med students

[plastikosmd]

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"I think if a medical student is going to be a doctor they should start thinking that they are the doctor as soon as possible. That means doing what they can for their patient. If they want to view it as not their job then nobody is going to shoot them but how can you expect people to respect them for that attitude?"

well stated, for my field where we take only 2 people per year and everyone has to pull their own weight. team dynamics are important and therefore resident evaluations are also. we look critically at how students perform on the service, judging aptitude and attitude. a 240+ and AOA means nothing if you are not proactive. I also do recognize that this may be different for other fields. i can only say that if our intern was told by a rotating student (and our field is elective to rotate on..so in theory you want to be there)that they felt the intern should do the H+P/help with patient data collection (film/labs)/not feel the need to take call etc. because they got paid, they would not make our rank list. there are plently of other programs and fields that they may be a better fit at.

 

[Annette]

Scutwork= stuff to complain about when you are a student but have to do by yourself once you are an attending!😛

When students and interns are wondering if they are being scutted, they should consider "will doing this give my intern/resident more time to teach me, and do they?" I never saw a problem with sending students to dinner, asking them to pick me up something while I finished stupid stuff they wouldn't gain anything from. Later, I'd make certain that we cover a topic of interest.

As for the bashing EM portion of the thread, as there is in every specialty, there are doctors who are stellar/good/marginal/ and damned scary. So some people think they are "just" screens, well, it is a very important process, and not necessarily easy. My experience has been that most EM docs will start an appropriate initial treatment for the patients I'm consulted on. The diagnosis may need to be refined, but 75-90% of the time the EM doc has hit the right Dx.

 

[EM_Rebuilder]

I sent home I bet over a dozen belly pains the previous month when I was in the Emergency Department. Consulted surgery only twice. One went to the OR with a hot appy. The other was a whipple 2 months previous that had 3 recurrences of infection/abscess. With such recent complications and belly pain that patient says "It feels just like when I had to come in the hospital last time' was enough for me (and of course the Att) to call Surgery.

Evidently I committed some type of malpractice since I sent out nearly a dozen people with belly pain?

On the flip side, I believe every single case that goes to the OR gets infected. Any time I have seen someone in the ED with a recent surgery, its because they had an infection of the OP site. Therefore, shall I assume that EVERY surgery patient gets an infection? Every lap band/gastric bypass has a bowel nick? Just like every single belly pain gets a Surgery consult? I know better and I wish some others would mature and understand the same....


I am surprised to hear EM called lazy. I do not really care if someone calls me or my specialty lazy, but people like rads and anesth will tell you they are lazy (I am NOT making any statements here... got friends in both and they say they did it because they are lazy. That is not my opinon of them). If anyone thinks EM is lots of nothing, I hope you have an EM month coming up so that you can see that is not the case. What defines being lazy? Its all relative I guess. I was in the hospital 31 hours on call in the MICU. Slept about 30 mins at most three different times. Came home and been scrubbing burned up soot out of a motorhome. Now its 1AM and I am playing on SDN. Am I lazy? I am off tomorrow and plan on being a bum and sleep until noon... so maybe I am? Who cares...

 

[pillowhead]

I am surprised to hear EM called lazy. I do not really care if someone calls me or my specialty lazy, but people like rads and anesth will tell you they are lazy (I am NOT making any statements here... got friends in both and they say they did it because they are lazy. That is not my opinon of them). If anyone thinks EM is lots of nothing, I hope you have an EM month coming up so that you can see that is not the case. What defines being lazy? Its all relative I guess. I was in the hospital 31 hours on call in the MICU. Slept about 30 mins at most three different times. Came home and been scrubbing burned up soot out of a motorhome. Now its 1AM and I am playing on SDN. Am I lazy? I am off tomorrow and plan on being a bum and sleep until noon... so maybe I am? Who cares...

I'm sorry but your last paragraph reeks of hypocrisy. I have friends who went into EM who did so according to them because of the short hours and the fact that they didn't feel like they had to really master anything. In short, because they felt they're lazy. But if I were to say people like EM will tell you they are lazy, I don't think you'd be too happy.

