reactions to 3rd year?

[bear]

I am finding some aspects of 3rd year really rewarding and interesting, but I am stunned by the blatant, rampant use of med students as unpaid (in fact, paying) and massively overworked drones. The Q3- or 4 call nights, for example--how can students learn effectively when they are exhausted? Or: I really don't learn much from seeing 20 runny noses during a long day at the clinic, and after that I come home and sit down to teach myself the huge volume of stuff I actually need to learn for the shelf exam. That's crazy.

What amazes me is that no one blinks at this, and that students aim to please no matter how absurd things get. I know that what keeps the whole system floating is students' need for everyone else's approval in order to move on to the next point in our careers, but it is very disappointing. Maybe I'm naive, but I had hoped for better. Any other opinions on this?

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[BeeGee]

I understand your feelings about seeing the same Allergic Rhinitis, Allergic Sinusitis, Acute Nasopharyngitis... and other -itisssss day after day. It can grow BORING. You must be doing your Family Medicine Rotation now. I am also, and it is downright monotonous. Luckily, I saw a couple of acute exacerbations of Crohn's disease that were sprinkled in amongst the constant flow of patients with identical CC's and HPI's all morning long. The residents are getting screwed for real though because they're there when we aren't, and always are there when we are. Sometimes I wonder if they ever go home. They can't call $40,000 for 90+ hours/week getting paid... that's barely a tip. Besides, this year seems to be flying by so maybe the 2nd half of our 3rd year will be better.

 

[Linie]

Hi. I hope people who are applying to med school are reading this because the amount of scut you do depends on your med school. At my school, the residents and attendings are adamant that the student's job is to learn, not to do scut. And q3-q4 call is only a guideline, not something that is enforced (so that if you need a particular day off, you can arrange it), and students are NEVER supposed to take Saturday call, ensuring that they get at least one day off per week. Tell people who are applying to your school what the attitude is like so they can weigh your school against others. And you might want to try to change the attitude at your school... talk to you dean about how you can effectively take action.

There are some residents and attendings here who must have trained at programs that abused students, because their attitudes are so at odds with everyone else's, but they are re-educated quickly.

Best of luck.

 

[postbacchus]

Linie - Where do you go to school?

 

[jen628]

Third year basically sucks no matter how "good" your hours are. There are a few cool moments, such as when you deliver a baby by yourself for the first time. But they don't happen too often.
I also find that in general those who say it isn't so bad are really practicing that victim-adores-the-perpetrator response. But decide for yourself-would you agree when your fellow classmate says, "We have to be there at 5 am, which isn't too bad." Most students (at least the ones I know) lose perspective during the year, if they haven't already.

 

[tonem]

Or maybe third year really isn't so bad. I think its all relative and more a function of the environment and culture of different medical schools and the personal experiences of individual students.

In my case, my experiences have been more in line with Linie's because my school also believes that we as students are there to learn.

Jen, I'm sorry you feel like a victim. That really sucks.

 

[Fanconi]

I just really miss sleeping in on Saturdays!!!

 

[tulanestudent]

ok, sorry, but I think some of you are big whiney babies. One of the major goals of third year is, I think, to help us decide what we want to do when we finish school. Unless we work similar hours that residents do and do the same things they do, how will we really know what life will be like in that field? If we only see the fun and exciting stuff, we don't get a true picture practicing in that field.

One good example is an ortho resdient I worked with, who went to one of those "good" schools that made sure students on surgery always got a lunch break, went home around 6pm daily so they could have plenty of study time, and rarely took call. This guy found himself in internship in a whole different world than he expected to be in, and this I think is partly the fault of his school not exposing him to what real life in surgery is. The same could happen to any students who routinely try to choose the easy hospital or clinic locations for rotations.

And, half way through my third year, enjoying my 2 week holiday break, while my peers with real jobs work chirstmas and new years eve, I don't think we shoudl complain.

 

[Catherine]

What's more amazing is that students pay their (private) schools about 25k and the schools pay nothing for the 3rd and 4th year rotations. So, you pay about 100k for 2 years basic science education. At DO schools this is even more 'criminal' because the full time faculty / student ratio is much lower. Do the math ... a class of 150 generates about 4 million a year. So, from the combined 1 thro 4 years the income is about $16 million a year with only 2 years of basic science classes to run. And, we still hear that tuition fees only partly coves costs! These schools are either run by overpaid / greedy individuals or financial idiots. No wonder every Caribbean island wants a school. No wonder another two DO schools are due to open. That's one hell of a business model, and one that any MBA would laugh at.

