccuracies when she presents. If you she teaches you something you win if she messes it up Oh well.... Either way let it roll off your back. It doesnt matter its just a distraction. As for the mms exam. I would say that we usually let the medical students help us with thAt. We'd appreciate it if you could get that done for us. I have found that running is a good way to clear your mind of ridiculous crap like this.

That.

Shes a sub-intern, isnt she? She should be giving presentations at least once a week. Im sure she can handle that while taking care of her ONE patient... Next time she spouts out some hot-shot nonsense which shows memorization of a textbook, and no clinical sense, say "why dont you prepare a short presentation...." If nothing else, it will show her the latest research and guidelines on the topic, which are generally a little different from what you learn in med school.

I also seem to remember the MMSE being the med students "responsibility" on some med school rotations...

 

[microscp2]

thank you guys !!!

 

[lowbudget]

She sounds obnoxious. Page her to breakfast and make her late for rounds.

Why is she carrying 1 patient? She needs to be carrying 5, following up on labs, reading about patient-specific care issues, medications/side effects/contraindications, and writing discharge summaries. She should be too busy to be offering sideline commentaries.

And, I don't want a 3rd year medical student presentation that I can read from a First Aid. Lame. I expect her to bust out a presentation that is specific to the care of the patient she is following where they have multiple problems that interact, e.g. CHF in the setting of COPD, HIV in the setting hepatic/renal failure. Or whatever.

Challenge your medical student, hold them accountable to their responsibilities, and they'll be part of your team instead of obstructing progress.

Part of the issue here is that as residents, this may be the first time you've managed someone more junior than you. And most physicians have never had a real job where they managed anyone prior to medical school. Worse of all, how do you manage someone when you're busy with work and trying to learn all at the same time? All of this teaching/managing/supervising is part of learning medicine as a resident.

 

[Doctor4Life1769]

Who cares? Let the med student have her hey day and wish her luck in derm. Anyone can act like a know-it-all when you're not truly responsible for the care of a patient. She will one day become an intern and there will be a med student who makes her look bad. Welcome to life. Study harder.

If anything, turn a negative into a positive. Help her succeed. Tell her that you're impressed with her performance thus far and give her more responsibilities, more patients, more presentations, and more latitude in directing a patient's care. When she hits a road block, teach her.

Put another way, there is nothing to gain if you try to destroy her. There is so much to gain for you, for her, for the team when you do the opposite.

This.

You have no idea how many interns/residents have a major chip on their shoulder when a med student not interested in their service shows up and is on their game. Allow that student to take a bigger role in pt care, don't try to break the student's confidence. I had an attending attempt to do that to me, and it did not go over well (with me).

 

[Doctor4Life1769]

I had the feeling people will think is about knowledge, is not that. Let me give you an example. I just started at the ward 2 days ago, the student has been there already for 3 weeks. I inherited an HIV patient from the other intern, that had a biopsy for kaposi sarcoma that was confirmed positive over a week ago. We are not even discussing that at rounds. Out of the blue, she started telling me in front of everybody with a tone and attitude ," have you told the patient about the implication of having kaposi sarcoma, does he understand that once is in the skin, the possibility to spread to other parts of the body is high......." I am like why I have to bring that up now, the results has been out for over a week, has been given by the attending and the other intern,I hope, you guys were here rounding with them, why you did not bring that up last week ?
Another example, same day. Had a very busy day, had 2 admissions in top of all the patients ( I am an Intern so carrying 6 out of the 8 patients in the team, she is carrying one) so forgot to do a mini mental in a patient that came with hypoglycemia. She was like " Well, do you know how to do a mini mental status? " I responded OMG! of course I know how to do a mini mental status, I just finished medical school last year . I am in my early 40's so am thinking she is just thinking I finished school long time ago or something.

She sounds ******ed. Does she even take on patients? Or does she bring up pointless bull****?

 

[Reductio]

She sounds ******ed. Does she even take on patients? Or does she bring up pointless bull****?

Seems like she takes one patient, and talks a lot.

Waddaya mean dont break the students confidence, yet let her take a bigger role in patient care? Tell her "youre impressed with her performance"? Gimmie a break. This isnt grade school. Good medical education takes you to the edge of your confidence level and pushes it out.

Give her a challenge. And seriously. One patient? She should have 5 patients, equal share of admissions, and one presentation per week at least.

 

[Toohotinvegas33]

Im going to sit on both sides of the fence on this one.

