Medical students have been getting on my nerves

[ExcaliburPrime1]

I have always prided myself on being the resident who "remembers what it's like" to be a student and my policy is to teach as much as possible, answer questions, and give them minimal scut work. Like, I'll ask them to do some annoying scut work once, so they see what it's like, but then never again, just so they have the experience and not to reduce my workload (because it'll take longer having them do it, explaining it, and then checking over it.)

Anyway, for the past week I find that I'm getting annoyed with their very presence. First, they seem so obviously "fake interested", as in, they'll ask irrelevant questions just to show that they are "thinking" about their patients but really they're trying to get acknowledgment that they have been doing their reading some obscure case report that has no practical value at this time.

Next, after I pre-round with them and we interview the patients together, we go back to HQ and I need a little time to jot down my note and collect my thoughts so I can present something. They take this opportunity to chat about the latest TV shows or...

I think I've just become a cranky old man. I'm going to stop right now and really remember what it was like to be that awkward third year just starting out in the hospital.

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[jack.jaret]

Honestly, I think you've forgotten what it's like. Yes, they are fake interested. Yes, they are chit chatty about TV shows. I'm sure they've heard stories about students staying quiet and then receiving feedback on their evaluations saying "student was obviously disinterested." And the TV shows is to show they have a personality. Don't be so hard on them man.

 

[splik]

It's not you - it's them! Some students are just awful to teach, they sap the life out of you, are a thorn in your side, contribute nothing of value, and clearly do not want to be there. Others are a joy to teach and their enthusiasm and energy is infectious. They do their best to be helpful and be interested and are nice to have around. It is important to give feedback to the annoying students as they will likely irritate the hell out of everyone as they go on which will not help them. One thing that is difficult for beginning clinical students is knowing "how to be a medical student" and providing them clear information on what you expect from them can go a long way. Still, there will always be some students who will drive you crazy and "don't get it" no matter how much you invest in them.

 

[Gastrapathy]

20+ years ago; I still remember as a MS3, the psych resident asked the two rotators what we planned to do. I said IM. My compatriot, who was president of the Radiology interest group, lied and said psych or rads. The crusty 45 year old resident's eyes lit up, "perfect, we need for you to see the worst of our specialty so you can make an informed choice". Put him on nights and all kinds of other pain. Turned to me and said, "so medicine? Ok, CL Monday to Thurs, the weekend team covers Fri so I don't think you'll get much out of that. Hey, it's thurs afternoon, see you Monday." Turned out he was the CL resident and a great teacher.

 

[F0nzie]

Give them $20 to bring back some lunch. While they're gone you finish your notes. When the food comes back you talk about TV shows. Win-win.


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[Goro]

I have always prided myself on being the resident who "remembers what it's like" to be a student and my policy is to teach as much as possible, answer questions, and give them minimal scut work. Like, I'll ask them to do some annoying scut work once, so they see what it's like, but then never again, just so they have the experience and not to reduce my workload (because it'll take longer having them do it, explaining it, and then checking over it.)

Anyway, for the past week I find that I'm getting annoyed with their very presence. First, they seem so obviously "fake interested", as in, they'll ask irrelevant questions just to show that they are "thinking" about their patients but really they're trying to get acknowledgment that they have been doing their reading some obscure case report that has no practical value at this time.

Next, after I pre-round with them and we interview the patients together, we go back to HQ and I need a little time to jot down my note and collect my thoughts so I can present something. They take this opportunity to chat about the latest TV shows or...

I think I've just become a cranky old man. I'm going to stop right now and really remember what it was like to be that awkward third year just starting out in the hospital.

Pimp the F out them.

 

[Crayola227]

Pimp the F out them.

nothing like a good pimp smack to make them shut the **** up out of fear

they just haven't been shamed into silence yet, OP

seriously, they need both constructive advice AND discipline to learn how to be good med students if that's possible, or to at least learn how to get the **** up out the way

I've never met a med student so obnoxious they couldn't be shut the **** up, but that doesn't mean every doc has the skills. Some docs can with just their presence or the way they type, it's pretty eerie and masterful.

 

[SmallBird]

Anyway, for the past week I find that I'm getting annoyed with their very presence. First, they seem so obviously "fake interested", as in, they'll ask irrelevant questions just to show that they are "thinking" about their patients but really they're trying to get acknowledgment that they have been doing their reading some obscure case report that has no practical value at this time.

