No teaching?

[Hornet871]

---

Members don't see this ad.

Hi again. Sorry - not really, come to think of it - to gripe and moan again, but is anyone else out there in an EM residency in which there is no teaching?

At my program, the attendings "fake it" for the first couple of months of your intern year and then disappear for the remaining 34 months. All they do is sign charts, tell you exactly what to do (they know better than I, of course, but I'd like at least to proffer a plan and then have it rejected or modified), and push more charts onto you.

Even as an intern, the "teaching" consisted more of a handful of pimp questions sprinkled throughout the laborious 13-hour day. There was never "quality bedside teaching" of any kind, the sort I've heard people refer to in this forum.

I get the distinctive feeling that I'm here for one reason: to move the meat. My program director rarely addresses us in conference except to rant and rave about bottom line numbers and how the hospital can increase its profitability.

Just wondering if I am alone in this quandary or if I am uniquely unteachable and unlovable.

 

[Apollyon]

At our program, it's individual attendings that suck, but not an institutional problem. One of our colleagues that transferred in described a similar situation where he was at, with the drive to get the patients out. If your PD isn't pushing it, it, unfortunately, is probably a systemic problem. How are inservice scores? If people are doing all right, they might be learning more than what they think they are. Otherwise, it may be up to you to bury your brain in Rosen and Tintinalli, while your hands treat 'em and street 'em.

 

[jf]

It would be really nice if you could tell prospective applicants which program you are referring to since this is pretty much an anonymous forum.

Thanks

 

[Sessamoid]

At my program, the attendings were very education-centric, and as a whole they led you through the thought process rather than just telling you what to do. You were expected to "move the meat" in your last year, but when I was there many of the attendings made it a point to pick up the patients that had little or no potential educational value if the volume was getting a little hairy.

 

[waterski232002]

At my program, the attendings were very education-centric, and as a whole they led you through the thought process rather than just telling you what to do. You were expected to "move the meat" in your last year, but when I was there many of the attendings made it a point to pick up the patients that had little or no potential educational value if the volume was getting a little hairy.

Sessamoid and Hornet... can you guys PM me what programs you guys trained/train at... Thanks

 

[DrQuinn]

Sorry to hear that, Hornet. You know I got nuttin' but SDN love for you, so it hurts ot hear another brother get beat down.

At my program (which you should have ranked higher), there is none of what you speak. All of the attendings teach a great deal at the bedside (more correctly at the "desk" side where we sit down and discuss cases). Our PD does expect us to see a "reasonable" amount of patients, but nothing crazy. As a PGY2 I am averaging close to 2 patients an hour. As an intern it was around 1.5 - 1.7.

Q

 

[Hornet871]

Sorry to hear that, Hornet. You know I got nuttin' but SDN love for you, so it hurts ot hear another brother get beat down.

At my program (which you should have ranked higher), there is none of what you speak. All of the attendings teach a great deal at the bedside (more correctly at the "desk" side where we sit down and discuss cases). Our PD does expect us to see a "reasonable" amount of patients, but nothing crazy. As a PGY2 I am averaging close to 2 patients an hour. As an intern it was around 1.5 - 1.7.

Q

Wow, 2 pts/hr is unheard of at my program, simply because the acuity is so high, it takes so g*dd*mned long to get labs back, and there's a lot of cajoling involved in getting nursing to do anything for you.

In fact, no one ever sees 2 pts/hr - that would be 24 pts/shift! A great shift entails seeing 13-15 pts. One time I saw 18.

I miss Tampa!

 

[NinerNiner999]

We get about 20 minutes of teaching per patient. We work up our room and the attendings circle from room to room to write their notes. When they come in, they talk about our management choices, how they do things, tweak our plans, and let us go. If our plan differs they let us keep it going as long as it isnt too far off the beaten path (I gave IV caffeine for post LP headache and the nurse had never seen it done before).

 

[anonymousEM]

Appolyon, I hope the one who transferred in with you is happier now than he was here. I'd say that things have changed some at our program and the move the meat mentality is much more often superceded by discussing an interesting case and mgt with attendings while working up several patients...on a good day I probably see 8-12 high acuity or 12-24 mod-low in an 8 hr shift...depends on the day and how many of the nurses are "gone to lunch" though...I like the fact that our PD doesn't give us tests on Tintinialli every week, though. Just one more thing for me to have to keep up with...I'd rather do it at my pace.

 

[Sessamoid]

Wow, 2 pts/hr is unheard of at my program, simply because the acuity is so high, it takes so g*dd*mned long to get labs back, and there's a lot of cajoling involved in getting nursing to do anything for you.

In fact, no one ever sees 2 pts/hr - that would be 24 pts/shift! A great shift entails seeing 13-15 pts. One time I saw 18.

I miss Tampa!

I do think there's some importance in learning how to "move the meat", because it is an important part of the job. Obviously, that's difficult in a dysfunctional work environment, but you'd be surprised at what you can do given a well-run department and a little practice.