1. Nothing good will come from purposely trying to bring someone down.

2. Sub-I should be carrying alot more patients, i carried atleast 3-4 and all new admits were mine.

3. Unless she has seen how you treat a certain condition already, there is usually room for improved on the A/P. The book may say treatment is steriod/fluids...etc, but for how long? what dose? complications to treatment? discharge planning?

4. She should not be asking interns if they know how to do xyz, especially in family medicine which is so broad and each resident may have there own interest which they will pursue. This may need to be addressed by the chief or attending in private.

5. She may be very bright, but seems like she is lacking in etiquette. comments like "very knowledgeable but, does not work well with the team" "is defensive with feedback" etc on her eval will wake her up.

 

[Reductio]

Im going to sit on both sides of the fence on this one.

1. Nothing good will come from purposely trying to bring someone down.

2. Sub-I should be carrying alot more patients, i carried atleast 3-4 and all new admits were mine.

3. Unless she has seen how you treat a certain condition already, there is usually room for improved on the A/P. The book may say treatment is steriod/fluids...etc, but for how long? what dose? complications to treatment? discharge planning?

4. She should not be asking interns if they know how to do xyz, especially in family medicine which is so broad and each resident may have there own interest which they will pursue. This may need to be addressed by the chief or attending in private.

5. She may be very bright, but seems like she is lacking in etiquette. comments like "very knowledgeable but, does not work well with the team" "is defensive with feedback" etc on her eval will wake her up.

By now, I'm assuming her sub-I is well underway. If these issues havent been addressed by now, her evaluation needs to reflect serious deficiencies in professionalism, response to feedback, and teamwork.

 

[MeowMix]

You are tired, stressed, nearly done with intern year. In your position, I would manage this student with zen-like calm and know that she is just doing what she thinks she has to do. Those pre-Derm students are insane at this time of year - they can lose all sense of how to act like a human. Your attendings are well aware of how obnoxious students can be.

You have nothing to lose (your program is not going to fire you because some med student acted like an ass). You have everything to gain by NOT reacting to her in public, demonstrating your maturity (which, after all, is what we over-40s are known for). I would just say thank you for everything new she shares, and try to refrain from stabbing her in the eye with a reflex hammer. Because that probably would get you fired.

 

[Reductio]

You are tired, stressed, nearly done with intern year. In your position, I would manage this student with zen-like calm and know that she is just doing what she thinks she has to do. Those pre-Derm students are insane at this time of year - they can lose all sense of how to act like a human. Your attendings are well aware of how obnoxious students can be.

You have nothing to lose (your program is not going to fire you because some med student acted like an ass). You have everything to gain by NOT reacting to her in public, demonstrating your maturity (which, after all, is what we over-40s are known for). I would just say thank you for everything new she shares, and try to refrain from stabbing her in the eye with a reflex hammer. Because that probably would get you fired.

I will henceforth be carrying a reflex hammer in my white coat.

I'd posit that we all have something to gain from her being evaluated appropriately.

Obnoxious students make obnoxious residents and obnoxious attendings, who will be obnoxious co-workers. Nip this in the bud, and we'll all be better off.

 

[microscp2]

By now, I'm assuming her sub-I is well underway. If these issues havent been addressed by now, her evaluation needs to reflect serious deficiencies in professionalism, response to feedback, and teamwork.

I was not the only one, the chief of the team had to give her feedback, and it was ugly, since in her last day morning round, we were discussing one case, and she contradicted the attending. In that same morning, she contradicted the chief and tried to make the night intern look bad, saying " he forgot to mention in his H&P this pt had this and this" when in fact he didn't. She was told she came across as rude, and she was shocked, saying is the first time she had an evaluation like that.

 

[lowbudget]

I will henceforth be carrying a reflex hammer in my white coat.

I'd posit that we all have something to gain from her being evaluated appropriately.

Obnoxious students make obnoxious residents and obnoxious attendings, who will be obnoxious co-workers. Nip this in the bud, and we'll all be better off.

That's fine, but if you're gonna evaluate her that way, do it midway in the rotation and do it verbally in person. Give her a chance to redeem, and if she fails to redeem, let her know in person and verbally and submit it by paper. Blindsiding a student at the end of a rotation on an evaluation without first discussing it is just plain no gonads and outright passive aggressive.

