Question for 3rd and 4th years :-)

[jhu1]

So I have a question for 3rd and 4th year and that is about how the schedual is going to work during the weekends of your rotations? Are you on-call or something all the times during the weekends? or when its friday evening and you are off then you have the whole weekend for yourself to travel, go get drunk or whatever ...

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[calespine]

It's highly variable on which rotation you are on. Family med- free weekends. Ob/gyn we usually split weekend call amongst the rotating med students. Gen surg- just bring your sleeping bag and tooth brush to the hospital for the whole rotation- kidding, sort of. Each rotation will usually tell you about their own specific schedule beforehand- there isn't a set call schedule across the board.

 

[SouthernSurgeon]

Agree with above. Highly variable. Here's the gist of my experiences:

Ob/Gyn: Weekends are just another day. Work work work. Get on average one day off in seven.
Peds: Inpatient - come in on weekends to round, write notes, maybe admit a patient; get out pretty early unless your team is on call; Get on average one day off in seven. Outpatient - weekends off
Medicine: Similar to peds
Surgery: Come in really early, preround, round with team, do some floor work, write notes, get out pretty early unless you're on call or are on an emergency surgery service (then you get to wait around for appendices to burst); get on average one day off in seven.
Psych: Weekends off

 

[Law2Doc]

So I have a question for 3rd and 4th year and that is about how the schedual is going to work during the weekends of your rotations? Are you on-call or something all the times during the weekends? or when its friday evening and you are off then you have the whole weekend for yourself to travel, go get drunk or whatever ...

Depends on the rotation. Some rotations (esp psych, FM), you get the weekends off. On many of the other rotations (esp IM, OB, surgery) they do the 4 weekend days off a month plan -- where you have one weekend totally two split weekends, and one totally on weekend. On some of these off days, you may be catching up on sleep a good portion of the time. It should be noted that even if you are off, you sometimes have to study for the shelf exam, so I wouldn't plan on a lot of weekends to simply travel or get drunk. Third year is tough because you cannot plan your schedule. It's the first time for most that your time is totally not your own.

 

[Doctor Bob]

It will also vary greatly based on the hospital and school you're at.

At the hospital I did my 3rd year rotations at, the IM department was admitting so many uninsured patients and had such a high census, that the FP department admitted a lot of the insured patients for the IM docs. So on our FP rotation we had to take call and do hospital rounds in addition to outpatient clinic.

Needless to say the IM months were non-stop rounding and admitting and call.

OB/GYN was actually a pretty light month comparatively (8-5 M-F with call one day every two weeks)

 

[JStub]

With the exception of IM (usually), OB, and surgery (I had weekends off though) you will usually have weekends off. It really depends though (inpatient vs outpatient FM, Peds, etc).

 

[DaveinDallas]

I think I've only had one rotation - Peds - where my weekends were my own. Otherwise, I had to work weekends as needed. Even in Peds, if they'd have scheduled it, you work it.

You better get used to the idea, right now, that your life is no longer your own....You live and die by the schedule that is set for you and no amount of whining, bitching, or finagling will change that......If you need days off for legitimate things, ask for them. If you get them, be grateful, otherwise, shut up. I find it amusing when I hear my younger classmates pitch a hissy fit and get their panties in a wad when they find out that going to a younger siblings college graduation is not an excusable absence and they're going to get docked 4 points....and they just can't understand why the argument of 'I can't get out of it, my parents want me to go' doesn't wash.....what, are mommy and daddy going to set your schedule in residency also?

As I was once told, 'It's better for you to report in sick and make them send you home, rather than to call in sick. It shows commitment and people respect that....'.

To back up what I'm saying, there were two students on a service I was on but not on the same team, that were asking me about call schedule. This was early in 3rd year and they hadn't taken call on this particular service yet. I briefly told them the call schedule and they loudly responded with,'Well that just sucks' when I mentioned the way the call worked on weekends and nights, etc. While we were talking, I noticed my resident eyeballing them. After they left, I went over and mentioned the conversation and told him how I felt (and truly do) - I was part of blue team and if blue team was in house, I was in house for as long as blue team was there. He complimented me on my attitude at that time and indicated it was what they were looking for.....

Anyway, short version - you adapt to the schedule---and try to do so without complaining...

 

[nlax30]

I think I've only had one rotation - Peds - where my weekends were my own. Otherwise, I had to work weekends as needed. Even in Peds, if they'd have scheduled it, you work it.

You better get used to the idea, right now, that your life is no longer your own....You live and die by the schedule that is set for you and no amount of whining, bitching, or finagling will change that......If you need days off for legitimate things, ask for them. If you get them, be grateful, otherwise, shut up. I find it amusing when I hear my younger classmates pitch a hissy fit and get their panties in a wad when they find out that going to a younger siblings college graduation is not an excusable absence and they're going to get docked 4 points....and they just can't understand why the argument of 'I can't get out of it, my parents want me to go' doesn't wash.....what, are mommy and daddy going to set your schedule in residency also?

As I was once told, 'It's better for you to report in sick and make them send you home, rather than to call in sick. It shows commitment and people respect that....'.

To back up what I'm saying, there were two students on a service I was on but not on the same team, that were asking me about call schedule. This was early in 3rd year and they hadn't taken call on this particular service yet. I briefly told them the call schedule and they loudly responded with,'Well that just sucks' when I mentioned the way the call worked on weekends and nights, etc. While we were talking, I noticed my resident eyeballing them. After they left, I went over and mentioned the conversation and told him how I felt (and truly do) - I was part of blue team and if blue team was in house, I was in house for as long as blue team was there. He complimented me on my attitude at that time and indicated it was what they were looking for.....

Anyway, short version - you adapt to the schedule---and try to do so without complaining...

Good post.