Just because you have friends who went into rads and anesthesiology who are lazy and just because I have friends who went into EM who are lazy, doesn't give either of us the right to paint the whole specialty with such a b road brush.

 

[snoopy brown]

I sent home I bet over a dozen belly pains the previous month when I was in the Emergency Department. Consulted surgery only twice.

*sigh* I thought we weren't discussing the ED any more, but since we apparently are ...
The argument is always the same. Guys in the ED say that they see tons of volume. I agree, you do. You say that you work while you're there. Well, yes and no. Certainly not comparatively. We all know that EDs have busy times and dead times (that are hours long). That's just a fact. Other services don't.

And do you see patients that nobody is consulted on? Of course. But that's a silly argument. There are two groups of people that are easy for anyone, the obvious non-admit and the obvious admit. You talk about a post-op patient who has had recurrent infections and now has abdominal pain. So? That's also a no-brainer in the opposite direction, there's no reason to be proud of that. The problem is that in the middle is everyone else. You want to talk about abdominal pain? I've seen it where surgery is consulted, says it's not surgical, so then GI is consulted, and if they're not impressed then it'll go to medicine. Likewise I've seen it where even if the consultant feels the patient doesn't need to be admitted and writes a note stating that clearly the ED admits them anyways.

And by the way, citing time in the MICU when you're not on an ED rotation is not a great way to prove that the ED is or is not lifestyle.

 

[8744]

I'm sorry but your last paragraph reeks of hypocrisy. I have friends who went into EM who did so according to them because of the short hours and the fact that they didn't feel like they had to really master anything. In short, because they felt they're lazy. But if I were to say people like EM will tell you they are lazy, I don't think you'd be too happy.

Just because you have friends who went into rads and anesthesiology who are lazy and just because I have friends who went into EM who are lazy, doesn't give either of us the right to paint the whole specialty with such a b road brush.

Whoa. I bet they were disappointed. The hours (in residency) may be shorter than for other specialties and we may get more days off but we make up for it in volume of work and speed when we are on. By the end of our residency we are supposed to be seeing 2.5 patients per hour which is 30 patients in a 12-hour shift. That is hardly "lazy."

 

[8744]

Scutwork= stuff to complain about when you are a student but have to do by yourself once you are an attending!😛

When students and interns are wondering if they are being scutted, they should consider "will doing this give my intern/resident more time to teach me, and do they?" I never saw a problem with sending students to dinner, asking them to pick me up something while I finished stupid stuff they wouldn't gain anything from. Later, I'd make certain that we cover a topic of interest.

As for the bashing EM portion of the thread, as there is in every specialty, there are doctors who are stellar/good/marginal/ and damned scary. So some people think they are "just" screens, well, it is a very important process, and not necessarily easy. My experience has been that most EM docs will start an appropriate initial treatment for the patients I'm consulted on. The diagnosis may need to be refined, but 75-90% of the time the EM doc has hit the right Dx.

It's the principle of the thing. I would never ask a medical student to run a personal errand (and getting chow is the ulitmate personal errand) because it puts him on the spot. On one hand he may be mad because you are treating him like a gopher but on the other he will be reluctant to tell you to "pound sand" for fear of both his grade and of defying authority.

The essence of good manners and respect is to never put people in a situation where your behavior makes them uncomfortable. Good manners and respect are scarce in medical training but that doesn't mean we have to contribute to the problem. I'll get my own chow (which is free at my program for residents anyways) before I'll try to get a medical student to run an errand just to give me more time to do my work. It's a little thing but still an abuse of authority. If there is nothing for the medical students to do the best thing to do is send them home or let them get some sleep if they are on call.

 

[Dr. Will]

*sigh* I thought we weren't discussing the ED any more, but since we apparently are ...
The argument is always the same. Guys in the ED say that they see tons of volume. I agree, you do. You say that you work while you're there. Well, yes and no. Certainly not comparatively. We all know that EDs have busy times and dead times (that are hours long). That's just a fact. Other services don't.

