Preceptors in M3

[honey0102]

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I'm in a rotation where we actually work at two sites for outpatient peds. Two different preceptors.
In my first site, everything is amazing. My preceptor does expect a lot-but I'm able to meet and exceed his expectations-he has told me I'm doing a great job. of course, he does provide feedback-which I accept, and even seek out-I really do believe it is helpful. But when a job is well done he says so. He has told me that I am doing great and that he is very impressed. With my demeanor, interaction with patients, HMP's, notes, etc.

But in my other clinic, polar opposite experience. My preceptor never misses an opportunity to belittle me. Even if I ask a question to show I'm engaged, did the reading the night before, etc, she speaks to me in a very condescending tone, asks me questions until I don't know an answer and gets angry at me for it, etc. She picks at my HPIs and presentations, cuts me off mid-sentence to yell at me. Admittedly-I'm not perfect-but I think I'm on par with other M3's. Her entire demeanor has me struggling not to cry each day as I leave. Just the way she looks at me, speaks to me, makes it clear. To be fair, I'm not the only one facing this-many people in classes before have reported this.

Again: I totally welcome feedback. But I think the kinds of things this preceptor gets angry over, are pretty minute-if she provided it as feedback, and not a belittling point, I'd have felt so much better.

And certain things she has issue with...I've casually asked my other preceptor if he would have issue with it..he seemed confused I even asked that and indicated no...

I guess my question is: How do I keep going? This experience has me really discouraged. My patients love me and my other preceptor thinks highly of me, but this lady straight up makes me want to cry everyday. Despite doing well in classes/Step/patient encounters/other rotation, she alone is making me doubt my abilities in medicine and it's affecting my mental well-being.

The day and night difference between what my two preceptors say of me, is actually astounding.

 

[libertyyne]

There are usually policies in the school handbook for mistreatment and reporting. I would urge you to do that and see if you can't get placed with someone else.

If you don't want to for that, take solace in the fact that this persons demeanor and misery has nothing to do with you and everything to do with their own problems.

 

[honey0102]

There are usually policies in the school handbook for mistreatment and reporting. I would urge you to do that and see if you can't get placed with someone else.

If you don't want to for that, take solace in the fact that this persons demeanor and misery has nothing to do with you and everything to do with their own problems.

Thanks so much. Fortunately, it's a short rotation. But yes true-what you said is correct. Thanks for the sympathy 🙂

 

[ciestar]

Report this. Hopefully no other student has to deal with this

 

[kraskadva]

My preceptor never misses an opportunity to belittle me. Even if I ask a question to show I'm engaged, did the reading the night before, etc, she speaks to me in a very condescending tone, asks me questions until I don't know an answer and gets angry at me for it, etc. She picks at my HPIs and presentations, cuts me off mid-sentence to yell at me. Admittedly-I'm not perfect-but I think I'm on par with other M3's. Her entire demeanor has me struggling not to cry each day as I leave. Just the way she looks at me, speaks to me, makes it clear. To be fair, I'm not the only one facing this-many people in classes before have reported this.

Different preceptors will have different teaching styles. Sifting out whether this is just an aggressive style of teaching or truly abusive is something you should think about and discuss with your school. If it is abusive, it should 100% be reported. But... as someone who has had both truly abusive and just aggressive instructors, I'd pose a few questions to you first...

When she "yells" at you, does she raise her voice or not? Does she insult you personally or just point out things done incorrectly/not to her standard. Does she do any of this in front of other people or just when it's the 2 of you?
The former, I'd call abusive. The latter, just aggressive.
Same questions for "belittling" you... is she pointing out gaps in your knowledge or things you've done incorrectly? Or is she insulting you personally?

The condescending tone, getting angry, etc I couldn't judge without being in the room with you.
But asking you questions until you don't know - that's totally normal. She's testing to see how far your knowledge goes. You don't need to/ are not expected to know everything. That's why you're a student and not the preceptor. And even she doesn't know everything.
Picking at your HPIs and presentations is normal - she's trying to help you get better.
Even the aggressiveness (if it's not abusive) is to help you get better - you will not always deal with nice, kind, soft-spoken people. You need to have thick skin and a backbone to handle the curveballs that will get thrown at you along the way, and learning how to deal with that is an important skill.