Only two weeks into 3rd year but you pretty much have to schedule life around your "work" schedule. We moved two weeks ago but I had to wait until today, my post-call day to schedule time for the cable guy to come out, and had to wait until a free weekend afternoon to get a haircut, etc... No complaining, ya just gotta make it work and put off certain things until you have the time.

 

[Bacchus]

I had almost always weekends off even as a 3rd and 4th year med student. It really varies on which university you went to and which hospital you rotate at. I usually just rotated a few hours in the morning in x service and always hed weekend off except for the few times I had call in Traumatology and Ob/Gyn which were just a few times.

As an intern we follow a q3 system so one week I work on Sunday, the next weekend I work on a Saturday and the third week I work on a Friday, deliver the shift on Saturday and depending on the rotation I leave early or not and have something close to a full weekend off in the few rotations I am allowed to deliver the shift quickly. Surgery in my case is annoying in floor workload, but you deliver the shift insanely fast. You usually are free at around 9 am!! W00t! I've heard the other rotations I've yet to do also have this nice characteristic. Peds is the only rotation where you are delivering the shift as late as 5 pm on a weekend.

I don't believe US medical education is like this. Sounds like a vacation if you ask me.

 

[Law2Doc]

I don't believe US medical education is like this. ...

Yeah it's not.

 

[Dr Bartlet]

I think I've only had one rotation - Peds - where my weekends were my own. Otherwise, I had to work weekends as needed. Even in Peds, if they'd have scheduled it, you work it.

You better get used to the idea, right now, that your life is no longer your own....You live and die by the schedule that is set for you and no amount of whining, bitching, or finagling will change that......If you need days off for legitimate things, ask for them. If you get them, be grateful, otherwise, shut up. I find it amusing when I hear my younger classmates pitch a hissy fit and get their panties in a wad when they find out that going to a younger siblings college graduation is not an excusable absence and they're going to get docked 4 points....and they just can't understand why the argument of 'I can't get out of it, my parents want me to go' doesn't wash.....what, are mommy and daddy going to set your schedule in residency also?

As I was once told, 'It's better for you to report in sick and make them send you home, rather than to call in sick. It shows commitment and people respect that....'.

To back up what I'm saying, there were two students on a service I was on but not on the same team, that were asking me about call schedule. This was early in 3rd year and they hadn't taken call on this particular service yet. I briefly told them the call schedule and they loudly responded with,'Well that just sucks' when I mentioned the way the call worked on weekends and nights, etc. While we were talking, I noticed my resident eyeballing them. After they left, I went over and mentioned the conversation and told him how I felt (and truly do) - I was part of blue team and if blue team was in house, I was in house for as long as blue team was there. He complimented me on my attitude at that time and indicated it was what they were looking for.....

Anyway, short version - you adapt to the schedule---and try to do so without complaining...

It sounds to me as if you're a bit of a suck up. Frankly, a younger sibling's college graduation is a valid excuse for a student. Not a resident, but for a student, yes.

 

[Scaredshizzles]

It sounds to me as if you're a bit of a suck up. Frankly, a younger sibling's college graduation is a valid excuse for a student. Not a resident, but for a student, yes.

Yea, that last paragraph about going up to the resident afterwards and saying basically that he wasn't like the other students and believed in being a team player qualifies for douche bag status. He'll eventually learn that that is what his colleagues think about him.

 

[Pinkertinkle]

While we were talking, I noticed my resident eyeballing them. After they left, I went over and mentioned the conversation and told him how I felt (and truly do) - I was part of blue team and if blue team was in house, I was in house for as long as blue team was there. He complimented me on my attitude at that time and indicated it was what they were looking for.....

Anyway, short version - you adapt to the schedule---and try to do so without complaining...

Way to suck up.

 

[SouthernSurgeon]

Yea, that last paragraph about going up to the resident afterwards and saying basically that he wasn't like the other students and believed in being a team player qualifies for douche bag status. He'll eventually learn that that is what his colleagues think about him.

Agree

 

[USArmyDoc]

I think I've only had one rotation - Peds - where my weekends were my own. Otherwise, I had to work weekends as needed. Even in Peds, if they'd have scheduled it, you work it.

You better get used to the idea, right now, that your life is no longer your own....You live and die by the schedule that is set for you and no amount of whining, bitching, or finagling will change that......If you need days off for legitimate things, ask for them. If you get them, be grateful, otherwise, shut up. I find it amusing when I hear my younger classmates pitch a hissy fit and get their panties in a wad when they find out that going to a younger siblings college graduation is not an excusable absence and they're going to get docked 4 points....and they just can't understand why the argument of 'I can't get out of it, my parents want me to go' doesn't wash.....what, are mommy and daddy going to set your schedule in residency also?

As I was once told, 'It's better for you to report in sick and make them send you home, rather than to call in sick. It shows commitment and people respect that....'.

To back up what I'm saying, there were two students on a service I was on but not on the same team, that were asking me about call schedule. This was early in 3rd year and they hadn't taken call on this particular service yet. I briefly told them the call schedule and they loudly responded with,'Well that just sucks' when I mentioned the way the call worked on weekends and nights, etc. While we were talking, I noticed my resident eyeballing them. After they left, I went over and mentioned the conversation and told him how I felt (and truly do) - I was part of blue team and if blue team was in house, I was in house for as long as blue team was there. He complimented me on my attitude at that time and indicated it was what they were looking for.....
Anyway, short version - you adapt to the schedule---and try to do so without complaining...

WTF?? Why would you run over to the resident and say that. If he asks, just tell him you were talking about call. I don't know of anyone who likes working on the weekends. I don't like it but I don't hate it either. That is the way medicine is....simple.....but to run over and do that.....wow

 

[medschoolmania]

Yea, that last paragraph about going up to the resident afterwards and saying basically that he wasn't like the other students and believed in being a team player qualifies for douche bag status. He'll eventually learn that that is what his colleagues think about him.

definetly

 

[JPmamd09]

There's a way to work your butt off and have it get noticed. A good student doesn't have to say he/she is a team player - it's easily picked up on by the rest of the team if he/she is.