Medical students absolutely do that, and its part of a discourse maturation process - younger trainees frame there clinical communication in ways that allow them to prove competence, whereas over time one is able to let go of this in favor of communicating in a way that is focused on the needs of the patient and clinical team. In a medical student this is developmentally appropriate. It becomes a real challenge when it persists into residency - I worked with a 2nd year resident who felt an endless need to justify every single action and statement I might have provided feedback on, which just made it clearer to me they were still so insecure about their knowledge and skills that they couldn't help but be threatened by feedback. I've tried pointing this out and occasionally you can help someones professional development, but sometimes you just have to let them grow up on their own.

 

[deleted736562]

One of the biggest challenges of being higher in the hierarchy is to make sure you're not countertransfering on students or lower level residents. I find it helpful to look at interactions with other staff not really that different from interactions with patients. You don't want someone's personality to bias the way you treat them, especially that you have much more power (it's so easy to become easily irritated by the slightest thing), without of course losing perspective of expectations for them and professional standards. Maintaining strong boundaries, a professional attitude and minimizing your emotional counter-transference I think is very important. Then the bigger trick is how to do all of that and be approachable and easy going. I'm not saying this is what is happening here but just a general advice.

 

[HarryMTieboutMD]

No matter how much you love teaching or how bright your med students may be, they can ALL appear annoying/in your way/burdensome to teach. But this is because MS3 at most US medical schools is a huge waste of time and a glorified shadowing/faking interest experience.

As a PGY4 I have very little clinical interaction with med students (just give them some lectures) but when I do I do the clinical work as quickly as I can because they slow me down tenfold. When I'm done with that I go over their notes/how they are going to present, etc. I spend most extra time pimping them and teaching them intern type stuff they need to know

 

[FlowRate]

It kinda weirds me out when med students are SUPER enthusiastic about relatively mundane things, like admitting a patient who was already seen in our ED. I think that's the part of 3rd/4th year that I've already forgotten, because I know I was pretty stoked to be doing stuff as an MS4 that I find much less compelling now.

 

[Bartelby]

It kinda weirds me out when med students are SUPER enthusiastic about relatively mundane things, like admitting a patient who was already seen in our ED. I think that's the part of 3rd/4th year that I've already forgotten, because I know I was pretty stoked to be doing stuff as an MS4 that I find much less compelling now.

A lot of students do their best to "play the game," because the subjective evaluations usually make the difference between honors and not, and residency programs obsess over honors. It's unfortunate, but the system rewards this and feeds into it. I try to empathize with annoying behavior like that as long as it doesn't become too caricatured.

 

[Shikima]

A lot of students do their best to "play the game," because the subjective evaluations usually make the difference between honors and not, and residency programs obsess over honors. It's unfortunate, but the system rewards this and feeds into it. I try to empathize with annoying behavior like that as long as it doesn't become too caricatured.

This is true..

 

[okokok]

Next, after I pre-round with them and we interview the patients together, we go back to HQ and I need a little time to jot down my note and collect my thoughts so I can present something. They take this opportunity to chat about the latest TV shows or...

Like a lot of people are saying, I think they often just don't know how to act. Just saying something like, "Hey I'm just gonna focus on getting this note done, feel free to study or whatever til I'm done" will let you work in peace (unless the student is really clueless) and alleviate their nervous energy/social ineptitude.

Thank you so very much for trying with us students, though! I know most of the time, most of us feel every bit as annoying as we probably are.

 

[thoffen]

I've been lucky as a resident, a chief, and as an attending to get good students. Only had a couple I can think of who really weren't interested in psych. Plenty who were trying too hard but no one that I would call fake interested. But I have seen this and I know exactly what you're talking about.

Perhaps it's not just luck, though. If you can get people to pay attention to what is actually important for a patient and the values that you have that got you interested in psychiatry, I think people will latch on to that. So much better to learn something when you can see it translate to patient care or decision making or simply a reflection of the limits of humanity.

Get them interested in what they should be learning.

 

[Nasrudin]

nothing like a good pimp smack to make them shut the **** up out of fear

they just haven't been shamed into silence yet, OP

seriously, they need both constructive advice AND discipline to learn how to be good med students if that's possible, or to at least learn how to get the **** up out the way

I've never met a med student so obnoxious they couldn't be shut the **** up, but that doesn't mean every doc has the skills. Some docs can with just their presence or the way they type, it's pretty eerie and masterful.

Strong pimp game...