Reading through your other posts, you seem timid...like here

I promise I'm not a troll...but I just have to ask, how did you survive M3? We just began it and I feel so stressed. The idea of being constantly evaluated, second by second, is scary. On the one hand we are students who definitely don't know everything, the best way to learn is by admitting your weaknesses/gaps in knowledge but can't that get you marked down? My staggering lack of knowledge in the clinical arena scares me-its probably on par with a M3 student but still, just so scary. I'm can't figure out how to learn it all-people say, do UWorld-but then when we haven't learned the material won't we just get all the questions wrong?
And perhaps what scares me the most, is what I've heard about mean, scary attendings-the ones who belittle people-and I have also heard some of the ones I'lll be working with are pretty intimidating. I'm at this point so scared that when my other attending told me I did a good job, I was wondering if he actually meant it or was just "being polite"-in general, can you take their word for what they say? For reference, mostly any professor I've worked with in the past has been calm and nice and caring, so not really used to dealing with assertive personalities

and that makes me think that you might be making more of this than it is.
Is she just an assertive personality and you need to learn to deal with it? Or is she truly abusive?

 

[honey0102]

Different preceptors will have different teaching styles. Sifting out whether this is just an aggressive style of teaching or truly abusive is something you should think about and discuss with your school. If it is abusive, it should 100% be reported. But... as someone who has had both truly abusive and just aggressive instructors, I'd pose a few questions to you first...

When she "yells" at you, does she raise her voice or not? Does she insult you personally or just point out things done incorrectly/not to her standard. Does she do any of this in front of other people or just when it's the 2 of you?
The former, I'd call abusive. The latter, just aggressive.
Same questions for "belittling" you... is she pointing out gaps in your knowledge or things you've done incorrectly? Or is she insulting you personally?

The condescending tone, getting angry, etc I couldn't judge without being in the room with you.
But asking you questions until you don't know - that's totally normal. She's testing to see how far your knowledge goes. You don't need to/ are not expected to know everything. That's why you're a student and not the preceptor. And even she doesn't know everything.
Picking at your HPIs and presentations is normal - she's trying to help you get better.
Even the aggressiveness (if it's not abusive) is to help you get better - you will not always deal with nice, kind, soft-spoken people. You need to have thick skin and a backbone to handle the curveballs that will get thrown at you along the way, and learning how to deal with that is an important skill.

Reading through your other posts, you seem timid...like here

and that makes me think that you might be making more of this than it is.
Is she just an assertive personality and you need to learn to deal with it? Or is she truly abusive?

Others in my school have had similar issues. And my other preceptors provide feedback all the time. That's really not an issue.
But yes-she does raise her voice. Yes in front of other people. And I wouldn't mind asking questions til I don't know-but when I don't know it-she will act like it's the end of the world "WHAT? You don't KNOW that?" etc.
I probably won't report it...it's hurtful, but not sure I'd say abusive, technically, no rules broken...just being impolite.... Also.. I don't want to get on other people's bad side-she has friends in the admin here, pretty sure.

 

[libertyyne]

Others in my school have had similar issues. And my other preceptors provide feedback all the time. That's really not an issue.
But yes-she does raise her voice. Yes in front of other people. And I wouldn't mind asking questions til I don't know-but when I don't know it-she will act like it's the end of the world "WHAT? You don't KNOW that?" etc.
I probably won't report it...it's hurtful, but not sure I'd say abusive, technically, no rules broken...just being impolite.... Also.. I don't want to get on other people's bad side-she has friends in the admin here, pretty sure.

I wont tell you what to do, but do keep in mind that not reporting this person has left this fester to the point of unbearability. IF someone had reported her earlier, and if she had recieved appropriate guidance she would be less likely to abuse future students.

 

[Matthew9Thirtyfive]

Check with your school because you may also be able to report through another preceptor who can do it after you rotate out so that you don’t have to fear retaliation.

 

[kraskadva]

Others in my school have had similar issues. And my other preceptors provide feedback all the time. That's really not an issue.
But yes-she does raise her voice. Yes in front of other people. And I wouldn't mind asking questions til I don't know-but when I don't know it-she will act like it's the end of the world "WHAT? You don't KNOW that?" etc.
I probably won't report it...it's hurtful, but not sure I'd say abusive, technically, no rules broken...just being impolite.... Also.. I don't want to get on other people's bad side-she has friends in the admin here, pretty sure.

2 part response to this...

1- I'm sure she has friends in the admin - thats how she got her position. But it doesn't matter. Every USMD school, per LCME requirements, has a non-retaliation protocol in place for these situations. So it cannot affect your grade. At worse, nothing changes and you have a talk with your dean/course director about thicker skin. At best, if warranted, she gets taken out of play as a preceptor. So if its upsetting you that much, then it deserves to be reported. Either the situation improves or you get help to deal with it. Its no lose for you.