But back to the original question: my experience at my school was pretty variable from rotation to rotation and even from site to site within rotations. For example, the surgical rotation sites varied significantly - from q3-q4 in house call to q7 sometimes in house/sometimes at home to q2-3 home call. Weekends on call started a little later than weekdays and ended earlier if no surgeries or emergencies came up. For us, peds was always q4 until 10pm during in patient; medicine was the same, however medicine teams would often let us do one admit then go home. The post-call day was a normal day. Weekend call days were like weekday call days, but if you weren't on call you were off. Ob was q6 overnight. Psych had some call, but it was pretty laid back.

If something comes up and you need time off, see if your team can help you swing it. You can always offer to make up an extra call with another team. And sometimes stuff happens. While I was on surgery call my grandma had a heart attack, and basically death was immanant. And I figured surgery of all rotations would be the least understanding. Well, my resident let me go home that night and told me to stay home the next day. When I showed up my senior gave me a hug and told me to go home and do what I needed to do. The course director told me not to worry about making anything up, and I ended up taking like three or four days off altogether (my grade wasn't impacted at all) to spend her last days with her. So you never know - plus I realized that my preconceived notions about surgeons were stupid.

 

[KeyzerSoze]

You better get used to the idea, right now, that your life is no longer your own....You live and die by the schedule that is set for you and no amount of whining, bitching, or finagling will change that......If you need days off for legitimate things, ask for them. If you get them, be grateful, otherwise, shut up. I find it amusing when I hear my younger classmates pitch a hissy fit and get their panties in a wad when they find out that going to a younger siblings college graduation is not an excusable absence and they're going to get docked 4 points....and they just can't understand why the argument of 'I can't get out of it, my parents want me to go' doesn't wash.....what, are mommy and daddy going to set your schedule in residency also?

Au contraire... Get used to the idea that everything in life is a trade off and comes with a cost, and that attending a sibling's graduation may be worth being docked 4 points on your rotation grade.

 

[45408]

I find it amusing when I hear my younger classmates pitch a hissy fit and get their panties in a wad when they find out that going to a younger siblings college graduation is not an excusable absence and they're going to get docked 4 points....and they just can't understand why the argument of 'I can't get out of it, my parents want me to go' doesn't wash.....what, are mommy and daddy going to set your schedule in residency also?

No kidding. One of my classmates is a true team player, and even though his wife whined pretty hard when he said he couldn't make it to her delivery in time, he stuck through it and made sure to see that consult in the ER.

 

[Doctor Bagel]

About the not missing anything ever sentiment. You're a med student. The world's not going to fall apart if you're not there, so don't miss very important things in your life just to make some possibly miserable resident happy. And I'm saying miserable here because a non-miserable resident would be happy for you to take off for legitimate family stuff.

 

[SouthernSurgeon]

About the not missing anything ever sentiment. You're a med student. The world's not going to fall apart if you're not there, so don't miss very important things in your life just to make some possibly miserable resident happy. And I'm saying miserable here because a non-miserable resident would be happy for you to take off for legitimate family stuff.

Agree with this. One of my peds interns at the beginning of the year (who went to my med school as well) gave me very similar advice (b/c she skipped an important event and regretted it), and it was well-appreciated.

 

[DaveinDallas]

Ding,ding,ding.....guilty of stupid douchebag moment......

Once again, the forums cure the cranial-rectal 'I can't believe
I got that stupid' inversion.....

 

[plainolerichie]

Ob/Gyn- 1 call every two weeks, and mine were all on Friday!
Peds, Medicine- Worked q4 call, if that day feel on a weekend either on call or post call, then I worked that day and the day after, weekend be damned; basically every 3/4 weekends had the whole weekend off and every 3/4 weeks had no days off!, the rest I had one day off
Family, Pysch - No weekend!!!
Surgery for us was q6 overnight call; if on call or post call on weekend, had to be there. If not, you got one day off the weekend
Ortho rotation- did call every weekend and worked M-F, including 2 weeks with no day off...

 

[Jamers]

So I have a question for 3rd and 4th year and that is about how the schedual is going to work during the weekends of your rotations? Are you on-call or something all the times during the weekends? or when its friday evening and you are off then you have the whole weekend for yourself to travel, go get drunk or whatever ...

Let's see:

Peds: we did two weekends, mainly just rounding on the patients, done by noon.

Geriatrics: it was basically an IM rotation so I hardly ever saw the light of day. Pretty much every weekend.

Psych: no weekends.

FP: No weekends

Surgery: Out of 26 days on the rotation, I was in the hospital 25.

ER: two Saturdays

Ob/GYN: Two weekends

Cardio: no weekends.

IM: So far, We have two weekends on call



You honestly just get used to it and its not that bad. I have this weekend off.

 

[Jamers]

No kidding. One of my classmates is a true team player, and even though his wife whined pretty hard when he said he couldn't make it to her delivery in time, he stuck through it and made sure to see that consult in the ER.

And now, hes divorced. Somethings are more important in life.

 

[KeyzerSoze]

And now, hes divorced. Somethings are more important in life.

Whoosh...

 

[plainolerichie]

I really don't think it is fair to be too critical to medical school students not wanting to miss important personal events and weekends etc. Students ARE NOT residents! Students aren't exactly needed in the hospital nor are we getting paid to be there and to be frank, we aren't that useful other than grabbing order forms, charts, etc. And unless it is a sub-I, most aren't going into the field they are rotating in but are there there only for education. Of all the times I've been on call, I NEVER learned even a fraction as much at 2:30 in the morning on a surgery rotation than I would have at 2:30 in the afternoon. Even in surgery/Ob-gyn at night, the residents and attendings are too grumpy and tired to really teach anything.