 

[lowbudget]

I was not the only one, the chief of the team had to give her feedback, and it was ugly, since in her last day morning round, we were discussing one case, and she contradicted the attending. In that same morning, she contradicted the chief and tried to make the night intern look bad, saying " he forgot to mention in his H&P this pt had this and this" when in fact he didn't. She was told she came across as rude, and she was shocked, saying is the first time she had an evaluation like that.

She's an idiot. Some people just don't have a clue. If she had worked 1 day in the real world on a team, she would have known that none of this behavior was kosher. Stupid. What's getting in the way between her and derm is her stupid mouth.

 

[Doctor4Life1769]

Seems like she takes one patient, and talks a lot.

Waddaya mean dont break the students confidence, yet let her take a bigger role in patient care? Tell her "youre impressed with her performance"? Gimmie a break. This isnt grade school. Good medical education takes you to the edge of your confidence level and pushes it out.

Give her a challenge. And seriously. One patient? She should have 5 patients, equal share of admissions, and one presentation per week at least.

What do you suggest doing? Berate the hell out of her? That'll look good on you, too. 🙄

No, you have the student take on more patients. More patients = she is busier = the less her mouth is open and the more she has to take care of and know. That was my point all along.

 

[montessori2md]

Im going to sit on both sides of the fence on this one.

1. Nothing good will come from purposely trying to bring someone down.

2. Sub-I should be carrying alot more patients, i carried atleast 3-4 and all new admits were mine.

3. Unless she has seen how you treat a certain condition already, there is usually room for improved on the A/P. The book may say treatment is steriod/fluids...etc, but for how long? what dose? complications to treatment? discharge planning?

4. She should not be asking interns if they know how to do xyz, especially in family medicine which is so broad and each resident may have there own interest which they will pursue. This may need to be addressed by the chief or attending in private.

5. She may be very bright, but seems like she is lacking in etiquette. comments like "very knowledgeable but, does not work well with the team" "is defensive with feedback" etc on her eval will wake her up.

As a somewhat mouthy med student, I agree with above. I don't think I'm her, but the best tip anyone ever gave me was, on rounds, not to ask questions/make comments about a patient that isn't yours. Someone should tell her that, to help her save herself. If a student is genuinely concerned about a patient (not hers) she can always bring it up with the intern separately. If she's just curious, then she can look up the answers for herself later, either by reading the chart or researching. But she sounds like she's more showing off than curious, so she probably needs to be given boundaries.

 

[MedicineDoc]

This thing has been analyzed out the bung hole. Who cares? It's not like anyone got sand kicked in their face in front of their girlfriend the prom queen. The only job of an intern is to learn and not piss anyone off enough to interfere with graduating/passing rotations or coming up with a good rec from the program director and 2 other faculty members by the time they graduate which in this case is at least 2 yrs from now. It doesn't matter. It's stupid.

 

[Reductio]

This thing has been analyzed out the bung hole. Who cares? It's not like anyone got sand kicked in their face in front of their girlfriend the prom queen. The only job of an intern is to learn and not piss anyone off enough to interfere with graduating/passing rotations or coming up with a good rec from the program director and 2 other faculty members by the time they graduate which in this case is at least 2 yrs from now. It doesn't matter. It's stupid.

In my opinion, This sort of mentality is the basis for a lot of problems in our profession. Its not about us flying under the radar so we can complete rotations without pissing anyone off, and getting three LORS. Its about training to become outstanding physicians, one part of which is to be teachers. Your residency, and career is not just about you.

As an intern or resident, it is your "job" to teach medical students, and to become competent, if not great at it.

This isnt about being scorned by some prom queen... Its an issue with a graduating 4th year medical student who hasn't learned professionalism, teamwork, and boundaries that should have been picked up early in 3rd year, if not sooner.

If residents having a discussion about how we can become better teachers seems stupid to you, and if improving your skills at teaching doesnt matter, then so be it. But as a colleague, I think its all of our loss.

 

[MedicineDoc]

Dont you have anything better to do like study or teach interns or something rather than make up garbage about people you never met in big long prose?

 

[Reductio]

Vacay, and a light rotation this month. Did you, or did you not post the following? Tell me, what garbage am I making up?

This thing has been analyzed out the bung hole. Who cares? It's not like anyone got sand kicked in their face in front of their girlfriend the prom queen. The only job of an intern is to learn and not piss anyone off enough to interfere with graduating/passing rotations or coming up with a good rec from the program director and 2 other faculty members by the time they graduate which in this case is at least 2 yrs from now. It doesn't matter. It's stupid.