2- I'm currently rotating with a preceptor who so many students complained about that 2 administrators felt the need to pull me aside at orientation and have a talk with me about thick skin.
However, from my perspective, there is absolutely nothing abusive about the way he teaches, he's just an aggressive personality that rubbed folks the wrong way. I happen to get along with him pretty well and he's not treating me any different that he did previous students.
So take your classmates feedback with a grain of salt. Your experience is the one that matters at this moment and the only one you can report on.

 

[Angus Avagadro]

2 part response to this...

1- I'm sure she has friends in the admin - thats how she got her position. But it doesn't matter. Every USMD school, per LCME requirements, has a non-retaliation protocol in place for these situations. So it cannot affect your grade. At worse, nothing changes and you have a talk with your dean/course director about thicker skin. At best, if warranted, she gets taken out of play as a preceptor. So if its upsetting you that much, then it deserves to be reported. Either the situation improves or you get help to deal with it. Its no lose for you.

2- I'm currently rotating with a preceptor who so many students complained about that 2 administrators felt the need to pull me aside at orientation and have a talk with me about thick skin.
However, from my perspective, there is absolutely nothing abusive about the way he teaches, he's just an aggressive personality that rubbed folks the wrong way. I happen to get along with him pretty well and he's not treating me any different that he did previous students.
So take your classmates feedback with a grain of salt. Your experience is the one that matters at this moment and the only one you can report on.

Your responses to OP has been kind and very objective. Much better than I could have written. 3rd yr students just haven't developed the clinical acumen yet to be helpful. Surgical Preceptors in July will roll their eyes and groan when the new 3rd yr arrives in the OR. Some preceptors are more impatient than others. If OP thinks her preceptors are tough, wait till they meet some difficult patients. Med students have received praise for academics in the past and get flustered when chided for the gaps in their knowledge base in the clinic. 3rd yr is also frustrating because you are of little help after 2 yrs of med school. Hang in there OP! You will get through because fear of looking inept is a great motivator. Make sure to channel this energy into productive reading and not despair.

 

[Naruhodo]

Hey there, I'm sorry you're dealing with this. Sometimes it seems to me like navigating all the different personalities is an equal challenge to acquiring all the necessary clinical skills and knowledge during 3rd year.

I was in a similar situation with a preceptor (brusque, belittling, and made me cry in public) and on the fence about reporting. What tipped me over was thinking about future students, and feeling like I wanted to say my piece with respect to how this person was likely to evaluate me. I decided not to report mistreatment (there were no personal attacks or harassment), but to write a candid assessment of my learning experience with this preceptor. I knew I didn't have much longer with the preceptor, and I figured even if it made things more difficult/awkward it might help future students. First of all, an admin from my school saw my evaluation and scheduled a time to check in by phone. They double-checked that I was OK finishing out the rotation with this person (I was) and that there wasn't mistreatment. The next time I saw the preceptor it was clear they'd seen the evaluating and they actually apologized for being so busy and said they'd work harder to be a better teacher. Now, if this were a specialty I was seriously considering I'm still not sure if I would have felt comfortable writing that evaluation (the department liason, who'd always been super nice to me seemed to be a bit more standoffish after), but as it was I felt like the benefits to me and others outweighed the cons.

It's a personal decision and you won't be wrong either way. Do give yourself time to cool down from any particularly harsh episodes before doing anything. I don't really buy the "thicker skin" argument (I think we can advocate for a better culture in medicine), but that may just be my experience with a former supervisor who said it was his personal mission to get me to toughen up... Good luck and I things turn out for the best!

 

[honey0102]

Your responses to OP has been kind and very objective. Much better than I could have written. 3rd yr students just haven't developed the clinical acumen yet to be helpful. Surgical Preceptors in July will roll their eyes and groan when the new 3rd yr arrives in the OR. Some preceptors are more impatient than others. If OP thinks her preceptors are tough, wait till they meet some difficult patients. Med students have received praise for academics in the past and get flustered when chided for the gaps in their knowledge base in the clinic. 3rd yr is also frustrating because you are of little help after 2 yrs of med school. Hang in there OP! You will get through because fear of looking inept is a great motivator. Make sure to channel this energy into productive reading and not despair.

Thanks so much for your encouragement! I really appreciate it!
Actually, we have had some difficult patients-but somehow, I'm able to take it better-I understand their frustration often stems from something pre-existing before I even entered the picture. And generally once I apologize to them (whether or not it's my fault) that seems to make things better.
Yes, I'll just continue to do my best and learn as much as I can. Thanks again

 

[honey0102]

Hey there, I'm sorry you're dealing with this. Sometimes it seems to me like navigating all the different personalities is an equal challenge to acquiring all the necessary clinical skills and knowledge during 3rd year.