In my opinion, med-students don't need to "train" or "get used to" spending the 80+ hours in the hospital, missing important personal stuff, not having weekends off, etc. There's no need to train just to miss crap and be miserable. All it is useful for is making life harder than it needs to be during medical school. It will all happen in due time for all of us as residents.

I'm going into a surgery specialty by the way, and doing 3.5 months of sub-I's this year, then residency (which I've already written off as no free time in my life both the sub-I's and residency) but that's my choice. I always felt bad when my fellow med student not wanting to do surgery during my rotation who had to stick there all the time, on call, sometimes working 13 days in a row, and in the hospital or class 80 hrs a week, etc. I just always felt there was no point and they were not learning anything with that extra time.

Anyways, just my two cents...

 

[Non-TradTulsa]

You better get used to the idea, right now, that your life is no longer your own....You live and die by the schedule that is set for you and no amount of whining, bitching, or finagling will change that......

God, what a great quote. True, dat.

jhu1, I gather the root of your question is that you're asking what 3rd year is going to be like (4th year, praise God, is a different story). My friend, fasten your seatbeat, 'cause it's gonna be a bumpy year.

So, you had time to "get drunk" on the weekends in 1st year/2nd year? Well, 1st and 2nd year are a lot of work and the tests are hard. But, in 3rd year, they have "shelf exams" at the end of each rotation and they're rather important to your future. Wanna do well on them? Study. Study hard. But, wait, didn't we just say that you'll be working in the hospital all day - and quite a few weekends as well? Yes, we did. So, when do you study? Whenever you jolly well can... only it'll be on your time, not your rotation's time. Which means that, if you want to do well, the very few "free" hours you have at night and on the weekends off you do get - you're going to be studying.

For OB/Gyn, Medicine, and Surgery - at a bare minimum - you can pretty much forget about free time where you can party and relax. That's just not how it works.

But, we survived it - you will too. Gotta tell you, though - been there, done that - so, better you than me, buddy.

 

[Doctor Phil]

Depending on the service, interns work up to 80 hours a week, right? How many hours/week "at work" is a reasonable schedule for a 3rd year med student?

Obviously students need to have clinical experiences, BUT must also have protected time to study.

A lot is expected of you once you get to residency. Not so much as a student. Your job is to learn.

I think this talk about being a "team player" has missed the mark. Being a team player does not mean doing everything that everyone else does no matter what. A team relies on different people for different things. On this type of team, there are junior and senior members, and it is the responsibility of the junior members to learn what they need to know to contribute when their time comes. AND, it is the responsibility of the senior members of the team to have the self-awareness and the perspective to acknowledge that the junior members have different needs due to the fact that they are in a different stage of their training.

The stories above illustrate some cases where the team has good leadership and an enlightened approach to medical education, and some cases where it sounds like there is a lack of leadership and students are being hazed. It's classic: people who are abused often turn around and abuse others.

Doctors are not inherently good teachers. In fact, they often lack the most basic pedagogical acumen and lack the time, incentive, or desire to develop it. On the other hand, there are great teachers everywhere, if you can find them. As students, we have to make the best of our situation, whatever it may be.

It is overly simplistic to say "60 hours a week makes a good doctor." 60 hours/week doing what? If the 60 hours is spent constructively, with protected time for study, with clear guidance and good mentoring, with challenges appropriate to your level of training, etc, then this will be time well-spent.

But if you spend 60 hours a week searching through the records room for files, commuting to an unrealistically far away satellite clinic, trying to figure out hospital software that no one bothered to show you how to use, etc, then this is wasted time.

Giving a 3rd year student an intern's schedule is a cop out. It is the easiest way to keep the student busy without coming up with a level-appropriate clinical curriculum.

Interns' schedules are for interns, and when you get there, it is what it is. It's a phase of training and it has a purpose at that moment in time. But I strongly disagree with the ill-conceived notion that a 3rd year medical student needs to be "prepped" by working the same schedule. Variability between the specialties makes sense, and experiencing that for a short window of time is beneficial. But to say that "because the intern works X hours, the student will also work X hours" is short-sighted and counterproductive, leading to early burn-out, decreased efficiency, loss of passion, and sub-optimal educational outcomes.

What do you think?

 

[KeyzerSoze]

I'm just an incoming M1, but FWIW I think that makes a lot of sense. I also applaud your use of a five-stage emphasis system; however, you could expand it to seven by allowing bold underlined and bold underlined italics.

 

[hippiedoc13]

Obviously students need to have clinical experiences, BUT must also have protected time to study.

A lot is expected of you once you get to residency. Not so much as a student. Your job is to learn.

I'm sorry, but what do you think the intern or resident's job is, exactly?

FYI, our job involves BOTH taking care of patients AND learning. The two go hand-in-hand. I have to know a lot more than you do...and there's no protected time for me to study. And in my job, the test isn't once every six weeks...it's every single day, multiple times per day. Deficits in our knowledge represent more than missed points on a test...they could mean a bad outcome for a patient.

Point is, your need to study is in no way more important than my need to study. And I find time to do it...at the end of a 14 hour day. You can too.

I'm not advocating for torturing med students just for the sake of torture. But you do need to learn how to integrate clinical and learning responsibilities, before you become a resident. And the only way to learn that skill is to practice doing it.

 

[Doctor Phil]

I'm sorry, but what do you think the intern or resident's job is, exactly?

FYI, our job involves BOTH taking care of patients AND learning. The two go hand-in-hand. I have to know a lot more than you do...and there's no protected time for me to study. And in my job, the test isn't once every six weeks...it's every single day, multiple times per day. Deficits in our knowledge represent more than missed points on a test...they could mean a bad outcome for a patient.

Point is, your need to study is in no way more important than my need to study. And I find time to do it...at the end of a 14 hour day. You can too.

