Scutwork

[45408]

Probably the "worst" thing I've done is after a long case, tell the student "Hey, if I let you go get lunch now, could you grab something for me?"

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[jcu]

Probably the "worst" thing I've done is after a long case, tell the student "Hey, if I let you go get lunch now, could you grab something for me?"

That's not bad in the slightest. I've actually offered to grab a resident a sandwich/snack when I know they're especially bombarded with cases that day.

 

[da8s0859q]

Another annoying thing: residents that wont you leave the team room to go study in a quiet area when nothing is going on because then you wont be around to run scut work if they need it.

Had a couple of those on surgery. Most of the time, I dodged them and went to go study for awhile between cases anyway. It did hurt me on my eval, but I also did well on the shelf and actually learned something, so...

The few times I've been asked to do scut work it's been prefaced by, "I know this is totally scutty but..." and this really helps.

I know residents are super busy and I don't mind helping in "scut" ways as long as they realize that I'm doing it because they are a nice person and it's the right thing to do, not because I'm going to learn something by getting them coffee.

My experience also.

 

[olemissbabydoc]

I finally have a resident who scuts the hell out of me. I'm blaming it on his international education - maybe that's the way they did it as third years. Idk, but it's really annoying. You just had that chart in your hand, why did you put it down at my feet and tell me to pick it up?

 

[Doctor4Life1769]

I finally have a resident who scuts the hell out of me. I'm blaming it on his international education - maybe that's the way they did it as third years. Idk, but it's really annoying. You just had that chart in your hand, why did you put it down at my feet and tell me to pick it up?

lol nice.

 

[da8s0859q]

I finally have a resident who scuts the hell out of me. I'm blaming it on his international education - maybe that's the way they did it as third years. Idk, but it's really annoying. You just had that chart in your hand, why did you put it down at my feet and tell me to pick it up?

Maybe it's just because being this far into M3 has ruined my tolerance for things like this, but I'd probably tell him to pick up his own damn chart.

GET a chart from the rack for you while you're doing a d/c summary? Sure. Drop some notes on several different floors because you need to see a pt? Got it. Pick up a cup of coffee since I'm going to get some myself? Absolutely.

**** like that? No sir.

 

[olemissbabydoc]

I probably would've myself if it wouldn't have been the first week of the rotation. Now I tell him exactly that.

 

[K31]

I probably would've myself if it wouldn't have been the first week of the rotation. Now I tell him exactly that.

That may have been the point.

 

[ArcGurren]

My favorite bit of BS scutwork assigned to me by an illustrious surgery prelim (a night float resident who came in late, mind you):

"Oh, it's 1 am and you've been up all night on call? Go round on all the patients on the floor, write down all the new labs and vitals for the patients on note sheets so that I can fill in the blanks and sign them. And then get coffee for me when I wake up... I'm going to go take a nap".

Screw you, I hope you never match categorical.

 

[KnuxNole]

If I were you, I would write all fake numbers, and pee in the coffee.

 

[2012mdc]

Probably the "worst" thing I've done is after a long case, tell the student "Hey, if I let you go get lunch now, could you grab something for me?"

That's not even close to scut. I had residents tell me all the time to go grab lunch and give me some money to grab lunch for them as well. Totally reasonable especially on busy services.

I never minded helping somebody out especially when they were nice about it and it helped them lighten the load and take care of their primary patient responsbilties. But scutting me out so you can sit on your ass and play with your iPad or scutting me out because you showed up 1 hour late (happened consistently)? No thank you

 

[Dirt]

My favorite bit of BS scutwork assigned to me by an illustrious surgery prelim (a night float resident who came in late, mind you):

While we're on the topic of stereotyping interns/residents, mine generally go as follows:

Good:
Prelims with advanced positions, esp those in surg/medicine going into rads, rad onc, Optho, Anesthesia

Bad:
Prelims going into nothing, especially those who did not match in ortho or other competitive specialties and could not scamble into something categorical
IMGs (no offense, but we are talking stereotypes here)

 

[RySerr21]

rad prelims are the absolute worst. they dont give a ****, always complain about how much medicine sucks, and don't teach you anything because they dont know anything and dont care to learn because they just want to survive the year and forget it ever happened

 

[turkeyjerky]

rad prelims are the absolute worst. they dont give a ****, always complain about how much medicine sucks, and don't teach you anything because they dont know anything and dont care to learn because they just want to survive the year and forget it ever happened

Why would you expect an intern to teach anyway?