And do you see patients that nobody is consulted on? Of course. But that's a silly argument. There are two groups of people that are easy for anyone, the obvious non-admit and the obvious admit. You talk about a post-op patient who has had recurrent infections and now has abdominal pain. So? That's also a no-brainer in the opposite direction, there's no reason to be proud of that. The problem is that in the middle is everyone else. You want to talk about abdominal pain? I've seen it where surgery is consulted, says it's not surgical, so then GI is consulted, and if they're not impressed then it'll go to medicine. Likewise I've seen it where even if the consultant feels the patient doesn't need to be admitted and writes a note stating that clearly the ED admits them anyways.

And by the way, citing time in the MICU when you're not on an ED rotation is not a great way to prove that the ED is or is not lifestyle.

Have you visited every ED in the country to really verify this, or are you generalizing again? Especially with the "dead time fact." Yes, this may happen at some community type hospitals but come to any inner city/county hospital and you will see that volume is always present no matter what time of the day or day of the week it is. Places like this, it's more unusual to have this "dead time."

BTW...how many ED's have you been in to provide your "n"?

 

[snoopy brown]

Have you visited every ED in the country to really verify this, or are you generalizing again?

What a great argument. My hat is off to you, sir.

 

[Dr. Will]

We all know that EDs have busy times and dead times (that are hours long). That's just a fact. Other services don't.

Ummm...my argument holds becuase this was your original statement. So until you can prove that ALL ED's are like this on a consistent basis, your argument doesn't quite pan out as "FACT." If you want to rephrase this to your "opinion," then fine...but don't pass it off as "FACT." Again...you are generalizing. This may be true of your ED, but not of all.

 

[snoopy brown]

So until you can prove that ALL ED's are like this on a consistent basis, your argument doesn't quite pan out as "FACT."

OK. I guess we'll just go with the generic ED argument that "it's like that everywhere you've been but everywhere else it's not, you can believe it."

 

[Dr. Will]

OK. I guess we'll just go with the generic ED argument that "it's like that everywhere you've been but everywhere else it's not, you can believe it."

Again, you generalize. I never said that it's always busy at all the places I've been. The majority, yes, waiting room always has patients to see. Some ED's I've been to do have lulls. But the ones that weren't as busy were set within the community. And as for places that I haven't been too...I'm dead sure there are ED's that mirror what you speak of, and plenty that aren't (I do know people in ED's around the country as I went to medical school with them so it isn't surprising that they have busy ED's as well).

Your arguments about the majority ED residents, their work ethic, and the departments they work in are flawed. I have yet to sit here and bash on anyone else. I'm not entirely sure as to why you do when from your statements it seems that your experience is truly limited. Chip on your shoulder? Who knows. Anyways, I'm off for a nap since I'm covering Ortho nights off service and plan to work hard as I always do. Didn't get into my specific program by not working hard and in no way do I think I'd have it easy over the next four years. Later troll.

 

[fuzzyerin]

The argument is always the same. Guys in the ED say that they see tons of volume. I agree, you do. You say that you work while you're there. Well, yes and no. Certainly not comparatively. We all know that EDs have busy times and dead times (that are hours long). That's just a fact. Other services don't.

If the ED that you work out has hours of dead time, that would mean the following:

1 - there are no Medicine admissions during this time
2 - there are no Surgical admissions during this time

And if that's the case, I would argue that then EVERYONE could have free time! The medicine residents, once their service is "tucked in" and they've rounded for 10 hours (there's another generalization - as an ob/gyn, I think medicine rounds for hours on hours on end and talks alot without acting much and jeez, I'm just joking here) would be going to sleep. The surgical residents, once everyone is done in the OR and everyone on the floor is stable, would be going to sleep. The busy-ness of an ER determines the busy-ness of the whole hospital!

I hate ER consults as much as the next person...except when it gets me an OR case. But I respect our ER residents and attendings - heck, I even like them! At least they make an attempt to do a pelvic exam before they call me! And I know they send home plenty of people that come to the ER for "vaginal bleeding" and on those nights that I get sleep because of their hard work, I thank them

 

[snoopy brown]

And if that's the case, I would argue that then EVERYONE could have free time!