I'm not advocating for torturing med students just for the sake of torture. But you do need to learn how to integrate clinical and learning responsibilities, before you become a resident. And the only way to learn that skill is to practice doing it.

Hippiedoc, I agree 100%. In fact, I would argue (collegially, of course) that because of the incredible responsibility and pressure placed on interns and residents, it is of paramount importance that 3rd and 4th year medical students have protected time to study in addition to a rigorous clinical schedule.

My point was that there's a spectrum. Before you have the responsibility of signing off on patient orders, you've got a long way to go. The truth is, the intern/early resident is right in the middle of this spectrum, so they get it the roughest.

If I told you "you have to run a marathon 2 months from now," I don't think you would go out and start training by running a marathon. You need to build up to that. You don't run the marathon until it's time. Not even once. Likewise, there is no point to making a 3rd year student work intern hours "just because" they'll have to later. That's like saying "you have to run a marathon next month, so I want you to run one now." You'll get injured, you'll burn out, you'll be sore for 2 weeks and miss out on important training time. And worst of all, you will not perform as well as you could perform when the real marathon comes.

Now as I said, if there is a solid clinical curriculum that takes place within these hours, then so be it. But lacking that - and some places are doing exactly that - I think it's just an ill-conceived notion or a cop out.

 

[Doctor Phil]

I'm just an incoming M1, but FWIW I think that makes a lot of sense. I also applaud your use of a five-stage emphasis system; however, you could expand it to seven by allowing bold underlined and bold underlined italics.

Thanks so much for your kind comments.

 

[Law2Doc]

Hippiedoc, I agree 100%. In fact, I would argue (collegially, of course) that because of the incredible responsibility and pressure placed on interns and residents, it is of paramount importance that 3rd and 4th year medical students have protected time to study in addition to a rigorous clinical schedule. ...

Nah, you are missing the point. In third year you will see that things shift from the form of classroom learning you had up to that point, to a form of learning that is actually much better suited to becoming a clinician. You learn from doing. The classroom/book learning stuff is well and nice, but very very very secondary. For this reason residencies are going to pretty much completely ignore the first two years of med school, and focus on later year evals (along with the boards). The reading isn't something that should be considered of paramount importance and protected, it is something you of necessity have to shoehorn around that which is actually of the paramount importance. This is hard for premeds to realize -- that the form of learning they had done up until now isn't the right way to learn to practice medicine. You learn by being on the wards. You fine tune by reading. So no, you shouldn't have protected time to study. You should focus on the clinical stuff and squeeze the study in where you can. That's the way the rest of your career works. You learn on the job. It's like an apprenticeship -- you get more and more experience, starting out working under folks, and develop into a good clinician. Along the way, you read, because it helps the clinical stuff, not because it is something independently important. You can learn more reading on the side while doing, than you can with time set aside reading. This is a very hard concept for premeds, because again, it's a big shift from how you have been trained up to now. But that's sort of the point -- third year and beyond is really the start of your training, the years prior to that are just foundation. You will squeeze in reading on the side first because it is self preservation to do so (due to pimping), and later because it will be patient preservation to do so. No need to set aside blocks, which of necessity would come out of the more important ward time.

It's a very different form of education, but much much more useful in training you how to be a good doctor. Any good doctor can look up things he doesn't know, but it's much harder for someone full of facts to learn how to be a good doctor unless he's logged the time on the wards. So this is where you seem to miss the point -- that the real education doesn't come during that reading time, and so no, you absolutely positively should not have "protected time" for this -- you should be expected to squeeze this in where you can, as you might any secondary focus. It's not the primary one. The premed in you makes you focus on the book learning, but you are gradually going to be broken from this focus starting in third year, and by the time you are in residency, you will get why your idea is a bit off focus.

 

[FractureFixer]

Nah, you are missing the point. In third year you will see that things shift from the form of classroom learning you had up to that point, to a form of learning that is actually much better suited to becoming a clinician. You learn from doing. The classroom/book learning stuff is well and nice, but very very very secondary. For this reason residencies are going to pretty much completely ignore the first two years of med school, and focus on later year evals (along with the boards). The reading isn't something that should be considered of paramount importance and protected, it is something you of necessity have to shoehorn around that which is actually of the paramount importance. This is hard for premeds to realize -- that the form of learning they had done up until now isn't the right way to learn to practice medicine. You learn by being on the wards. You fine tune by reading. So no, you shouldn't have protected time to study. You should focus on the clinical stuff and squeeze the study in where you can. That's the way the rest of your career works. You learn on the job. It's like an apprenticeship -- you get more and more experience, starting out working under folks, and develop into a good clinician. Along the way, you read, because it helps the clinical stuff, not because it is something independently important. You can learn more reading on the side while doing, than you can with time set aside reading. This is a very hard concept for premeds, because again, it's a big shift from how you have been trained up to now. But that's sort of the point -- third year and beyond is really the start of your training, the years prior to that are just foundation. You will squeeze in reading on the side first because it is self preservation to do so (due to pimping), and later because it will be patient preservation to do so. No need to set aside blocks, which of necessity would come out of the more important ward time.

It's a very different form of education, but much much more useful in training you how to be a good doctor. Any good doctor can look up things he doesn't know, but it's much harder for someone full of facts to learn how to be a good doctor unless he's logged the time on the wards. So this is where you seem to miss the point -- that the real education doesn't come during that reading time, and so no, you absolutely positively should not have "protected time" for this -- you should be expected to squeeze this in where you can, as you might any secondary focus. It's not the primary one. The premed in you makes you focus on the book learning, but you are gradually going to be broken from this focus starting in third year, and by the time you are in residency, you will get why your idea is a bit off focus.

I dont think its very secondary when the reading is what will allow you to pass and ace the shelf exams. No reading = most likely fail. So it is not really secondary. It is a necessary part of 3-4 year. But I will allow the rest of your post which was okay.

