"Problem students" (3rd/4th year)

[quickfeet]

The following is a list of so-called "problem students" cited from a study on medical student problem behaviors, page 373 of Success on the Wards: 250 Rules for Clerkship Success.

• Bright with poor interpersonal skills
• Excessively shy, non-assertive
  
• Poor integration skills
• Over-eager
• Cannot focus on what is important
• Disorganized
  
• Disinterested
• Poor fund of knowledge
• Psychiatric problems and/or substance abuse problems
• Cannot be trusted/dishonest/manipulative

Which ones do you run into most frequently of these subtypes?

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[cbrons]

It seems to me that "Bright with poor interpersonal skills" and "Excessively shy, non-assertive" would be the most common subtype.

There is a fine line between "Over-eager" and just taking initiative and trying to learn. At some schools, they probably think you are "Over-eager" if you want to do more than shadowing, whereas at others they probably think you are "Excessively shy" if you don't want to put in a central line on day 1 of SUb-i.

Maybe the 4th years can help clarify what crosses the line into "over-eager" because it seems (so far) to me that you really have to take initiative to learn stuff your 3rd year. Probably has a lot to do with basic social intelligence/tact.

 

[Morzh]

Over eager is probably code for "obnoxious gunner", although I think there is a milder variant that includes the students who take the advice of "being enthusiastic and taking initiate" too seriously, especially if combined with a below-average social intelligence. Based on the few classmates of mine who I might say fit this category, I would characterize them as such:

-Usually very high energy (seriously suspected one might be using stimulants)
-A little awkward
-Express lots of strong opinions and say things like "If I offend someone, oh well, I don't care! It doesn't bother me at all if someone has a problem with me!" (usually referring nursing and ancillary staff)
-They tend to stick out more in "action" settings like OR/ED/L&D/ICU, and do things like signing up for 4 of the 5 "big" cases of the week even when they make up only 25% of the students on the team, leaving all the cases they deem boring for their classmates. Basically using their "assertiveness" to bypass peer discussion and equitable distribution. It's very entertaining when two over-eagers are put on the the same team!
-They ask the residents/attending incessant questions, most of which are very obscure, irrelevant, or obviously show-off questions. When things get busy and the residents are stressed out they have a hard time reading these cues and continue to bombard them with random questions.
-All that said, they usually weren't maliciously or intentionally being gunnery, they're just kinda oblivious..

• Bright with poor interpersonal skills -- every class has a handful of these
• Excessively shy, non-assertive -- usually the most beat-down and cynical by the end of the year after repeatedly being torn apart on evals for "appearing disinterested, unenthusiastic"
• Poor integration skills -- what does this mean?
• Disinterested -- had one teammate fit it.. would just disappear for hours at a time.. evals did not go well!

 

[Jeffrety]

The following is a list of so-called "problem students" cited from a study on medical student problem behaviors, page 373 of Success on the Wards: 250 Rules for Clerkship Success.

• Psychiatric problems and/or substance abuse problems
• Cannot be trusted/dishonest/manipulative

Why are these students touching patients in the first place?

All other faults are forgivable. They indicate naivete on the part of the student but these two are pretty flagrant character and fitness deficiencies that schools should be catching.

 

[22031 Alum]

"Poor integration skills" might mean having difficulty integrating into a team. I've seen students who thrive with individual work but falter when it comes to being part of a team all day every day. It could also mean having trouble synthesizing information into a coherent clinical picture, but I'd personally file that under "Cannot focus on what is important."

 

[Etorphine]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2574397/

"Underrepresented minorities more likely reported lower grades in all clerkships (P < 0.001)

Men more likely reported lower grades in obstetrics/gynecology (P < 0.001) and psychiatry (P = 0.004)

Asians more likely reported lower grades in obstetrics/gynecology (P = 0.007), pediatrics (P = 0.01) and neurology (P = 0.01)

The independent associations between lower clerkship grades and nonwhite race, male gender, older age, lower quality of clerkship experiences, and being less assertive and more reticent are concerning and merit further investigation."

n=2395, 105 schools

 

[justin1390]

But seriously, if you have good interpersonal skills, you can cover up a decent amount of the problem behaviors the OP listed. Hard to cover up intoxication or psych issues.

 

[Dave89]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2574397/

"Underrepresented minorities more likely reported lower grades in all clerkships (P < 0.001)

Interesting, because I've always been told that "diversity" is a strength. Something clearly requires further study!

But seriously, if you have good interpersonal skills, you can cover up a decent amount of the problem behaviors the OP listed. Hard to cover up intoxication or psych issues.

I'm having a flashback to that scene in House in which the whole team rushes to the hospital smelling of alcohol after Chase's bachelor party. Imagining a group of 3rd years on rounds like that is actually kind of amusing.

Back to the OP, I'd wager that the most common problem is "poor integrative skills." This is an area on which students work pretty much throughout their entire 3rd and 4th years (if not residency as well), so it makes sense that it would be a relatively common complaint.

Most of the others are essentially indicative of character flaws.

 

[madchemist89]

To the OP, every single medical student falls under at least one of those categories.

 

[Etorphine]

Interesting, because I've always been told that "diversity" is a strength. Something clearly requires further study!

Come to your own conclusions, but I think the circumstances leading to the data are complicated. To me, some of the results in that study bring up questions about equity and whether the clerkship experience varies on which group of individuals one belongs.

 

[justin1390]

Why are these students touching patients in the first place?

It's shocking the number of psychiatric problems that pop up during medical school. I know of at least half a dozen in my class and at least 3-4 in the class ahead of me. That's just in a network of 40 or so students I interact with regularly. Med school is hard, I've been lucky to have a great support system and have held up well. Others are not so lucky, are pressured into medical school, find they hate it but have the loan burden. It leads to a lot of substance and psychiatric problems. Some get better after residency, some don't. No one's perfect, I suppose. As long as they're utilizing resources and on a sober road, they kudos.

 

[OnePunchBiopsy]

Just remember, none of these are psychological disorders unless they interfere with your daily activities