The reason you do so much 'scut' is because that is often a facilities motivation for taking in students. Remember, the school is not paying anyone to take you.

It really is about time that the whole medical education system was changed. Most BS classes could be completed as part of u/grad. Then 1 year didactic and 2 years clinical - where students get what they are paying for - that is, being taught.

 

[Nanon]

Originally posted by bear:
•I am finding some aspects of 3rd year really rewarding and interesting, but I am stunned by the blatant, rampant use of med students as unpaid (in fact, paying) and massively overworked drones. The Q3- or 4 call nights, for example--how can students learn effectively when they are exhausted? Or: I really don't learn much from seeing 20 runny noses during a long day at the clinic, and after that I come home and sit down to teach myself the huge volume of stuff I actually need to learn for the shelf exam. That's crazy.

What amazes me is that no one blinks at this, and that students aim to please no matter how absurd things get. I know that what keeps the whole system floating is students' need for everyone else's approval in order to move on to the next point in our careers, but it is very disappointing. Maybe I'm naive, but I had hoped for better. Any other opinions on this?•••


I found this post really interesting in a lot of ways. Unfortunately I don't have the time to comment fully, but you state that you saw 20 runny noses today, when in fact you saw 20 PEOPLE with runny noses today. 20 lifetimes that at this moment are dealing with an out of control mountain of used kleenex on their bedstands and a demanding boss on the phone who wants to know when that runny nose will stop running. Your job is to make the damned appendage stop running, and you make that sound relatively easy. But if your job is easy to the point of being boring, the people attached to those irritating noses are not, I assure you.

The hours are criminal, and there is no other profession that I can think of that requires those kinds of hours for training. But, unless you chain yourself to a White House tree in protest, or quit medschool, this is your lot in life. It's up to you to make this a less soul sucking experience. I think your patients are a good place to start if you are looking for relevance.

Nanon

 

[jen628]

I think the responses in this thread are a perfect example that you will always be able to find people who can justify what they are going through. In fact, it is probably psychologically more healthy to view your "lot" with such submission.

The other common occurence is for those who believe they are happy falling in line to view those who disagree with disdain, or at least intolerance. Otherwise, they might be tempted to actually consider another viewpoint-and this might lead to less comfort in their own position, or "lot."

It's the same story throughout history.

tonem, I'm sorry you misunderstood my post. That really sucks.

 

[tonem]

no problem

 

[freshity]

jen, i think your projecting too much of your own misunderstanding into trying to analyze why some of us aren't losing our minds over the hours issue in third year. have you ever thot that for some of us it's just not that big of a deal? it's that simple. if you implore "us" to try to understand that not everyone feels the way we do, then by necessity you must see that we don't all feel the way you do. and i don't hate you for it--but i'm not going to wrap my head (and my pop psychology) around why you feel the way you do. i'll leave that up to you. personally, i've lived thru a lot worse things than getting to a hospital at 5:00am everyday--no matter how many days i have to do that. and it's not just me: people feel this way for a variety of reasons. i never want to lose this sense of perspective. on my worst day in the hospital, at least 100 of the people i come in contact would trade places with me in a heartbeat. i'll never shake that feeling. it's not even all that profound. call it what you want, tho. i hope it turns out well for you.

i'm in medical school. i want this. to me, it's pretty awesome. the hours???!!!!

 

[Billie]

I'm with you Fre****y. But I think my perspective comes from the "old person" perspective Since I was out working for 10 years before I started med school, I had plenty of 60+ hour weeks (I admit I don't think I approached 80-100 hour weeks) as just a secretary. So being in surgery at 7am, and having to be at the hospital even earlier than that is just not that big of a deal. I am definitely a night owl and prefer sleeping in, but oh well. You do what you have to do.

And your final line speaks to me as well...

•i'm in medical school. i want this. to me, it's pretty awesome. the hours???!!!!•••

 

[bear]

Everybody!

Let's not get all global and moralistic about this. My point was only that the 3rd year--a time for learning lots and lots of medicine (and then demonstrating that knowledge on difficult shelf exams) is structured so that conditions make it really hard to achieve that goal!