 

[hippiedoc13]

I dont think its very secondary when the reading is what will allow you to pass and ace the shelf exams. No reading = most likely fail. So it is not really secondary. It is a necessary part of 3-4 year. But I will allow the rest of your post which was okay.

Passing shelf exams is not the primary objective of 3rd and 4th year. Learning how to take care of patients is. You can't learn how to manage patients while sitting at home on your couch with a textbook.

Trust me, managing one patient with CHF will stick in your mind so much more clearly than reading about it 5 times without that clinical experience.

 

[Doctor Phil]

Nah, you are missing the point. In third year you will see that things shift from the form of classroom learning you had up to that point, to a form of learning that is actually much better suited to becoming a clinician. You learn from doing. The classroom/book learning stuff is well and nice, but very very very secondary. For this reason residencies are going to pretty much completely ignore the first two years of med school, and focus on later year evals (along with the boards). The reading isn't something that should be considered of paramount importance and protected, it is something you of necessity have to shoehorn around that which is actually of the paramount importance. This is hard for premeds to realize -- that the form of learning they had done up until now isn't the right way to learn to practice medicine. You learn by being on the wards. You fine tune by reading. So no, you shouldn't have protected time to study. You should focus on the clinical stuff and squeeze the study in where you can. That's the way the rest of your career works. You learn on the job. It's like an apprenticeship -- you get more and more experience, starting out working under folks, and develop into a good clinician. Along the way, you read, because it helps the clinical stuff, not because it is something independently important. You can learn more reading on the side while doing, than you can with time set aside reading. This is a very hard concept for premeds, because again, it's a big shift from how you have been trained up to now. But that's sort of the point -- third year and beyond is really the start of your training, the years prior to that are just foundation. You will squeeze in reading on the side first because it is self preservation to do so (due to pimping), and later because it will be patient preservation to do so. No need to set aside blocks, which of necessity would come out of the more important ward time.

It's a very different form of education, but much much more useful in training you how to be a good doctor. Any good doctor can look up things he doesn't know, but it's much harder for someone full of facts to learn how to be a good doctor unless he's logged the time on the wards. So this is where you seem to miss the point -- that the real education doesn't come during that reading time, and so no, you absolutely positively should not have "protected time" for this -- you should be expected to squeeze this in where you can, as you might any secondary focus. It's not the primary one. The premed in you makes you focus on the book learning, but you are gradually going to be broken from this focus starting in third year, and by the time you are in residency, you will get why your idea is a bit off focus.

L2D,

I don't know... maybe I am the naive 3rd year medical student you describe, or maybe we just disagree. I'll grant you this: you're a few years ahead of me in training, and probably have some perspective that I don't have. So perhaps when I get there, I'll see things your way.

But I also think that you might be missing what I'm saying. So let me spell it out.

• 
  Part 1: The clinical, hands-on portion of the 3rd and 4th year medical student's training is the most important component in undergraduate medical education. It should be filled with valuable clinical training.

• 
  Part 2: It is also important to use this clinical experience as a springboard for exploration of the pertinent literature, which will de facto (since I take it you are also conversant in legal lingo) occur at a time other than while the student is engaged in clinical activities.

What do you disagree with?

You seem to take issue with the term "protected time". Medical students and residents have been abused for years. This is common knowledge. Thus I use the word "protected". Recently, residents - and as an extension, their patients - were afforded protection in terms of defining their work hours. Before that, older docs - who had been through the earlier system - thought it was the best and only way to educate physicians. You are now enjoying the benefits (believe it or not) of the reformers who came before you.

To argue that 3rd year medical students and residents need the same educational experience (if that's what you're doing) is pedagogically unsound. They're at different stages of their training. Need I say more?

And last time, I gotta emphasize this point: If the clinical experience is rocking, bring it on. But if you're just filling my time, let me go study.

Let me explain where I'm coming from. The service I'm on (my first) was not well-prepared to take medical students. Apparently there was some miscommunication about how many students there would be and when we were starting. As a result of this, the other day I ended up getting assigned to spend several hours sitting in on nutritional consults ("eat normal portions") in Spanish (which I don't speak). Do you think this was a good use of my time?

 

[Law2Doc]

I dont think its very secondary when the reading is what will allow you to pass and ace the shelf exams. No reading = most likely fail. So it is not really secondary. It is a necessary part of 3-4 year. But I will allow the rest of your post which was okay.

You need to learn to pass tests reading on the sly, not through protected time. That's the way the rest of your career will play out -- you will always have boards or specialty boards or renewals you need to squeeze in on top of practice. It's expected that you keep learning in your own time in this career. But to have protected time is putting the focus on the wrong thing. It's saying -- school is about sitting and reading, and in fact third year is where you are supposed to start breaking away from that notion. Which is why it's a hard concept for folks who are coming out of 4 years of college and two years of med school which were primarily didactic and into the next phase of their life which will be primarily clinical.

 

[Law2Doc]

...
What do you disagree with?

You seem to take issue with the term "protected time". Medical students and residents have been abused for years. This is common knowledge. Thus I use the word "protected". Recently, residents - and as an extension, their patients - were afforded protection in terms of defining their work hours. Before that, older docs - who had been through the earlier system - thought it was the best and only way to educate physicians. You are now enjoying the benefits (believe it or not) of the reformers who came before you.

To argue that 3rd year medical students and residents need the same educational experience (if that's what you're doing) is pedagogically unsound. They're at different stages of their training. Need I say more?

And last time, I gotta emphasize this point: If the clinical experience is rocking, bring it on. But if you're just filling my time, let me go study.

Let me explain where I'm coming from. The service I'm on (my first) was not well-prepared to take medical students. Apparently there was some miscommunication about how many students there would be and when we were starting. As a result of this, the other day I ended up getting assigned to spend several hours sitting in on nutritional consults ("eat normal portions") in Spanish (which I don't speak). Do you think this was a good use of my time?

