New M3s

[AlternateSome1]

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Hey guys,

I am a new medicine intern and I am trying to get a feel for the best things to teach to incoming students. Right now my teaching consists of:

1) making sure the third years on service get to touch/see/listen to all interesting exam findings on the team

2) explaining our course of action beyond the info that flies by on attending rounds

3) give short 5 minutes talks on subjects relating to patients


Now, is there any other thing you wished your resident would do to help you learn/get involved? Are there any basic medicine info or hospital mechanics info that you wish someone would explain?

Thanks.

 

[Ypo.]

That sounds awesome. 👍

 

[MirkoCrocop]

well, for what its worth, i always liked the ones that would let me go early.

 

[mules05]

Hey guys,

I am a new medicine intern and I am trying to get a feel for the best things to teach to incoming students. Right now my teaching consists of:

1) making sure the third years on service get to touch/see/listen to all interesting exam findings on the team

2) explaining our course of action beyond the info that flies by on attending rounds

3) give short 5 minutes talks on subjects relating to patients


Now, is there any other thing you wished your resident would do to help you learn/get involved? Are there any basic medicine info or hospital mechanics info that you wish someone would explain?

Thanks.

Having just barely finished 3rd year, I found that the residents I liked the most and learned the most from were the ones who really involved me in the team and let me help out- for example, a surgery resident who would ask me to go d/c staples or do discharge summaries. It also was nice, when doing things like this, to get a "thanks, that really helped us out," even though I know the resident could have done it in half the time. Plus, I learned, and got more efficient and more able to help and really contribute to the team. I also had a couple of residents who went out of their way to let me do procedures- from asking respiratory techs to let me extubate, to trolling the ICU with me to find patients who needed ABGs. I had one resident who would just let me go early and never wanted to make me do scut work, which was nice, but I wasn't learning anything and I felt like I was just dead weight to the team. I finally pointed out to him that I might go into his specialty and be his intern in a couple years, and it was better for all of us if I learned how to do the scut now.

 

[futuredo32]

Letting me go home early when there is absolutely nothing to do was very appreciated. However, I wouldn't want to go home early just to go home early.

The intern I worked with on my IM rotation would ask me to pick a topic once or twice a week that we'd both read up about and then discuss the next day. I really liked this approach to learning instead of random pimp questions.

Being thanked for helping out on my surgery rotation was awesome too🙂. (and like the above poster, I know that I didn't do anything spectacular, but a "thank you" was really nice).

 

[BigRedBeta]

I appreciate when residents tell me what they're expectations are - you don't have to say "if you do this, I'll give you a good eval" or anything like that, just the sorts of things you believe they should be able to accomplish at this point in the year.

The things you've mentioned are great. I think it's important that things not only be relevant to the patients, but also the shelf. Anything you can add that you know will present there will be a benefit.

Pulling off important articles that you know are good explanations of a topic is also helpful - sometimes even if it's really, really, really basic stuff. I just had an attending yesterday point me to a Cleveland Clinic Journal of Medicine article about pre-op evaluations. I've been involved in "clearing" patients for surgery since the first day of my family med rotation 8 months ago, but it was awesome having some evidence and explanation of the ethos/reasoning of this very common thing to do in a general medicine clinic.

Just some thoughts. Thanks for thinking about the ways in which you can help students - it's very awesome.

 

[QofQuimica]

The intern I worked with on my IM rotation would ask me to pick a topic once or twice a week that we'd both read up about and then discuss the next day. I really liked this approach to learning instead of random pimp questions.

I think this is a great idea. 👍

 

[AlternateSome1]

Thank you for the replies.

 

[Agent Splat]

I always appreciated it when residents would explain little things, like why they chose a certain IV solution, or dosage of a drug and stuff...that sort of thing. Also, my first ever intern was terrible about keeping me updated on things that happened with patients if I wasn't around. If I only had 2 patients to follow, I was supposedly supposed to "know more about them" than anybody else. But if they freaking coded during the night or required an emergency tracheobracheomoblotic fistulotomy, I would want my intern to let me know. I'd be busy with another patient and she'd go and be placing orders and changing things up and I'd be clueless as to when or why it happened. It was insulting and embarrassing to be kept in the dark about my own patients.