We are not yet being paid to do a job--we are paying to learn. Although of course that includes learning about what it's going to be like to practice later (the rewards of helping as well as the frustrations of feeling exhausted and racing the clock), most of it still needs to be about hard-core medicine (signs, sympts, differentials, tx...).

Nanon, I couldn't agree more that the "runny noses" I mentioned were attached to actual people (kids, in fact--it was peds outpatient). I would love to be able to see them regularly, and to get to know them and their families. There are 2 things that make it hard to see past the runny noses: One is having only 5 minutes with each patient, and of course this is part of practicing medicine these days--a huge frustration for everyone, but a fact of the profession now, and anyway NOT what I was writing about.

The other is what I have tried to say earlier--at this stage of my training I am still paying to learn about diagnosing and treating diseases, and while seeing 20 instances of one thing certainly teaches me about that topic, it doesn't help me with that goal. Being kept chronically exhausted doesn't, either. Right now I am a student, not an employee (and I don't think they should be abused either, although that too is another topic...).

Anyone who chooses a career in medicine now has to decide that the years of training, the (still) quite rigid culture, the mountains of work and the endless hours are worth the many, many rewards. If you don't truly feel that, you will be unhappy, because although some of those characteristics might change--sometime, in some places--that's what we have now. All I am saying is that the 3rd year of med school is stunning in its inefficiency for learning and its abuse of students, and that I am amazed that we put up with it.

 

[bear]

Everybody!

Let's not get all global and moralistic about this. My point was only that the 3rd year--a time for learning lots and lots of medicine (and then demonstrating that knowledge on difficult shelf exams) is structured so that conditions make it really hard to achieve that goal!

We are not yet being paid to do a job--we are paying to learn. Although of course that includes learning about what it's going to be like to practice later (the rewards of helping as well as the frustrations of feeling exhausted and racing the clock), most of it still needs to be about hard-core medicine (signs, sympts, differentials, tx...).

Nanon, I couldn't agree more that the "runny noses" I mentioned were attached to actual people (kids, in fact--it was peds outpatient). I would love to be able to see them regularly, and to get to know them and their families. There are 2 things that make it hard to see past the runny noses: One is having only 5 minutes with each patient, and of course this is part of practicing medicine these days--a huge frustration for everyone, but a fact of the profession now, and anyway NOT what I was writing about.

The other is what I have tried to say earlier--at this stage of my training I am still paying to learn about diagnosing and treating diseases, and while seeing 20 instances of one thing certainly teaches me about that topic, it doesn't help me with that goal. Being kept chronically exhausted doesn't, either. Right now I am a student, not an employee (and I don't think they should be abused either, although that too is another topic...).

Anyone who chooses a career in medicine now has to decide that the years of training, the (still) quite rigid culture, the mountains of work and the endless hours are worth the many, many rewards. If you don't truly feel that, you will be unhappy, because although some of those characteristics might change--sometime, in some places--that's what we have now. All I am saying is that the 3rd year of med school is stunning in its inefficiency for learning and its abuse of students, and that I am amazed that we put up with it.

 

[Voxel]

"I am amazed that we put up with it." What are you going to do about it? Form a union and strike? You'll take it like a man (or woman) in the drill seargents medical college. Drop and give me 20.

 

[jen628]

Apparently my anecdote about long hours has been misinterpreted to represent my entire opinion of third year. Figures.

As I said initially, there are a few cool things. At our stage, however, the negatives often outweight the positives. Frequent long hour shifts are merely one of these negatives. Let's put it this way, we would be good subjects for Marmot to continue to study the effects of lack of job control on heart disease.

And I'm not sure that any of the people I meet would want to trade places with me, fre****y, especially when they find out what it's really like. Maybe that's your ego shining through. At least you will fit in amongst your peers. Maybe that's what makes it easier for you.

Finally, I think Voxel makes an excellent point, "What are you going to do about it? Form a union and strike? You'll take it like a man (or woman) in the drill seargents medical college."

Couldn't have said it better myself.

 

[freshity]

jen, i can't help but reapply your line of thinking and propose: perhaps it is your ego leading you to believe this life of yours is sooo hard, and this work we do is sooo difficult that others--yes, less fortunate--couldn't possibly want this. they couldn't possibly want to give a little of themselves (3rd year, right. yeh, that's one year) to reap substantial fortune later in life: countless job opportunities, the promise of a more than livable wage, the priveleges bestowed upon physicians by the general public. instead, we cry that our schedules, the demands upon us are so unrelenting.

don't you think other people understand hard work? or worse, getting paid nothing for working one's fingers to the bone? you strike me as someone who has no notion of how hard work truly can be. woe.....