Um, no offense but you do realize that inpatient services do a lot more than just admit people and round on them, right? As an ob, I know you also have clinic, don't forget inpatient consults, and so on. A dead ER, yes, does mean less work for everyone at some point, but the beauty of it is that ERs are dead in the early AM and mornings when people do their rounding. Does that mean that they lock their doors or that zero people in the history of the world have appeared? No, but it's quite un-busy I can tell you. I would also note that people's attitudes towards the ER change markedly once they become attendings. I'll give you a few guesses as to why.

 

[Tired]

The essence of good manners and respect is to never put people in a situation where your behavior makes them uncomfortable. Good manners and respect are scarce in medical training but that doesn't mean we have to contribute to the problem. I'll get my own chow (which is free at my program for residents anyways) before I'll try to get a medical student to run an errand just to give me more time to do my work. It's a little thing but still an abuse of authority. If there is nothing for the medical students to do the best thing to do is send them home or let them get some sleep if they are on call.

I very much agree with you, but I also think that medical students sometimes confuse "personal errands" with "team scut". For example, I would never ask a med student to get me coffee. That is rude and inappropriate. But I would ask them to run and get me xrays. Some of them obviously view this as a "personal errand" when it is not. It is what they'll be doing every day for a year when they hit intern year.

My rule of thumb is simple: I never ask students to do something I don't feel is absolutely necessary. Food and dry cleaning are not absolutely necessary. Hunting down films or getting info from nursing is absolutely necessary. It is unfortunate that, by MS3 year, everyone hasn't come to recognize the distinction.

 

[Annette]

Panda Bear and Tired, read again. I said send the students to dinner. I didn't say "go get me food even if you were headed to the library and weren't going near the caf, pay for me, and do it stat!"

If I'm stuck arguing with nursing about putting patient with chest pain on a telemetry floor, the students aren't doing squat and not learning jack, they are actually getting time to get something into their stomachs, AND carving some time so I can do some didactic teaching all in one, I don't see jack wrong with having them pick something up for me while they are in the cafeteria. We all win. If you have a problem with that, I'm damn glad I didn't have to work with you. Maybe my students never had a problem with this because I made certain that I taught. And, I never asked then to do something even remotely considered a "personal errand" if the students weren't going to get something in return.

 

[8744]

Panda Bear and Tired, read again. I said send the students to dinner. I didn't say "go get me food even if you were headed to the library and weren't going near the caf, pay for me, and do it stat!"

If I'm stuck arguing with nursing about putting patient with chest pain on a telemetry floor, the students aren't doing squat and not learning jack, they are actually getting time to get something into their stomachs, AND carving some time so I can do some didactic teaching all in one, I don't see jack wrong with having them pick something up for me while they are in the cafeteria. We all win. If you have a problem with that, I'm damn glad I didn't have to work with you. Maybe my students never had a problem with this because I made certain that I taught. And, I never asked then to do something even remotely considered a "personal errand" if the students weren't going to get something in return.

Well, that's the problem. Most students are fairly timid and, as they respect your authority, will get your dinner even if it makes them feel demeaned. That's the trap of abusing authority. A lot of people will let you do it for fear of speaking up.

Here's the problem with your thinking: a) You make it sound like eating a meal is a privilege that you grant to your students when it most certainly is not. Everybody deserves the chance to eat a decent meal and it is seldom so busy on a ward team that everyone cannot get down to the cafeteria for twenty minutes. By "letting" them eat you are taking credit for granting a boon which is not yours to grant. In the normal adult world we do not have to get permission to eat or go to the bathroom and our boss doesn't expect special favors for letting us do these things. You are proposing a level of control over your students which you do not or should not have. b) Teaching is your responsibility and is not something that you barter. It is not a win-win. You humilate your timid medical student by making him into your servant but this is not a fair exchange for teaching.

On another note, was I the only medical student who went to school at a modern hospital where radiology studies and labs were on the computer and thus did not have to be fetched?

Oh, and I don't argue with nurses. I listen to their suggestions and take their advice if it is sound but argue? Never. I give orders, they implement. Nothing to argue.