I was in a similar situation with a preceptor (brusque, belittling, and made me cry in public) and on the fence about reporting. What tipped me over was thinking about future students, and feeling like I wanted to say my piece with respect to how this person was likely to evaluate me. I decided not to report mistreatment (there were no personal attacks or harassment), but to write a candid assessment of my learning experience with this preceptor. I knew I didn't have much longer with the preceptor, and I figured even if it made things more difficult/awkward it might help future students. First of all, an admin from my school saw my evaluation and scheduled a time to check in by phone. They double-checked that I was OK finishing out the rotation with this person (I was) and that there wasn't mistreatment. The next time I saw the preceptor it was clear they'd seen the evaluating and they actually apologized for being so busy and said they'd work harder to be a better teacher. Now, if this were a specialty I was seriously considering I'm still not sure if I would have felt comfortable writing that evaluation (the department liason, who'd always been super nice to me seemed to be a bit more standoffish after), but as it was I felt like the benefits to me and others outweighed the cons.

It's a personal decision and you won't be wrong either way. Do give yourself time to cool down from any particularly harsh episodes before doing anything. I don't really buy the "thicker skin" argument (I think we can advocate for a better culture in medicine), but that may just be my experience with a former supervisor who said it was his personal mission to get me to toughen up... Good luck and I things turn out for the best!

Thanks for sharing your story. I'm so sorry you had to go through all that.
I agree-I'd way rather have a better culture in medicine. We are taught (rightly so) to be nice to everyone around us, the team, etc-not sure why preceptors are allowed to get away with being abusive. But I guess for now, all we can do is just try our best.
I appreciate everyone's support and sympathy on this thread 🙂

 

[7331poas]

Cant wait for my entire residency application to come down to whether I had preceptor A or preceptor B.

 

[NickNaylor]

If you do end up going the reporting route, be sure to report specifics. Vague feedback like "they're mean" is unhelpful. Provide concrete, specific examples as this is far more actionable.

I dealt with these issues all the time as a chief, and, administratively, it's next to impossible to do anything without clear, specific examples of what was going on.

At a minimum, I would suggest reaching out to your clerkship director for advice and to provide feedback.

 

[BunnyMan17]

I had one preceptor whose existence seemed to exude disdain for us MS3s, it drove me up a wall. I found it helpful to keep a small log of sorts in a google doc where I wrote examples of his behavior so as to provide specific vs. vague feedback (my school does pretty regular faculty/preceptor feedback). When I got to the end of the rotation I cooled down, took a step back, and looked over my notes. Came to the conclusions A) He was not a nice person; B) His jabs always (not so gently) nudged us to improve our clinical reasoning or expose knowledge gaps we didn't know were there; and C) He spend a lot of time teaching us he didn't have to.

 

[honey0102]

I would literally do research on a patient's Sx and come up with a prioritized differential. I'd show my sources too.
Preceptor would disagree with said differential. Or add or remove something. Which I get and I'd want to learn from it
But in the process-she would BLAST me-I mean totally blast me. Blast me for including things (often lower) on my Dx. I'd have very similar cases w/ similar answers with the other preceptor and he was like "Good job!!!" She would accuse me of including it for being biased, or careless-even after I admitted she is right but explained I did research on it on X website, explained my thought process.
I even got an answer right (refer patient to X department), she began to pimp me on what X department could do-pimps me until I no longer know (it was getting deep into the details of X department's subspecialty, not IM shelf material)-I offered to read up on it to learn more-she yelled at me for "not knowing what I'm talking about". She then asks the other students-they too have no idea.
At the end of this rotation, I am feeling horribly discouraged about medicine. I was optimistic entering in-and still am, with my other preceptor-but this was a bad experience. She has also talked poorly about other med students, nurses, and residents to us. And all the things they taught us about professionalism, I wonder if it applies to preceptors-IMO this lady was not professional. The way she spoke to us, and spoke to us about residents and nurses, was not what I'd expect of a professional.

 

[Angus Avagadro]

I had one preceptor whose existence seemed to exude disdain for us MS3s, it drove me up a wall. I found it helpful to keep a small log of sorts in a google doc where I wrote examples of his behavior so as to provide specific vs. vague feedback (my school does pretty regular faculty/preceptor feedback). When I got to the end of the rotation I cooled down, took a step back, and looked over my notes. Came to the conclusions A) He was not a nice person; B) His jabs always (not so gently) nudged us to improve our clinical reasoning or expose knowledge gaps we didn't know were there; and C) He spend a lot of time teaching us he didn't have to.