I'm just starting my inpatient senior resident duties. So far... I've only seen... uber conscientious, sweet-to-a-fault, medical students. Pimping them into submission would just be pointlessly sadistic.

But I'll keep practicing my back hand, should I need to fire one off.

 

[LasVagus]

We're experts in human behavior so we should know what's going on: medical students are exhibiting the behavior that's rewarded. If the medical profession could emancipate itself from its collective need for admiration and stop rewarding those who kiss butts, then the inauthentic enthusiasm described above would disappear over night. Personally, I love medical students. They keep me on my toes and give me an opportunity to talk about interesting ideas in psychiatry. I also feel for them: after working harder than 95% of all people for their entire lives they're now going 6 figures into debt for the opportunity to sit in the corner and be told by someone whose job is to teach them that they are getting in the way. I vote we give 'em a break.

 

[MacDonaldTriad]

I have grown very comfortable belonging to groups of self congratulating grey haired old men. It has been very useful as there are no examples of other organizations in academic medicine. Se La Vi.

 

[Nasrudin]

We're experts in human behavior so we should know what's going on: medical students are exhibiting the behavior that's rewarded. If the medical profession could emancipate itself from its collective need for admiration and stop rewarding those who kiss butts, then the inauthentic enthusiasm described above would disappear over night. Personally, I love medical students. They keep me on my toes and give me an opportunity to talk about interesting ideas in psychiatry. I also feel for them: after working harder than 95% of all people for their entire lives they're now going 6 figures into debt for the opportunity to sit in the corner and be told by someone whose job is to teach them that they are getting in the way. I vote we give 'em a break.

One fine morning. Last week. Particularly amped up on 5 cups of coffee. I launched into an exegesis. Wild eyed. Peering into the soul of my medical student... (Who is one of those hyper-maternal, hyper-agreeable, perpetually sweet, everyone needs my protection types)...telling her she desperately needed to know her own shadow monster. Less she end up the doormat of a malevolent partner. Or the trampled, suicidal, medical student ready to end it all.

I think it went well. She thinks I'm a lunatic.

This is how I pimp. I guess...

 

[QofQuimica]

Eventually you reach a point where you stop caring that you're boring all of your trainees. Or even your colleagues.

No, but all kidding aside, if they're new third years, then of course they don't know what's expected. Be a mensch and tell them what you expect. And if they want to prove to you that they're reading and working hard, give them the opportunity to do that, but direct them to do it in productive ways that will help them learn. I'm obviously biased since I'm doing a whole fellowship, but having students read up on and/or present on some aspect of psychopharmacology/drugs of addiction is always useful.

 

[NickNaylor]

I agree with most of the suggestions that have been mentioned. I love working with and teaching medical students generally, though some of them can really make the experience quite painful. Things that I've found helpful:

1) As mentioned above by @QofQuimica, making clear your expectations can be a huge help. The new medical students are clueless generally but then especially clueless about - and perhaps scared of - psychiatry specifically, so any clear explanation of what you expect of them can be helpful. I tell students on the first day that I expect essentially nothing of them over the next couple of days, but after that I expect them to be doing the daily interviews and, after seeing a few initial interviews, taking a stab at those as well. I expect them to make collateral calls when indicated. I expect them to write notes and discuss a plan with me. Typically this helps them figure out what they're actually supposed to be doing on a day-to-day basis rather than just sitting around feeling lost. Getting on the same page with the attending in terms of their expectations can also be helpful.

2) Know your audience. The likelihood is that most medical students will not become psychiatrists, however they will almost certainly encounter psychiatric patients and may even manage straightforward conditions. Keeping this in mind, I pretty much never teach on topics like schizophrenia or bipolar disorder unless asked because these are not diagnoses they will be making or treating. They will learn the barebones for all of that stuff in their own studying and in their didactics. However, they absolutely will be encountering MDD, anxiety disorders, and substance use disorders, thus my goal for students that aren't interested in psychiatry is to at least feel comfortable making these diagnoses and coming up with a reasonable initial management plan for each of them. If they have questions about specific topics then I'm happy to do some teaching on that as well. Point is, figure out what is or will be important to them in their careers - or whatever they're interested in - and try and make sure they have the chance to take that away from their time with you.