 

[OveractiveBrain]

I think we have the potential for an intellectual discussion. So far it sounds like people stating their views without hearing anyone else's. Hopefully, I will manage to illustrate the two competing views and move the discussion forward on an intellectual level. If I have used your quotes or your meaning out of context or have gotten it wrong, I apologize, and feel free to correct. Mainly, this statement is directed at Substance, since I spend the most time on his side, and begin with his perspective first.

Substance (and so far, I think he stands alone) has taken the standpoint that "the system should be better." The presumption being that if the system worked right, physicians could be the managers they are supposed to be. In that, physicians, or, more to the point of this thread, physicians in training should not be doing the work the system should do for them.

(And this is my own commentary) The problem with this concept is that the system sucks, and patient care comes first. In order to achieve a new system where tracking down paperwork isn't the job of the trainee would require a trainee strike, or something of the liking. The result would inevitably worse patient care. The counter to this own line of thinking is that physicians have taken on additional responsibilities that slow them down. Why would the nurse bring patients to the clinic room when a doctor will do it? Why would the nurse take vitals if the doctor will do it? WHy would the doctor let this happen? Because its easier to it ourselves then wait for someone else to do it.

As I see it, Substance is taking an idealized perspective. Train the next generation of trainees to be in charge. To do that means to refuse to do menial tasks themselves because its easier and faster for the team, right now. The short term benefit of "someone getting the job done" has long term costs that injure the profession.

I think he stands alone, or at least off from the pack, because his ideas challenge the current situation, and he takes such a principle-centered stance; we in the field have difficulty visualizing that pragmatically. The students, of course, shout "hooray! no work," and likely miss the more important message in bold. The question is, is there injury to the profession as a result of physicians getting the job done, no matter how it gets done or who does it?

There comes a limit to what a physician or medical student should be expected to do. As a resident, and future attending, I will never expect the medical student to put the "team" ahead of the patient. For them, the obligations are to the patient first, to their own learning second, and to the team last. Running to health records, as your example has stated, is a worthless endeavor for anyone who has not been hired by the hospital to do that kind of work. And outside of a stat situation I cannot see why any doctor or medical student would have to play the part of a porter to help their patients.

If anything, I think that instilling an attitude of "you're not above any menial hospital work" in medical students and residents harms our field. This attitude has culminated in a profession of hammerheaded self-serving dimwits who are proud of their 40 hour shifts but don't realize that they are being fleeced by the MBA yuppie hospital admins and politicians. Reimbursements are being cut and work is getting more complicated because we let it happen.

A medical student should learn that some tasks are beneath them. Being the porter is one of them. Being the secretary is another. Then maybe the new generation of physicians will have more confidence at the negotiating table and will know their true worth. If we can't stand up for ourselves, we'll never stand up for our patients.

The other side of the coin is that there is no menial task, and that patient care right now should benefit. If that means that "someone has to get the job done" then so be it. Whether its me, the clerk, or the medical student, it doesn't matter. Its the argument that there is short term gains for the patient with hopefully long term gains for the trainee.

This point is well illustrated by this attending:

I just wanted to comment on the educational value of daily progress notes, at least on a medicine service. Often times I have an assesment/plan that may have 7-8 problems that I am actively managing (not too difficult in a noncompliant 75 year old demented ESRD pt with sepsis from a HCAP pneumonia who develops an NSTEMI, for example). I would be hard pressed to effectively organize my thinking, as well as relay these thoughts to the floor nurse (who wants to know the plan on their pt but isn't available when I'm rounding), case manager (who has to justify the pt's continued presence in the hospital to their insurance company who wants this all to be treated as an outpt), subspecialists, etc. It also lets me know what the subspecialists thoughts are without having to track them down. Multiply this by the 20 pts I see a day. At a minimium it saves me a ton of pages. The bottom line is that note writing (in Medicine at least) is a skill that must be developed over time and is ESSENTIAL to providing good pt care and continuity of care (when you go off service, or a midlevel is seeing that pt for a day). I STRONGLY recommend not blowing note writing off as scut or of no educational value. Yeah they may not count now, but this is the time when you should be asking your resident/attending for feedback because, as previously mentioned, come July 1 you better know what you're doing!

While pertinent only to note writing, it illustrates that real, true to life skills can be developed by what some people consider scut. So far, most people have fallen into this category.

(Back to my commentary)

The difficulty is finding the line where people cross from "meaningful learning" to "menial task." Zagdoc has done the very things that Substance considers scut as a resident. Thus, Zagdoc takes the stance that there is no menial task, and that patient care is far more appropriate. Substance would say that Zagdoc SHOULDNT HAVE TO do the things he's doing, we've been duped by everyone else.