As I mentioned earlier, fear of appearing inept is a great motivator to read and retain what the preceptor says. The embarrassment of having your knowledge gaps exposed often magnifies the incident in your mind and your documentation of the events illustrates that. A very insightful and helpful post.

 

[honey0102]

As I mentioned earlier, fear of appearing inept is a great motivator to read and retain what the preceptor says. The embarrassment of having your knowledge gaps exposed often magnifies the incident in your mind and your documentation of the events illustrates that. A very insightful and helpful post.

I agree-and I do read up on my patients before and after-I feel if I didn't, I'd not be gaining as much from the rotation.
But yelling at students, gossiping about nurses and residents to us-not something I deem necessary

 

[kraskadva]

I would literally do research on a patient's Sx and come up with a prioritized differential. I'd show my sources too.
Preceptor would disagree with said differential. Or add or remove something. Which I get and I'd want to learn from it
But in the process-she would BLAST me-I mean totally blast me. Blast me for including things (often lower) on my Dx. I'd have very similar cases w/ similar answers with the other preceptor and he was like "Good job!!!" She would accuse me of including it for being biased, or careless-even after I admitted she is right but explained I did research on it on X website, explained my thought process.
I even got an answer right (refer patient to X department), she began to pimp me on what X department could do-pimps me until I no longer know (it was getting deep into the details of X department's subspecialty, not IM shelf material)-I offered to read up on it to learn more-she yelled at me for "not knowing what I'm talking about". She then asks the other students-they too have no idea.

^this (minus the yelling - if it was voice-raised & belittling), while not gentle, I wouldn't take issue with. You're being trained to practice medicine, not take a test. Doesnt matter if its not on the shelf, because life, and medicine, do not compartmentalize themselves so neatly ever.
Sources don't belong in a differential - you at the source at that point. Being accurate, non-biased, and knowing exactly what you're referring a patient for are all important things. And getting an answer right on a guess doesn't count - you need to know that its right and be able to say why - hence precluding many of the other things you probably have on your ddx.
No one expects you to know all of that now at the beginning of 3rd year, but being forced one way or the other to learn it is helpful for the long run.

This part below is not okay.

At the end of this rotation, I am feeling horribly discouraged about medicine. I was optimistic entering in-and still am, with my other preceptor-but this was a bad experience. She has also talked poorly about other med students, nurses, and residents to us. And all the things they taught us about professionalism, I wonder if it applies to preceptors-IMO this lady was not professional. The way she spoke to us, and spoke to us about residents and nurses, was not what I'd expect of a professional.

You can damn someone with faint praise. The professional throwing of shade is an art form. But straight out talking **** about coworkers or students is not acceptable.

Again, if you're getting abuse, or seeing seriously unprofessional behavior (and I would definitely count the 2nd quote as that), you should report it to your school. But nobody ever said this training would be easy or gentle, and it seems to me that that's what you're getting a taste of here.

 

[honey0102]

^this (minus the yelling - if it was voice-raised & belittling), while not gentle, I wouldn't take issue with. You're being trained to practice medicine, not take a test. Doesnt matter if its not on the shelf, because life, and medicine, do not compartmentalize themselves so neatly ever.
Sources don't belong in a differential - you at the source at that point. Being accurate, non-biased, and knowing exactly what you're referring a patient for are all important things. And getting an answer right on a guess doesn't count - you need to know that its right and be able to say why - hence precluding many of the other things you probably have on your ddx.
No one expects you to know all of that now at the beginning of 3rd year, but being forced one way or the other to learn it is helpful for the long run.

This part below is not okay.

You can damn someone with faint praise. The professional throwing of shade is an art form. But straight out talking **** about coworkers or students is not acceptable.

Again, if you're getting abuse, or seeing seriously unprofessional behavior (and I would definitely count the 2nd quote as that), you should report it to your school. But nobody ever said this training would be easy or gentle, and it seems to me that that's what you're getting a taste of here.

I actually value being told if my differential is wrong, or being asked to expand on something even if that extends beyond the given field. After all, we are all here to learn.
The belittling, raised voice, eye rolling, etc-that was what got me-and I'm sure if this person can talk poorly about nurses/residents to us, we are being gossiped about as well.

 

[kraskadva]

I actually value being told if my differential is wrong, or being asked to expand on something even if that extends beyond the given field. After all, we are all here to learn.
The belittling, raised voice, eye rolling, etc-that was what got me-and I'm sure if this person can talk poorly about nurses/residents to us, we are being gossiped about as well.

And that is what you should talk to your school about.