 

[bulletproof]

Well, that's the problem. Most students are fairly timid and, as they respect your authority, will get your dinner even if it makes them feel demeaned. That's the trap of abusing authority. A lot of people will let you do it for fear of speaking up.

Here's the problem with your thinking: a) You make it sound like eating a meal is a privilege that you grant to your students when it most certainly is not. Everybody deserves the chance to eat a decent meal and it is seldom so busy on a ward team that everyone cannot get down to the cafeteria for twenty minutes. By "letting" them eat you are taking credit for granting a boon which is not yours to grant. In the normal adult world we do not have to get permission to eat or go to the bathroom and our boss doesn't expect special favors for letting us do these things. You are proposing a level of control over your students which you do not or should not have. b) Teaching is your responsibility and is not something that you barter. It is not a win-win. You humilate your timid medical student by making him into your servant but this is not a fair exchange for teaching.

On another note, was I the only medical student who went to school at a modern hospital where radiology studies and labs were on the computer and thus did not have to be fetched?

Oh, and I don't argue with nurses. I listen to their suggestions and take their advice if it is sound but argue? Never. I give orders, they implement. Nothing to argue.

thank you. 👍

 

[snoopy brown]

By "letting" them eat you are taking credit for granting a boon which is not yours to grant. In the normal adult world we do not have to get permission to eat or go to the bathroom and our boss doesn't expect special favors for letting us do these things. You are proposing a level of control over your students which you do not or should not have.

That's only partly true. While you certainly can eat any time, you also have responsibilities as part of the team. I suppose some people have the view that medical students can just cut out and eat when they want without asking permission because they are "adults" (i.e., if they are not being actively taught) but those are the medical students that people dislike because they are there for their part and their part only. On the other hand I agree that there's no call to deliberately torture your medical students. But I think what Annette meant was that she was allowing the students to eat earlier or at a more convenient time than they otherwise would have (e.g., 8 PM versus 1 AM), which can happen on some services.

You may feel that you are being more generous to your medical students, but I believe Annette is in surgery (I could be wrong I'm not sure). You may have the ability to be more generous than her. Keep that in mind.

 

[8744]

That's only partly true. While you certainly can eat any time, you also have responsibilities as part of the team. I suppose some people have the view that medical students can just cut out and eat when they want without asking permission because they are "adults" (i.e., if they are not being actively taught) but those are the medical students that people dislike because they are there for their part and their part only. On the other hand I agree that there's no call to deliberately torture your medical students. But I think what Annette meant was that she was allowing the students to eat earlier or at a more convenient time than they otherwise would have (e.g., 8 PM versus 1 AM), which can happen on some services.

You may feel that you are being more generous to your medical students, but I believe Annette is in surgery (I could be wrong I'm not sure). You may have the ability to be more generous than her. Keep that in mind.

Surgery, like most other inpatient residencies, is chock-full of slack time. I have done six months of surgery rotations as a resident (and four as a medical student) and it was seldom so busy that there was no time to eat except that many residents and attendings are frightfully disorganized and highly inefficient in how they plan the day. Scrub out to eat? Of course not. But twenty minutes here or there at random times is completely possible, especially on most surgery call, and all that should be necessary is a "Hey, Annette, I'm going to grab some chow."

Say what you want about Emergency Medicine but it is a lot harder to break away for a meal while working in the department, especially on a busy night, and we most certainly do not take a break to go eat but instead run down to the cafeteria and grab something which we eat on the fly on the way up. We do not have the ability to be more generous with our time because time is our enemy.

But we aren't dicks about it either and I don't attach strings to meal privileges. And it has nothing to do with being generous. That's the point. Medical students are not my dependents and I do not hold such total suzerainty over them that I grant them the privilege to take care of the common functions of life (like eating, crapping, and sleeping). This is the problem with medical training, namely the idea that by virtue of a couple years of experience we can be petty dictators to our collegues.