That came off as pretty bitter. Sorry. I appreciate what you're doing.

 

[persia]

Alternate,

Just by asking makes me think you are on your way to being one of the nicer residents around.

Not that you would do this but: please don't say ridiculous things like 'you should already know that,' when a student asks why you are using a certain BP med (or whatever). Please don't gossip about how you don't like your students or this one is so (whatever). Please don't roll your eyes, or ditch your students by running off down the hall and around the corner.

My feeling is that you are not that type, but these are actual cases drawn from the medical files of a certain hospital, here to illustrate the depths of immaturity and high levels of stress which some people can sink to.

In short, just be that friendly smiling person who acknowledges the students and says real things and does not let stress overwhelm basic professionalism. You sound like you will be awesome! 👍

 

[JustPlainBill]

Well, let's see:

1) Make your lectures useful. W/o sounding cocky or 'superior', some of the lectures I've received from PGY-2s are things we were taught in
cardio in 2nd year and added no new knowledge.

2) Make your lectures cohesive. Most of the 'lectures' I've had a just
pulling random factoids out of the air w/o a cohesive presentation.

3) Remember that most of your students have to study for shelf exams/departmental final exams. Cut them loose in time to be able to get some quality study time in each day. Remember that while you're copacetic w/getting there at 07:00 and working until 7:00, most of your students will have to study until midnight and won't be out in a bar drinking beer or vegging in front of the TV but hitting it with the books. I know, a right of passage and all that but it tends to piss people off when residents/interns/attendings waste time because the hospital is their social life and they forget that students aren't getting paid for this and have other responsibilities to take care of or they'll never see 'M.D.' or 'D.O.' behind their name.

I think my biggest suggestion is to be mindful of time and present things in a cogent, cohesive fashion rather than the random factoids and info bits I've been getting......

 

[Ypo.]

Not that you would do this but: please don't say ridiculous things like 'you should already know that,' when a student asks why you are using a certain BP med (or whatever). Please don't gossip about how you don't like your students or this one is so (whatever). Please don't roll your eyes, or ditch your students by running off down the hall and around the corner.

All those things have happened to me as well. Once, a resident mentioned to me how he'd like to "punch your classmate in the face" because as we passed my classmate in the hall he did not say hi to that resident.

The first night I was with a certain resident, she walked so fast I literally had to jog to keep up with her. The rest of the nights I worked with her she walked at a normal pace, so I think she was just trying to give me a rough time that first night.

I literally heard this at least ten times during my last rotation of third year; "you mean you're at the end of your third year, and you don't know _________." What a helpful comment that was!


I don't know why it's so hard to act decently towards others, but apparently some people really struggle with it. I swear to God I am not going to treat students that way when I'm a resident.

 

[SoCuteMD]

I had one medicine intern who would help prepare me for my presentation to the attending. It took time, and was definitely a kindness on her part rather than an obligation but it was great.

One of my medicine residents made sure that the med students saw every patient on the team every day. She'd round with just the med students and we'd trade off seeing and examining each patient. It meant I saw a lot more patients on my rotation, and I think it was incredibly helpful when it came time for the shelf.

Brand new MS3s sometimes have trouble coming up with a plan. Emphasize the importance of this to them - even if it's not the "right" plan they should work on formulating one so that they get used to it.

 

[medstylee]

i find it incredibly helpful when my intern spends a few minutes with me before rounds to go over A&P portion of my note. i want to be able to present my patient on rounds and then say WHY i think this patient should be NPO or why we should d/c this medicine, etc. it's easy for me to just list off my ideas for a plan, but when the intern goes over it with me and says this is good, this is unnecessary, that helps me contribute more in the decision making process the next time.

 

[scpod]

Now, is there any other thing you wished your resident would do to help you learn/get involved? Are there any basic medicine info or hospital mechanics info that you wish someone would explain?

Thanks.

Here's what I really like: While I see "all" the patients while rounding there are some that are "mine". When we get called with new admits, I get a couple of them to follow really closely. I dictate the H&P with impression and plan, write the admit note, write the progress notes, follow up with the consults, do the med reconsilliation, the discharge summary....etc. on those patients. Obviously, I present it all and it gets critiqued and countersigned. But, it makes me feel like those are "my" patients. The patients feel like I am "their" doctor too, because I spend a lot more time with them. And, the more I do that, the better I get at it.