The battle really hits a head where we talk about training the next generation. This is where I personally clash with Subtance's opinion. Because, if trainees are only trained to be managers, and do NO scutwork, what are we really teaching them?

I completely agree. I've never asked a medical student to do a task that I wouldn't do myself (and often do end up doing myself).

I made a similar point in a different thread, pointing out that even these seemingly menial tasks are part of providing patient care. A number of med students told me that they didn't really see patient care as their responsibility, and that they were only there to "learn."

Privilege in the medical field is already a problem. If nothing else, doing menial tasks teaches humility. I can forsee this comment being jumped on rather than the meaning of the post, so I hesitate to right it. But there it is, nonetheless. What is "learning?" How much should a doctor be expected to do on her own? Does "scut" have utility in training? And if that scut is done to better advance patient care, isn't that a win win?

Teamwork, humility, patient care, social interaction (i.e. with people above, below, and lateral to your status), life-long skills for practice. These are also needed. Medical management is easy, and comes with practice.

I am of course ignoring people who scut for the powertrip, because they want coffee, or because they were abused as a medical student. Perpetuating abuse is just abusive.

In the end, I have to agree there is a line where scut becomes abuse. And I am conflicted. I want the system to be better, such that we can be managers and not transportation techs or nursing aids.

- We should be in control of the hospitals and not their pawns [Substance].

Yet at the same time

-I believe that there is short term gain (patient care, team work) and long term utility (life skills) that are derived out of the menial tasks that most medical students consider scut [status quo].

Basically, I agree with the reason, the goal for Substance's position, I just don't agree that eliminating scut will get us there.

 

[copes]

Why would you expect an intern to teach anyway?

Because I am doing their work for them. And because I am paying thousands for an education while they are being paid to work.

 

[Sheldor]

Because I am doing their work for them. And because I am paying thousands for an education while they are being paid to work.

I believe his point is that, especially near the beginning of the academic year, the line between intern and med student is very small.

 

[copes]

The way I look at it as a medical student is that I have to pay my dues before becoming an attending. The system will always be imperfect and even if it were perfect people would always find something else to complain about. The bigger issue is that medical students are in the hospital to learn, and there needs to be a balance struck between education and service/scut. I think a lot of interns/residents/attendings forget what it feels like to be a medical student. Medical students are at the bottom of the totem pole and anyone who takes a few minutes out of their day to teach us something or reach out to us makes our day and makes us willing to work to make your day easier. Along the same lines a lot has been said about teamwork but the question is is their an effort made to make the medical students feel like a part of the team? If I am running around doing scut on random patients I don't even know then I won't be happy (not that it matters). But if you let me take ownership of my 3 patients, use them as teaching points, and involve me in the management of them, then I will go above and beyond in getting that report from an outside hospital faxed over. Medical students know who are the good teachers and will happily work to make their days easier.

I think we have the potential for an intellectual discussion. So far it sounds like people stating their views without hearing anyone else's. Hopefully, I will manage to illustrate the two competing views and move the discussion forward on an intellectual level. If I have used your quotes or your meaning out of context or have gotten it wrong, I apologize, and feel free to correct. Mainly, this statement is directed at Substance, since I spend the most time on his side, and begin with his perspective first.

Substance (and so far, I think he stands alone) has taken the standpoint that "the system should be better." The presumption being that if the system worked right, physicians could be the managers they are supposed to be. In that, physicians, or, more to the point of this thread, physicians in training should not be doing the work the system should do for them.

(And this is my own commentary) The problem with this concept is that the system sucks, and patient care comes first. In order to achieve a new system where tracking down paperwork isn't the job of the trainee would require a trainee strike, or something of the liking. The result would inevitably worse patient care. The counter to this own line of thinking is that physicians have taken on additional responsibilities that slow them down. Why would the nurse bring patients to the clinic room when a doctor will do it? Why would the nurse take vitals if the doctor will do it? WHy would the doctor let this happen? Because its easier to it ourselves then wait for someone else to do it.

As I see it, Substance is taking an idealized perspective. Train the next generation of trainees to be in charge. To do that means to refuse to do menial tasks themselves because its easier and faster for the team, right now. The short term benefit of "someone getting the job done" has long term costs that injure the profession.