Here's the deal. First, you might have a different view of how "protected" you are as a resident in terms of the 80 hour week when you get there. Many places are not yet in compliance, and even those that are tend to be protecting you out of moonlighting money (as moonlighting time would have to fit into that 80 hour cap), and finding various home networking ways to still have you working from home after the 80 hours is up. So the "benefits of the reformers who came before" is probably overstated, except in the more oppressive fields.

Second, you keep saying med students and residents are at different phases of their training and should be treated differently. Guess what -- once you get into third year the whole point is to start the transition to being clinically, not didactically educated. Hate to break it to you, but second year ended, and you are now in the next phase of your education, which is meant to be closer to the resident phase than the classroom phase. You still have some didactics, I'm sure, but in general, that phase of your life, the one where you cush up to a book with no other expectations but to read, has ended. You are no longer classroom wonks, you are clerking. That means you will primarily learn on the wards. Trying to draw a line and say, med students learn by sitting and reading in protected time, while only being on the wards part of the time, when there's cool stuff to do, is trying to recreate medical education. Your protected time to study ends with second year. Trying to cling to that form of education beyond second year is what is "pedagogically unsound". You are now in the next phase of your education -- one where you learn by doing and seeing, and squeeze in reading where you can. Get used to it -- it's the model that will be with you for the rest of your career. And it starts in third year, not once you hit residency. And no, the expectation won't be the same as for residents, don't you worry. But the format will be, from here on out.

Third, the problem with real life is it doesn't play out like a nice tight story. There's a lot of scut. You don't get to say, if things are "rocking" I'm there, but otherwise I don't see the point. Because taking the bad with the good has always been part of the apprenticeship model. There will be days where there is nothing cool that a med student can participate in, where the learning value is nil. So too with residents (who are still there for training). If there's something you can help out with, even if it's scut, you do it. Because you are being evaluated at teamwork, and at working with people/patients/coworkers. Sure, there will be hours where you feel like you could learn more in a book. And there will be programs that take on med students and aren't particularly sure how to use them. But that isn't really a good argument for a universal, "protected time" for book study. It's only an argument that programs that take med students should figure out how best to integrate them. Pairing them up with residents usually helps -- you don't always see the glamorous stuff, but at least you see patients. But saying -- I'm not learning much here so give me protected book time is trying to go back to second year -- basically trying to climb back into the womb. Sorry but that phase of your education ended and you will see will actually not have been the most effective phase of your career training -- just very good foundation on which to actually learn. Push forward, and you will see.

 

[FractureFixer]

You need to learn to pass tests reading on the sly, not through protected time. That's the way the rest of your career will play out -- you will always have boards or specialty boards or renewals you need to squeeze in on top of practice. It's expected that you keep learning in your own time in this career. But to have protected time is putting the focus on the wrong thing. It's saying -- school is about sitting and reading, and in fact third year is where you are supposed to start breaking away from that notion. Which is why it's a hard concept for folks who are coming out of 4 years of college and two years of med school which were primarily didactic and into the next phase of their life which will be primarily clinical.

I see what you are saying, its not important to becoming a clinician as is on-the-job training although it is important for continuing your knowledge base. I guess I am one of "those", scared of not knowing what I am doing come monday. I would rather be reading a textbook!!

 

[Doctor Phil]

Here's the deal. First, you might have a different view of how "protected" you are as a resident in terms of the 80 hour week when you get there. Many places are not yet in compliance, and even those that are tend to be protecting you out of moonlighting money (as moonlighting time would have to fit into that 80 hour cap), and finding various home networking ways to still have you working from home after the 80 hours is up. So the "benefits of the reformers who came before" is probably overstated, except in the more oppressive fields.

Second, you keep saying med students and residents are at different phases of their training and should be treated differently. Guess what -- once you get into third year the whole point is to start the transition to being clinically, not didactically educated. Hate to break it to you, but second year ended, and you are now in the next phase of your education, which is meant to be closer to the resident phase than the classroom phase. You still have some didactics, I'm sure, but in general, that phase of your life, the one where you cush up to a book with no other expectations but to read, has ended. You are no longer classroom wonks, you are clerking. That means you will primarily learn on the wards. Trying to draw a line and say, med students learn by sitting and reading in protected time, while only being on the wards part of the time, when there's cool stuff to do, is trying to recreate medical education. Your protected time to study ends with second year. Trying to cling to that form of education beyond second year is what is "pedagogically unsound". You are now in the next phase of your education -- one where you learn by doing and seeing, and squeeze in reading where you can. Get used to it -- it's the model that will be with you for the rest of your career. And it starts in third year, not once you hit residency. And no, the expectation won't be the same as for residents, don't you worry. But the format will be, from here on out.

Third, the problem with real life is it doesn't play out like a nice tight story. There's a lot of scut. You don't get to say, if things are "rocking" I'm there, but otherwise I don't see the point. Because taking the bad with the good has always been part of the apprenticeship model. There will be days where there is nothing cool that a med student can participate in, where the learning value is nil. So too with residents (who are still there for training). If there's something you can help out with, even if it's scut, you do it. Because you are being evaluated at teamwork, and at working with people/patients/coworkers. Sure, there will be hours where you feel like you could learn more in a book. And there will be programs that take on med students and aren't particularly sure how to use them. But that isn't really a good argument for a universal, "protected time" for book study. It's only an argument that programs that take med students should figure out how best to integrate them. Pairing them up with residents usually helps -- you don't always see the glamorous stuff, but at least you see patients. But saying -- I'm not learning much here so give me protected book time is trying to go back to second year -- basically trying to climb back into the womb. Sorry but that phase of your education ended and you will see will actually not have been the most effective phase of your career training -- just very good foundation on which to actually learn. Push forward, and you will see.

