Pimp questions in Clinicals

[greatnt249]

---

Members do not see this ad.

I beg to disagree. The attendings are assistant or full professors of our school. Our school pays them a salary. Our tuition comprises a principal amount of that. Hence we are paying for their time. This is how most med schools with an attached teaching hospital function.

Even they weren't paid they are in an ACADEMIC OR TEACHING HOSPITAL. If they want to speed through patients then there are plenty of private hospitals they could of gone to. Their job description is to teach residents and med students. If they don't do that then they are doing part of their job pretty ****ty.

And part of the resident's job description is to teach med students (at least at my school).

Maybe not in your case, but I think a lot of the misguided resentment stems from medical students' unrealistic expectations of what it means to learn/be taught on the floors. If you go into clinical years expecting daily lectures and hand-holding through the experience, you're going to have a bad time. Yes, it's annoying to essentially pay to work, but at the same time you're basically free to make whatever you want out of the rotation.

If you take initiative and try to get involved and still get shafted when it comes to being taught anything, then yeah, I agree you have crappy attendings and residents. However, working as physicians, even in an academic center, their number one job description is not teaching. Your goal should be to make your own learning experiences whenever there isn't dedicated teaching time.

 

[link2swim06]

Maybe not in your case, but I think a lot of the misguided resentment stems from medical students' unrealistic expectations of what it means to learn/be taught on the floors. If you go into clinical years expecting daily lectures and hand-holding through the experience, you're going to have a bad time. Yes, it's annoying to essentially pay to work, but at the same time you're basically free to make whatever you want out of the rotation.

If you take initiative and try to get involved and still get shafted when it comes to being taught anything, then yeah, I agree you have crappy attendings and residents. However, working as physicians, even in an academic center, their number one job description is not teaching. Your goal should be to make your own learning experiences whenever there isn't dedicated teaching time.

Fair enough, I agree it is not their number one priority.

However, I'd argue not even being allowed to present a patient reduces you to merely shadowing. Which is pretty unacceptable unless there are extenuating circumstances.

Also now that I have almost finished third year it is pretty evident what attendings are just being lazy with teaching and which ones are trying. I have a seen a vast range of quality.

 

[greatnt249]

Fair enough, I agree it is not their number one priority.

However, I'd argue not even being allowed to present a patient reduces you to merely shadowing. Which is pretty unacceptable unless there are extenuating circumstances.

Also now that I have almost finished third year it is pretty evident what attendings are just being lazy with teaching and which ones are trying. I have a seen a vast range of quality.

I would also agree that by clinical years, shadowing is pointless; those are the attendings and residents who are just being s****y teachers. The only slack I will cut those types is that it is rare that anyone is taught how to teach by that point, although I can appreciate a crappy, yet honest effort put forth as opposed to neglecting it altogether.

 

[Laryngophed]

what is the answer?

Demargination.

 

[tco]

I beg to disagree. The attendings are assistant or full professors of our school. Our school pays them a salary. Our tuition comprises a principal amount of that. Hence we are paying for their time. This is how most med schools with an attached teaching hospital function.

Even they weren't paid they are in an ACADEMIC OR TEACHING HOSPITAL. If they want to speed through patients then there are plenty of private hospitals they could of gone to. Their job description is to teach residents and med students. If they don't do that then they are doing part of their job pretty ****ty.

And part of the resident's job description is to teach med students (at least at my school).

This actually is nowhere near accurate. Hospitals pay a ridiculous portion of your tuition. If a medical school is not associated with a hospital, tuition is at least double what competing schools are, often more. Your tuition pays pretty much everything other than the physician's salaries. Often, a very small portion of their salary comes from the medical school. The rest is from RVU's.

 

[quechua]

This actually is nowhere near accurate. Hospitals pay a ridiculous portion of your tuition. If a medical school is not associated with a hospital, tuition is at least double what competing schools are, often more. Your tuition pays pretty much everything other than the physician's salaries. Often, a very small portion of their salary comes from the medical school. The rest is from RVU's.

Really? What about all of the private medical schools that shaft both IS and OOS students with absurd tuition even though they are affiliated with a teaching hospital?

I'm thinking of a few schools that didn't get your memo. Lol

 

[greatnt249]

Really? What about all of the private medical schools that shaft both IS and OOS students with absurd tuition even though they are affiliated with a teaching hospital?