 

[monkey7247]

Is it as bad if you get them lunch too? Sometimes I'll be finishing up paperwork and I'll ask my MS to go get lunch for the both of us on my tab. I figure it just saves them from watching me sign tedious medication reconciliation forms and coding for billing. But maybe I've been an ass and not realized it?

 

[Top Gun]

Is it as bad if you get them lunch too? Sometimes I'll be finishing up paperwork and I'll ask my MS to go get lunch for the both of us on my tab. I figure it just saves them from watching me sign tedious medication reconciliation forms and coding for billing. But maybe I've been an ass and not realized it?

Well, they're not paying for it out of their own pocket, and you're having the student get lunch for both you and him/her, so I would say, no, you're not being an ass.

 

[snoopy brown]

Surgery, like most other inpatient residencies, is chock-full of slack time. I have done six months of surgery rotations as a resident (and four as a medical student) and it was seldom so busy that there was no time to eat except that many residents and attendings are frightfully disorganized and highly inefficient in how they plan the day.

I'm interested in how you would recommend increased efficiency. (No sarcasm, regardless of what you may think; I'm interested from an academic perspective.)

 

[8744]

Is it as bad if you get them lunch too? Sometimes I'll be finishing up paperwork and I'll ask my MS to go get lunch for the both of us on my tab. I figure it just saves them from watching me sign tedious medication reconciliation forms and coding for billing. But maybe I've been an ass and not realized it?

Personally, it is insulting to get somebody their lunch even if they pay. When this was offered I said, "No thank you, I brought my own lunch."

How about just saying, "Not much here you can help me with. I'll page you if something comes up."

Or better yet, "Okay, I think we're done. No sense in you just watching me do paperwork. See you tomorrow."

The fact that some residents expect to have an entourage of groupie-like medical students drove and still drives me up the wall.

 

[8744]

I'm interested in how you would recommend increased efficiency. (No sarcasm, regardless of what you may think; I'm interested from an academic perspective.)

Oh man, don't get me started and you need to read my blog. But suffice to say that because residents are incredibly cheap labor for the hospital, even with the mythical (for surgery programs) 80-hour work week, there is no incentive at all for hospitals which rely on residents to streamline paperwork or show any regard whatsoever for the health, welfare, or free time of their chattel slaves. Therefore there is no "temporal control" like there is in the adult world where, as time is money, processes and procedures are streamlined to require the least amount of manpower and time, especially if they are not "mission critical."

As an example, when I was an engineer, my business was engineering consulting, not paperwork so everything I did was designed to maximize productive time at the expense of non-paying time. If the hospital had to pay residents overtime you would see how fast the bureaucracy would shed the myriad compliance and paperwork tasks that seem to multiply in teaching hospitals.

 

[monkey7247]

Personally, it is insulting to get somebody their lunch even if they pay. When this was offered I said, "No thank you, I brought my own lunch."
How about just saying, "Not much here you can help me with. I'll page you if something comes up."
Or better yet, "Okay, I think we're done. No sense in you just watching me do paperwork. See you tomorrow."
The fact that some residents expect to have an entourage of groupie-like medical students drove and still drives me up the wall.

I imagine this is program dependent. We (the residents) have gotten in trouble for letting students go early. They are expected to be at our sides while we see patients and it's not an option for me to turn them loose. Besides, if they said, "No thanks, I've got my own", I would fail them (j/k). However, they would end up just looking at my back for 10 minutes.

 

[snoopy brown]

But suffice to say that because residents are incredibly cheap labor for the hospital, even with the mythical (for surgery programs) 80-hour work week, there is no incentive at all for hospitals which rely on residents to streamline paperwork or show any regard whatsoever for the health, welfare, or free time of their chattel slaves.

Ah, that's different. I completely agree that hospitals use residents as slaves and along with litigious patients/lawyers this has led to an explosion in "compliance codes" and "regulations" and paperwork, all of which is done by residents (who are also doing other ancillary work that is not theirs to do). I thought you meant inpatient teams were inefficient as in "they're lollygagging around and spinning around on their seats in the computer room for a few hours."