 

[jen628]

"perhaps it is your ego leading you to believe this life of yours is sooo hard, and this work we do is sooo difficult that others..."

riiiight. try spending a minute away from your own thoughts in an attempt to hear those of others. this vaguely reminds me of my four-year-old cousin saying, "no, YOU have a big ego."

"they couldn't possibly want to give a little of themselves"

i can think of many people in many professions and otherwise that give substantially more to people in a more altruistic fashion than probably any third year med student. but there you go again, thinking how wonderful you are.

"instead, we cry that our schedules, the demands upon us are so unrelenting."

if this is your argument, then make it, as i have not.

"don't you think other people understand hard work?"

if by other people you mean yourself, i am not sure. but again, i think you are building a strawman of my argument. don't worry, i'm getting used to it.

"you strike me as someone who has no notion of how
hard work truly can be."

and you think you are doing patients a favor with this egotistic, judgmental attitude?? give me a break. you have no idea what i've been through to get here.

now if you want to return to the actual discussion, i would be happy to participate. but if you prefer to continue down this personal, albeit flawed road you have chosen, maybe we should go elsewhere as i'd hate to further tarnish this board with petty insults.

ttfn.

 

[freshity]

jen, where else shall we go? outside? no thanks. at this point i can see just where you're going with this (or not going, as it were), and i have no desire to join you. seen enough of that.

thanks anyway.

 

[WSUreds]

Fre****y,
You think you know, but you have no idea.

 

[Mary the Med Student]

I think that punishing hours contribute to our education, to a limited extent. However, once we've experienced the true pressures of any given field, I think that the focus should move towards a better learning environment. Multiple studies have shown diminished cognitive function after sleep deprivation. After a certain number of hours awake without sleep, people begin acting like drunkards, e.g. making poor decisions and losing motor control.

Personally, I think that the level of sleep deprivation required by the medical field at any level is downright dangerous - both to us and to patients. Doctors post-call have a alarmingly high incidence of MVA's. Furthermore, iatrogenic errors occur after sleep deprivation that hurt patient care.

I couldn't give a crap about scut, but inappropraite work hours leading to harming the patient is inexcusable.

-Mary

 

[mhaddi]

I agree with Mary. Why do medical students so eagerly accept all the unneccesary mental/physical abuse? It ranges from staying up 40 hours to hearing so called "respected doctors" refering to their patients as "beached whales". What the hell is going on? People need to speak out more about this ridiculousness. Is it that it's so hard to get into med school, and people think they are previleged? Would you jump off a 40 foot building if they told you to? I bet some among us would. What does that say about the training process? Patients deserve better. They deserve happy, healthy doctors.

 

[doughboy]

Half of you remind me of "eager beavers". Can I throw you a crumb so you can lick it up off the floor. I think we are overworked, underappreciated, and certainly taken advantage of. We expect an education yet I've found out that this is basically all self motivated and self taught. What can we do about it? Nothing that will make any difference for us now. Since I can't do anything about it, I'll join the rest of you and grin and bear it. However, I do have feelings of resentment and its only the "good" rotations that I've had that keep me believing that this "road" is the right one. I think I was already hazed once in college...thank you sir, may I have another?

 

[fourthwatch96822]

In response to someone's post about we med students having to work the hardest... I forgot which poster said that.

We have no business saying that our field is the hardest and most difficult to pursue. Some people here are saying that without having experienced other areas of academia.

I have dormed with graduate students whom never had the time to be on the computer posting on message boards! Just too busy preparing for classwork, teaching/dealing with undergrad students, working on research, etc. Even during the Christmas break, what did these people do? Work on their dissertations, etc. One individual continued this along with working at her practicum site.

It is really true that you need to walk a mile in one's shoes to know what one really goes through.

P.S. It is also true that we were not the only people that had to work hard in undergrad. Some grad programs are even harder to get into. Even some undergrad programs are just so rigourous that you need to work extra hard just to survive in it. For example, an undergraduate program in mathematics can be a huge undertaking.

Sometimes some need to work harder than others. It doesn't even always depend on your major/pre-med whatever. I have a friend who was pre-med; he aced everything and went out and had fun alot.