I'm thinking of a few schools that didn't get your memo. Lol

"Few" is the operative word here; I guarantee most attendings and especially residents don't see a dime of that money.

 

[quechua]

Dbl post.

 

[quechua]

"Few" is the operative word here; I guarantee most attendings and especially residents don't see a dime of that money.

"Few" as in the schools that literally came to mind at that moment.

Here is data backing my position: https://services.aamc.org/tsfreports/report.cfm?select_control=PRI&year_of_study=2013

There are 141 allopathic schools in the US. 54 are private. 46 of those [54] have tuition at $40K+/yr for both IS and OOS. For the record we could add Oakland and UVA to the list as well even though they are public. Though I don't have an exact number (and will definitely not take time to look it up) most allopathic medical schools have a dedicated teaching hospital affiliate. Especially the schools on that list. IJS.

Ultimately, I do agree that most attendings are not salaried based on the tuition of the students that they [are somewhat obligated to] teach. Looking at the number of attendings at any teaching hospital... It's not practical. Now program and clerkship directors may have a different story. So I was contesting only a portion of TCO's quote. See below.

?...If a medical school is not associated with a hospital, tuition is at least double what competing schools are, often more...

 

[Stellar Clouds]

Very little of your tuition goes towards paying faculty, regardless of private vs public institution:

Costs can be categorized as instructional costs and total educational resource costs. Instructional costs, which can be distinguished further as marginal costs or proportionate-share costs, are those costs that can be related directly to the teaching program and its support. Total educational resource costs are those costs supporting all faculty deemed necessary to conduct undergraduate medical education in all their activities of teaching, research, scholarship, and patient care. The authors review studies spanning a period of more than 20 years and find that instructional cost estimates of medical student education, when adjusted to a standard base year (1996 dollars), fall within a fairly narrow range: most are between $40,000 and $50,000 per student per year. Estimates of total educational resource costs show greater variation, but four of six estimates fall between approximately $72,000 and $93,000 per student per year.

Source: http://www.ncbi.nlm.nih.gov/pubmed/9075424

These estimates are in 1996 dollars. If you were actually paying your attendings' salaries, your tuition would be more like 104,000 - 134,000 per year (2012 dollars).

 

[link2swim06]

This actually is nowhere near accurate. Hospitals pay a ridiculous portion of your tuition. If a medical school is not associated with a hospital, tuition is at least double what competing schools are, often more. Your tuition pays pretty much everything other than the physician's salaries. Often, a very small portion of their salary comes from the medical school. The rest is from RVU's.

I can't speak for all med schools. At my school i am a 100% sure that the med school is financed about 40% by the state and 60% by our tuition. Our dean told us this during a lecture once.

The hospital isn't playing into the equation.

I never said that my tuition was the majority of their salary. What I was trying to say was a lot of the academic activities they participate in are funded by our tuition. Teaching is an academic activity. I am not expecting 8 hours of teaching but I do expect some teaching.

I pay $33,000 in tuition. If there are approx. 275 clinical days a year that is $120 a day. Plus the state is paying another $80. Lets say 60% of this disappears to admin, buildings, etc....that still leaves $80 of paid learning time. These are obviously made up percentages. I have no clue what the actual numbers are...but the point is that they are getting paid something.

They owe a small fraction of their time for teaching or they are doing their job poorly.


Maybe this is different at other schools.

 

[VisionaryTics]

Less jibber jabber, more pimping.

What is the most common bleeding diathesis? (aspirin use)

What are the most common causes of postoperative fever? (atelectasis[bs], UTI, PE, wound infection, drug fever)

 

[username456789]

Some good medicine pimp questions I got asked

How should you initially manage hyperkalemia?
Varied, but usually the answer was, check an EKG, if you see changes, push calcium gluc and start D5 + insulin, beta agonists, and kayexelate in any case.

I pimp every medical student on my service with this, including the physiology/'why" behind each therapy. As I mentioned on another thread, I've had upper level residents who had no clue that calcium gluconate had no effect on potassium levels, and thought that that was its function in managing hyperkalemia.

My 5 minute (or less) hyperkalemia "lecture" is simple and to the point, but is helpful in remembering the steps so that when they hit the wards their first month of internship and get a 3am call for a potassium of 6.6, they know what to do.