I think he stands alone, or at least off from the pack, because his ideas challenge the current situation, and he takes such a principle-centered stance; we in the field have difficulty visualizing that pragmatically. The students, of course, shout "hooray! no work," and likely miss the more important message in bold. The question is, is there injury to the profession as a result of physicians getting the job done, no matter how it gets done or who does it?



The other side of the coin is that there is no menial task, and that patient care right now should benefit. If that means that "someone has to get the job done" then so be it. Whether its me, the clerk, or the medical student, it doesn't matter. Its the argument that there is short term gains for the patient with hopefully long term gains for the trainee.

This point is well illustrated by this attending:



While pertinent only to note writing, it illustrates that real, true to life skills can be developed by what some people consider scut. So far, most people have fallen into this category.

(Back to my commentary)

The difficulty is finding the line where people cross from "meaningful learning" to "menial task." Zagdoc has done the very things that Substance considers scut as a resident. Thus, Zagdoc takes the stance that there is no menial task, and that patient care is far more appropriate. Substance would say that Zagdoc SHOULDNT HAVE TO do the things he's doing, we've been duped by everyone else.

The battle really hits a head where we talk about training the next generation. This is where I personally clash with Subtance's opinion. Because, if trainees are only trained to be managers, and do NO scutwork, what are we really teaching them?



Privilege in the medical field is already a problem. If nothing else, doing menial tasks teaches humility. I can forsee this comment being jumped on rather than the meaning of the post, so I hesitate to right it. But there it is, nonetheless. What is "learning?" How much should a doctor be expected to do on her own? Does "scut" have utility in training? And if that scut is done to better advance patient care, isn't that a win win?

Teamwork, humility, patient care, social interaction (i.e. with people above, below, and lateral to your status), life-long skills for practice. These are also needed. Medical management is easy, and comes with practice.

I am of course ignoring people who scut for the powertrip, because they want coffee, or because they were abused as a medical student. Perpetuating abuse is just abusive.

In the end, I have to agree there is a line where scut becomes abuse. And I am conflicted. I want the system to be better, such that we can be managers and not transportation techs or nursing aids.

- We should be in control of the hospitals and not their pawns [Substance].

Yet at the same time

-I believe that there is short term gain (patient care, team work) and long term utility (life skills) that are derived out of the menial tasks that most medical students consider scut [status quo].

Basically, I agree with the reason, the goal for Substance's position, I just don't agree that eliminating scut will get us there.

 

[RySerr21]

Why would you expect an intern to teach anyway?

my experience is that the categorical interns are more interested in learning for themselves (because they will actually be doing this for the rest of their lives) and in turn are more inclined to keep you involved with their patients and with what the team is doing (this includes teaching). As opposed to the radiology interns I have worked with, whose only focus is to get home as soon as possible. Its not just radiology, ive found this true with derm and anesthesai prelmis as well, maybe a little less so.

I believe his point is that, especially near the beginning of the academic year, the line between intern and med student is very small.

I'm not talking about the month of July. I had my medicine rotations/elective in Novemberr/December/January. As said above, I'm not commenting on their lack of knowledge (which is expected for any intern)...i'm commenting on their eagerness to learn, be a good team member, and involve students with what they are doing. They know they won't be doing this much longer, so they tend to care less. I don't necessarily blame them. They went in to radiology for a reason....I'm just saying from a medical student perspective, i'd much rather have a categorical than ANY prelim.

 

[Dirt]

rad prelims are the absolute worst. they dont give a ****, always complain about how much medicine sucks, and don't teach you anything because they dont know anything and dont care to learn because they just want to survive the year and forget it ever happened

Which is exactly what you want as an M4 in the early spring.

 

[2012mdc]

Which is exactly what you want as an M4 in the early spring.

Exactly.

And during M3 neither the categorical or prelims did much teaching, usually only the seniors.

On my M4 sub-I the categoricals did seem more interested in the literature and stuff like that but it wasn't a huge difference. They also knew I was only going to do a prelim year so neither group cared that much. The things they did teach were useful things for intern year which was appreciated.

It took me a while to figure out who was prelim and who was categorical and there wasn't a discernible difference between rads and derms and gas prelims. The rads and derm people actually seemed to be stronger interns than the categoricals.

 

[RySerr21]

Which is exactly what you want as an M4 in the early spring.

im not sure how thats relevant to what i was saying. Either way, those qualities I described are not desirable in a co-worker, regardless of year in schooling or time of year.

I'm not commenting on ability as a physician, obviously people that do derm and rads are very intelligent, hard working people (or else they wouldnt have matched). Its the attitude that has made them unbearable to be around (during ward months).