 

[deleted109597]

To snoopy,
If your ED pushes through more than 100K people per year, the odds of there being a downtime is fairly low. To pretend that while the rest of the hardworking residents are slavishly rounding in the early hours of the morning while the lazy EM residents are napping on patient stretchers is at best asinine, and at worst blatantly elitist.

I love how people imply that there aren't enough hours in the day to eat. If you have paperwork to fill out (and we all do), the table in the cafeteria works just as well as the one on the floor. It isn't that hard. You just have to learn how to be more efficient with your time. To you medicine residents, this means soap notes that aren't more than 1 page long. It means not writing things like "continue current management" next to problems on this list. If you aren't going to say what you are doing for it, don't list the problem. Historical problems not relevant to this visit don't need mentioning after the initial H&P. Discharge summaries should not include daily potassium levels (even if they are abnormal [note 3.4 does not imply enough abnormality to necessite a 1 hour mental masturbation session]).
If you want to see efficiency, work at a private, for-profit hospital. They know that time is money, so they make sure to make the best of their time.

 

[8744]

I imagine this is program dependent. We (the residents) have gotten in trouble for letting students go early. They are expected to be at our sides while we see patients and it's not an option for me to turn them loose. Besides, if they said, "No thanks, I've got my own", I would fail them (j/k). However, they would end up just looking at my back for 10 minutes.

That's the thing. Medical students are not employees and are not in the chain of command. To keep them hanging around doing nothing and to no purpose is pointless. At the very least they need time to study and not just aodd snatches of studying between being scutted out either.

 

[8744]

To snoopy,
If your ED pushes through more than 100K people per year, the odds of there being a downtime is fairly low. To pretend that while the rest of the hardworking residents are slavishly rounding in the early hours of the morning while the lazy EM residents are napping on patient stretchers is at best asinine, and at worst blatantly elitist.

I love how people imply that there aren't enough hours in the day to eat. If you have paperwork to fill out (and we all do), the table in the cafeteria works just as well as the one on the floor. It isn't that hard. You just have to learn how to be more efficient with your time. To you medicine residents, this means soap notes that aren't more than 1 page long. It means not writing things like "continue current management" next to problems on this list. If you aren't going to say what you are doing for it, don't list the problem. Historical problems not relevant to this visit don't need mentioning after the initial H&P. Discharge summaries should not include daily potassium levels (even if they are abnormal [note 3.4 does not imply enough abnormality to necessite a 1 hour mental masturbation session]).
If you want to see efficiency, work at a private, for-profit hospital. They know that time is money, so they make sure to make the best of their time.

On a typical medicine ward month, even when I rotated as an intern, there was plenty of dead time. Unfortunately it usually occured in the afternoon leading me to ask why it is so goddamned important to come in so early and work like slaves only to sit around doing practically nothing in the afternoon. Granted, my specialty is different but would it kill medicine programs to come in at eight, work efficiently, and be done by five (except for call when you can expect to be clobbered)? I mean, you could even take forty-five minutes for a civilized lunch instead of the usual scramble.

No fan of Europe am I but apparently their residents can manage the feat of seeing all their patients, writing orders, and following up on things without working twelve-hour days.

The problem is that everything nowadays is a friggin' emergency.

 

[monkey7247]

That's the thing. Medical students are not employees and are not in the chain of command. To keep them hanging around doing nothing and to no purpose is pointless. At the very least they need time to study and not just add snatches of studying between being scutted out either.

We're on the same page. If I had my way, I'd keep them through the morning group of patients (til ~2pm) and then send them off to study.

 

[deleted109597]

On a typical medicine ward month, even when I rotated as an intern, there was plenty of dead time. Unfortunately it usually occured in the afternoon leading me to ask why it is so goddamned important to come in so early and work like slaves only to sit around doing practically nothing in the afternoon. Granted, my specialty is different but would it kill medicine programs to come in at eight, work efficiently, and be done by five (except for call when you can expect to be clobbered)? I mean, you could even take forty-five minutes for a civilized lunch instead of the usual scramble.

No fan of Europe am I but apparently their residents can manage the feat of seeing all their patients, writing orders, and following up on things without working twelve-hour days.

The problem is that everything nowadays is a friggin' emergency.