 

[link2swim06]

What are all the orders for DKA?

What are non-MI causes of elevated troponins?

What criteria do you use when determining presence of a MI on a EKG with left bundle branch block?

What does a tylenol overdose look like 4 hours post-ingestion?

 

[hurryupnwait]

Parathyroidectomy pre-op,
Q: Negative sestamibi scan, what are we most likely to find here? (Adenoma as it is the most common cause of primary hyperparathyroism)

Intra-op, pointing to the superficial muscle of the neck,
Q: What muscle is this? (Platysma)
Q: What question am I going to ask next?
Q: In what animal is this muscle best developed? (Human)

This followed by multiple rounds of "What song is this? Who sings this? What movie was this song featured in?" and random questions about parathyroid mass, blood supply, etc.

 

[SciencePlus]

I was told that the Platysma was the most developed in the horse???

 

[ShinyDome19]

Vascular surgery:

Q: Pt in the room with an A-V fistula in the right-brachial area. Attending occludes the fistula with his finger and turns to me and says, the patient's heart rate just dropped. What is the name of the response that just happened and what is it's significance?

My answer - Baroreceptor reflex?
Physician then proceeded to yell at me for about 10 mins infront of his Nurse Practitioner about how horrible of a student I am for not knowing this...with the NP agreeing and throwing in that she couldnt believe I didnt know the answer...

Real Answer - Bezold-Jarisch Reflex, which indicates that the AV fistula is still working...and is a baroreceptor response...

 

[jerseytrash]

I pimp every medical student on my service with this, including the physiology/'why" behind each therapy. As I mentioned on another thread, I've had upper level residents who had no clue that calcium gluconate had no effect on potassium levels, and thought that that was its function in managing hyperkalemia.

My 5 minute (or less) hyperkalemia "lecture" is simple and to the point, but is helpful in remembering the steps so that when they hit the wards their first month of internship and get a 3am call for a potassium of 6.6, they know what to do.

👍👍 Excellent thing to teach, I think - it's well tested and very useful.

Other pimp questions that come to mind (cardiology related are mostly what I recall):

- What are the other causes of ST elevation other than an MI? (pericarditis, early repolarization, persistent ventricular aneurysm, LBBB, Brugada, and in severe hyperkalemia)

- What is the most common supply of the posterior descending artery? (RCA in 70% of cases).

- What should you not give someone with an inferior MI? (nitrates since if there's a concomittant RV MI you can drop their preload precipitously)

 

[evilbooyaa]

Vascular surgery:

Q: Pt in the room with an A-V fistula in the right-brachial area. Attending occludes the fistula with his finger and turns to me and says, the patient's heart rate just dropped. What is the name of the response that just happened and what is it's significance?

My answer - Baroreceptor reflex?
Physician then proceeded to yell at me for about 10 mins infront of his Nurse Practitioner about how horrible of a student I am for not knowing this...with the NP agreeing and throwing in that she couldnt believe I didnt know the answer...

Real Answer - Bezold-Jarisch Reflex, which indicates that the AV fistula is still working...and is a baroreceptor response...

I also had a vascular attending ask me another "I've asked this question and expect X answer, not a synonym for it".

He asked me about something, and I said lactic acid build up. He said, OK, how does lactic acid get eliminated? I brainfarted and couldn't remember if it was liver or kidneys. Then I remembered it turns to pyruvate in the liver, so I say, "liver". He goes, correct. What's the name of the cycle? I don't remember this, so I just say, "The lactic acid cycle(?)". He goes, "Oh, my oh, my. And you paid for your medical school education?" 5 minutes later, he goes "It's called the Cori cycle".

http://en.wikipedia.org/wiki/Cori_cycle

The Cori cycle (also known as Lactic acid cycle)

RAAAAAAAAAAAAAAAAAAAAAAGE when I realized I had been right. Those damn vascular attendings.

 

[rueby25]

what is the answer?

Demarginization.

Edit: Oops. Just saw this was answered above. I definitely got asked this though.

 

[vonburen]

I'm entering medical school, but I shadowed a few doctors who had third year students with them. One thing that keeps popping up is questions about

angiotensin ii blockers, ACE inhibitors, and other hypertensive drugs, what receptors they use, when to use them, where do the operate? Etc.
It makes sense, given our country's hypertensive epidemic.