Give them the time to go listen to lots of heart and lung sounds too. Encourage them to do it. Make them listen to murmurs and tell you what they think they are, and where the radiate. From what I've seen so far, patients like the extra attention, for the most part. Give them time to practice things like eye exams on these inpatients, because the patients aren't going anywhere, and nobody comes out of med school really knowing how to use an opthalmascope.

I have at least one topic given to me each day that I'm pimped on the next day-- unmercifully. It usually has to do with something that comes up on rounds...i.e. we have a patients with unconrolled DM. The next day I have to know how to diagnose, when to use insulins, what types of insulins there are, sliding scale, etc...and the next patient that comes on our service with the same problem is "mine" to treat.

Let them go to the drug dinners when you have them. Not only will they appreciate the free food, but I usually learn quite a bit.

If you have patients going for stress tests, EGDs, etc. let them follow a few of them. Patients always seem to ask about them and being able to explain the procedure in detail can calm them down sometimes. If your patients are having a surgical procedure, get the student to read up on those so they can explain them too.

Don't explain everything to them. If you have something like Up-to-date at your hospital, ask them a question on every patient. if they don't know it have them look it up and tell you the answer before the end of the day...i.e. This patient has been in Afib for a week. Why did we do a TEE and not a trans thoracic before cardioversion. Don't let them go before they explain it to you.

Just get them involved and keep them busy-- but not just with running down lab results. Try to make it something that they'll learn from. They'll love you for it.

 

[Lolo08]

Here's what I really like: While I see "all" the patients while rounding there are some that are "mine". When we get called with new admits, I get a couple of them to follow really closely. I dictate the H&P with impression and plan, write the admit note, write the progress notes, follow up with the consults, do the med reconsilliation, the discharge summary....etc. on those patients. Obviously, I present it all and it gets critiqued and countersigned. But, it makes me feel like those are "my" patients. The patients feel like I am "their" doctor too, because I spend a lot more time with them. And, the more I do that, the better I get at it.

Give them the time to go listen to lots of heart and lung sounds too. Encourage them to do it. Make them listen to murmurs and tell you what they think they are, and where the radiate. From what I've seen so far, patients like the extra attention, for the most part. Give them time to practice things like eye exams on these inpatients, because the patients aren't going anywhere, and nobody comes out of med school really knowing how to use an opthalmascope.

I have at least one topic given to me each day that I'm pimped on the next day-- unmercifully. It usually has to do with something that comes up on rounds...i.e. we have a patients with unconrolled DM. The next day I have to know how to diagnose, when to use insulins, what types of insulins there are, sliding scale, etc...and the next patient that comes on our service with the same problem is "mine" to treat.

Let them go to the drug dinners when you have them. Not only will they appreciate the free food, but I usually learn quite a bit.

If you have patients going for stress tests, EGDs, etc. let them follow a few of them. Patients always seem to ask about them and being able to explain the procedure in detail can calm them down sometimes. If your patients are having a surgical procedure, get the student to read up on those so they can explain them too.

Don't explain everything to them. If you have something like Up-to-date at your hospital, ask them a question on every patient. if they don't know it have them look it up and tell you the answer before the end of the day...i.e. This patient has been in Afib for a week. Why did we do a TEE and not a trans thoracic before cardioversion. Don't let them go before they explain it to you.

Just get them involved and keep them busy-- but not just with running down lab results. Try to make it something that they'll learn from. They'll love you for it.

i'd hate to be your medical student.

 

[McSnappy]

The ones I learned from.
1. Pimped me on the side - not in front of attending too often (probably b/c a pimp in front of the attending lead to the resident being pimped)
a. But, I learned from having to regurgitate under pressure. So, by the end of third year, I looked back and knew I learned the most from residents and attendings that expected more out of me.

2. Had me write most of the orders.

3. showed me how to write a note and present a note.

4. Taught me on SIRS, Sepsis, Light's criteria, Acid-base, labs of importance and ranges of importance.

5. Didn't ignore me when around other 'terns or residents.

6. In down-time, we would pick a topic on a patient we were both following and research the criteria, indications for treatment, etc. and regurg it to each other