The staff medicine here doesn't do the preround x3 bull****. They all round together starting at 8. They decided that the learning potential of 5am notes that are never critiqued wasn't worth it.
They also have NP/PAs do a lot of the scut paperwork.

 

[Annette]

Panda Bear, I hadn't quite thought of it like that. I didn't often have students get me anything, but when I did, it was when the caf was closing in 10-15 minutes- enough time if I didn't have to deal with nursing or other pain in the behind non-teaching issue. I see your point, and I agree asking students to do personal errands on a regular basis is not a good thing. I still think you are expecting too much inflexability for a very imperfect world. I agree there is plenty of slack time, but then it never is when you want/need it.

As for not "bartering" for teaching, I agree that I have a responsibility to teach. If I have no time to go to the bathroom, I can't ask the students to pick me up something from someplace they were already going to be, and not be a time sink, you really think I am going to give anything extra to teaching? There is no place that clearly defines how much teaching one is required to do. If I've already done teaching for three hours, have a choice to go to bed hungry a half hour earlier instead of teaching that extra half hour what do you think I'm going to do?

And the students you are describing are awefully odd. At one minute they feel confident enough to say "I'm leaving to get something to eat" at any time they feel hungry to being too timid to tell me the won't do something I have been an absolute ogre to ask them to do?

As for your sniff in the air, "I give orders, they implement. Nothing to argue.", keep deluding yourself. Telling them it is an order still takes time. You also probably have the luxury of having a program director/med ed that would back a resident over a nurse.

 

[Annette]

I love how people imply that there aren't enough hours in the day to eat. If you have paperwork to fill out (and we all do), the table in the cafeteria works just as well as the one on the floor.

Some places have restrictions on where you can take "chart material." I agree it is stupid, but I don't really want paperwork that has heaven only knows what placed on it/near it on the table where I'm eating my dinner. It is alot easier now I'm at a place that doesn't have pre-printed forms. It also helps when the cafeteria has serving hours longer than a half hour for lunch and dinner.

To you medicine residents, this means soap notes that aren't more than 1 page long.

The length of the note is often dictated by the attending. Again, I know it is stupid, but then again, you don't get much say when you are a slave/ resident.

It means not writing things like "continue current management" next to problems on this list. If you aren't going to say what you are doing for it, don't list the problem. Historical problems not relevant to this visit don't need mentioning after the initial H&P.

This differs from specialty to specialty. If I want to be paid for what I am doing, I have say what I am doing. Therefore, CPM And, "historical" problems have a way of coming back to bite you in IM. I don't advocate "#62 hiccups at age 39", but noting a total hip replacement 10 years ago in a septic patient CAN become important. It also helps when you have to hand over a service, and for cross coverage.

 

[snoopy brown]

To snoopy,
If your ED pushes through more than 100K people per year, the odds of there being a downtime is fairly low. To pretend that while the rest of the hardworking residents are slavishly rounding in the early hours of the morning while the lazy EM residents are napping on patient stretchers is at best asinine, and at worst blatantly elitist.

I have no idea how many patients my ED has. I do know that in my experience of three university institutions and two community institutions in three states there were consistent downtimes from approximately (repeat, approximately, meaning I was not sitting there with a stopwatch) 4 AM to 11 AM. Again to repeat for people who want to ignore what I actually say, this does not mean that anyone locked the doors or nobody ever came in or people turned off the lights and everyone fell asleep. What it does mean is that things were fairly quiet and the place was fairly empty. I suppose you can continue to say that it was amazingly coincidentally only where I was, which is fine with me.

Really the only people who don't know what the ED is like are pre-clinical medical students and pre-medical students. Believe me, if what I say is B.S., you really shouldn't care. All the medical students will go through their various rotations and say "gee, this is amazing, all the EM people do generally thorough work-ups and appropriate consults just like all the EM people say, and they are always busy and yet also polite and very mannered with their medical students unlike most inpatient services who won't even let them eat." Not to say that people think my specialty is perfect, far from it. Nor do I pretend my specialty is perfect. Take what you want from that.