3) Try and make sure they have at least some understanding of your rationale for management. Many of the complaints about psychiatry I hear about from medical students are that management really makes no sense, drugs seem chosen at random, evaluations seem highly subjective, etc. - and in fairness to them I do think there is a kernel of truth to each of these criticisms. But after we round, I make a point of sitting down with them for 15-20 minutes to talk about why we're making the changes we're making in medications, reasonable alternatives, what was notable about the interview, talking about differentials, etc.. I find that this tends to demystify psychiatry a bit and bring what we're doing a little closer to what they're used to, which is "objective" and "evidence-based" evaluation and treatment of medical complaints.

Sadly some students are hopeless and seemingly can't even fake interest or engagement if only for the purposes of good grades, but they tend to be few and far between in my experience. Most are eager (or at least fake enthusiasm well) to learn SOMETHING during their time on the rotation. I think the key job of the resident is to figure out what those somethings may be and deliver on them as best as you can.

 

[ExcaliburPrime1]

Thank you for the advice all around. As I indicated towards the end of my post, I recognized that the fault was likely with me and they were probably just doing the best they could and were only guilty of being new and nervous.

I like the advice to make expectations known, which I did early on, but could stand to reinforce. The other ideas of having them present on a topic of interest and the occasional pimp session (so they keep reading and instinctively fear being too chatty) are also much appreciated.

 

[NickNaylor]

Thank you for the advice all around. As I indicated towards the end of my post, I recognized that the fault was likely with me and they were probably just doing the best they could and were only guilty of being new and nervous.

I like the advice to make expectations known, which I did early on, but could stand to reinforce. The other ideas of having them present on a topic of interest and the occasional pimp session (so they keep reading and instinctively fear being too chatty) are also much appreciated.

On the pimping point, I pimp quite a bit but try and keep it as non-threatening as possible. I have essentially zero expectations with respect to their psychiatric knowledge base - and I make this clear to them from the outset - and that my whole goal in pimping is not to report back to the attending on how smart they are but, instead, to make sure that they understand why diagnoses/plans are what they are. When presented in this way, I find that most students appreciate it rather than getting freaked out about not knowing much of anything.

 

[AD04]

I don't mind students because they keep my knowledge sharp.

I remember what it was like as a student so I try not to waste their time:

- pimping to gauge level of knowledge
- assign reading topics which we discuss next day
- each student carry own patients (up to 3), discuss diagnosis and treatment plan
- student type out notes, review notes with students
- dismiss students after rounds and after notes done
- they usually leave between 12 PM - 2 PM, which leaves afternoon for me to do what I have to do

 

[WingedOx]

It's not you - it's them! Some students are just awful to teach, they sap the life out of you, are a thorn in your side, contribute nothing of value, and clearly do not want to be there. Others are a joy to teach and their enthusiasm and energy is infectious. They do their best to be helpful and be interested and are nice to have around. It is important to give feedback to the annoying students as they will likely irritate the hell out of everyone as they go on which will not help them. One thing that is difficult for beginning clinical students is knowing "how to be a medical student" and providing them clear information on what you expect from them can go a long way. Still, there will always be some students who will drive you crazy and "don't get it" no matter how much you invest in them.

I don't think I ever figured this part out.

 

[HarryMTieboutMD]

I don't think I ever figured this part out.

Agreed- it's a complete farce that serves little purpose anymore... learning how to be a doctor occurs in residency. As a med student I was horrible at presenting, coming up with a differential dx for basic things, knowing when/where to find things, recognizing sick from not sick etc etc and went from awful to mediocre during my 3rd year of med school (but still did reasonably well except for surgery- even proving how more BS the system is). I REALLY honed these skills and took ownership during the medicine months of my intern year through seeing tons of high acuity patients, reading on the fly, and actually having the responsibility of taking care of these patients- and it felt great to come into my own.

 

[Shikima]

Agreed- it's a complete farce that serves little purpose anymore... learning how to be a doctor occurs in residency. As a med student I was horrible at presenting, coming up with a differential dx for basic things, knowing when/where to find things, recognizing sick from not sick etc etc and went from awful to mediocre during my 3rd year of med school (but still did reasonably well except for surgery- even proving how more BS the system is). I REALLY honed these skills and took ownership during the medicine months of my intern year through seeing tons of high acuity patients, reading on the fly, and actually having the responsibility of taking care of these patients- and it felt great to come into my own.

So, knock out year 4 of medical school for an extra year of residency? I like it!

 

[FlowRate]

I don't think I ever figured this part out.

This is why derm/plastics types creep me out a little.

If anyone is a mid reader in medicine, it's them, not us.

 

[DD214_DOC]

This isn't unusual. I enjoy teaching. But some days I just want to be left alone to get my work done.


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