L2D,

It seems you are attributing some sentiments to me which I do not hold. When you make counterarguments against these, I guess that's what you'd call "ad hominem". For instance, asking for a few hours of protected reading time in a 60 or 70 hour work week doesn't seem like "cling(ing) to that form of education beyond second year" or "trying to climb back into the womb." Characterizing it as such makes your argument sound stronger, but it is not accurate. Believe me, I'm psyched the preclinical phase is over and the real fun can begin. I also feel compelled to look up the latest literature along the way.

Other than a few minor differences, I actually think we agree on general principles.

And you are definitively right that programs that take on med students should figure out how best to integrate them. I understand that's a separate (but related) issue. Solve this problem and the rest of this conversation may be moot.

Anyway, if you are in fact a lawyer by previous training, then there's no way I can win this "argument" so I'll leave it at that.

 

[Law2Doc]

I see what you are saying, its not important to becoming a clinician as is on-the-job training although it is important for continuing your knowledge base. I guess I am one of "those", scared of not knowing what I am doing come monday. I would rather be reading a textbook!!

You'd rather be reading a text book because that's what you are familiar and comfortable with, not because it's the "right" way to learn medicine. You will get past this.

 

[pseudoknot]

It seems you are attributing some sentiments to me which I do not hold. When you make counterarguments against these, I guess that's what you'd call "ad hominem".

I think making arguments against a position that your opponent doesn't really hold is usually referred to as the "straw man" fallacy. Ad hominem means arguing against your opponent's personal qualities rather than the matter being discussed.

http://www.nizkor.org/features/fallacies/

 

[plainolerichie]

You need to learn to pass tests reading on the sly, not through protected time. That's the way the rest of your career will play out -- you will always have boards or specialty boards or renewals you need to squeeze in on top of practice. It's expected that you keep learning in your own time in this career. But to have protected time is putting the focus on the wrong thing. It's saying -- school is about sitting and reading, and in fact third year is where you are supposed to start breaking away from that notion. Which is why it's a hard concept for folks who are coming out of 4 years of college and two years of med school which were primarily didactic and into the next phase of their life which will be primarily clinical.

I had that very idealistic way of learning primarily from the wards during my first rotation, where I even spent extra time on the wards and hospitals for my "real" education in ob/gyn. Then the shelf came, and I almost completely failed the shelf (I think one or two points) and still got bad evals from the clerkship directors, who I never really worked with. It served me little to nothing as far as making it to the next step in my training, which is to get into a residency program, being in the wards/clinics as much as I was to learn. That, and the learning ended up being so repetitive, that my time would have been better served at home in a book.

Since then and for the rest of my rotations, I would try to get home and study books ASAP.

I agree that ideally, during third and fourth year, studying from books should be supplemental and you really would learn in hospital even through all the scut and long hours, but it doesn't help you get to the next step of residency. In reality, evals are such a crap shoot that actually working hard does not seem to matter much, shelves are insanely hard and if you don't study tons from books instead of depending on your clinical experience, you're screwed.

 

[plainolerichie]

And along those lines, I remember when I was in an ortho rotation, ideally, I would have just spent those three weeks focused on working in the hospital/clinic while studying ortho books on the side. I'm sure the interns and resident who are also studying with working would study just "relevant" information. But I, as a med student with a shelf coming up was sitting there in the office (and being teased by my residents btw ) studying "Benign Perianal Diseases" for the shelf. My point is the studying that interns and residents need to do is vastly different than that of medical students. We have to study the management and work up of random **** and everything, not just what is relevant in the speciality we are working.

 

[Doctor Phil]

I think making arguments against a position that your opponent doesn't really hold is usually referred to as the "straw man" fallacy. Ad hominem means arguing against your opponent's personal qualities rather than the matter being discussed.

http://www.nizkor.org/features/fallacies/

Awesome. Love it. And yes, that's what I was trying to say. I wish it had a cool Latin name though. How about "gramen vir" fallacy?

The ad hominem part perhaps is inferring that because we are naive 3rd year students, we don't know any better, and our arguments are therefore without merit. Though I do grant that perspective changes with experience. And I appreciate hearing from people with more experience than me.

 

[doogoshly]

so far, IM q6 call, surg q5

 

[smq123]

I had almost always weekends off even as a 3rd and 4th year med student. It really varies on which university you went to and which hospital you rotate at. I usually just rotated a few hours in the morning in x service and always hed weekend off except for the few times I had call in Traumatology and Ob/Gyn which were just a few times.

As an intern we follow a q3 system so one week I work on Sunday, the next weekend I work on a Saturday and the third week I work on a Friday, deliver the shift on Saturday and depending on the rotation I leave early or not and have something close to a full weekend off in the few rotations I am allowed to deliver the shift quickly. Surgery in my case is annoying in floor workload, but you deliver the shift insanely fast. You usually are free at around 9 am!! W00t! I've heard the other rotations I've yet to do also have this nice characteristic. Peds is the only rotation where you are delivering the shift as late as 5 pm on a weekend.

As for whether your comment is aimed as my job as an intern being light, hrm.. no.

His comment was aimed at the fact that as an MS3, I rarely got weekends off, except for 1 or 2 rotations. I had a LOT of call on OB/gyn and Trauma as a med student - q4 overnight; come in and help round at least one weekend day. I had never had the chance to go home at 9 AM, nor did I have any free time at 9 AM. "Almost always having weekends off" is pretty atypical for a med student in the US.

Even on those rotations where I had weekends off, I still had to study, do write-ups, write reports, write essays, write presentations, prepare journal articles, etc.

Yeah, I wouldn't plan on having a lot of free weekends as an MS3. While it depends on the medical school and the hospital to a small extent, it's generally a lot of work, and extremely tiring. Although my progress notes that were written at the end of a 30 hour shift were pretty funny.