 

[Dirt]

im not sure how thats relevant to what i was saying. Either way, those qualities I described are not desirable in a co-worker, regardless of year in schooling or time of year.

When you are stuck doing a mandatory rotation in something you are not going into a couple weeks before match day, the last thing on earth you want is a resident who lectures you on topics you really don't care about and forces you to take call and carry a crapload of patients.

What you want is a rads prelim who says "why don't you just go home" at noon everyday.

 

[2012mdc]

im not sure how thats relevant to what i was saying. Either way, those qualities I described are not desirable in a co-worker, regardless of year in schooling or time of year.

I'm not commenting on ability as a physician, obviously people that do derm and rads are very intelligent, hard working people (or else they wouldnt have matched). Its the attitude that has made them unbearable to be around (during ward months).

I had the opposite experience. Out of the interns on my M3 and M4 I've had 4 that stood out above the others. 2 were prelims and 2 were categorical

I would be careful generalizing prelims (or anyone for that matter). It sounds like you got stuck with some rads prelims that matched into a harder year than they wanted. The ones I dealt with were helpful, didn't bitch too much, and again were strong interns. I'm specifically talking about performance on the wards and in morning report which has little to do with what it takes to match something competitive. Some who doesn't give a damn isn't going to be a strong intern no matter how intelligent they are

When you are stuck doing a mandatory rotation in something you are not going into a couple weeks before match day, the last thing on earth you want is a resident who lectures you on topics you really don't care about and forces you to take call and carry a crapload of patients.

What you want is a rads prelim who says "why don't you just go home" at noon everyday.

Exactly. And they can still teach you relevant stuff about patient care and management of the patients you do carry. Nothing you do as a M4 will truly prepare you for intern year. It's good to get some nuggets of advice. During M3 it's better to have a senior teach you anyway if you're considering IM as a career.

 

[RySerr21]

When you are stuck doing a mandatory rotation in something you are not going into a couple weeks before match day, the last thing on earth you want is a resident who lectures you on topics you really don't care about and forces you to take call and carry a crapload of patients.

What you want is a rads prelim who says "why don't you just go home" at noon everyday.

Like i said, I dont blame their negative attitudes. I hate doing mandatory rotations in things I am not going in to as well, and I wouldn't want to work with me on those rotations either. Their is a very big difference in my attitude, the quality of my work, etc. I'm not judging them. I dont think any less of them as human beings or physicains. Its just a fact - people are more enjoyable to be around if they want to be there, are enjoying themselves, etc. In my experience, on wards months, the prelim interns are NOT enjoying themselves. The rads prelims (or any prelim for that matter) have no say in when we go home, its up to our senior resident.

I had the opposite experience. Out of the interns on my M3 and M4 I've had 4 that stood out above the others. 2 were prelims and 2 were categorical

I would be careful generalizing prelims (or anyone for that matter). It sounds like you got stuck with some rads prelims that matched into a harder year than they wanted. The ones I dealt with were helpful, didn't bitch too much, and again were strong interns. I'm specifically talking about performance on the wards and in morning report which has little to do with what it takes to match something competitive. Some who doesn't give a damn isn't going to be a strong intern no matter how intelligent they are

thats my only point. I don't think every single prelim acts similar to the way the ones I worked with...however, the ones I worked with didn't give a damn at all, and it made my time with them not very enjoyable. Ive done multiple months of medicine wards and electives and have worked with rads, derm, neuro, and anesthesia prelims. The most enjoyable ones (ie ones with the best attitudes) were the anesthesia prelims. It very well could be that their prelim year sucks, in fact it probably does. Im just observing that the ones who are most vocal about their unhappiness and distaste for medicine in general have been the radiology residents that I have worked with. Trust me, i wish i could say that i had an experience similar to yours.

 

[jace's mom]

I finally have a resident who scuts the hell out of me. I'm blaming it on his international education - maybe that's the way they did it as third years. Idk, but it's really annoying. You just had that chart in your hand, why did you put it down at my feet and tell me to pick it up?

This. Oh my goodness, I had the same experience during third year, and yes, it was an IMG. Like you said, I think it's just a hierarchy thing that's taught at some schools. Things my upper level did:

1) Walked into the small room, counted the number of people (5), made 4 copies of the day's schedule on the machine that was right there in the room, handed a copy to the intern and said, "Make a copy for the medical student." Also, I'd been on the rotation for 3 weeks at that point, so she really should have had some idea what my name was. I was the only student, after all.

2) After dismissing everyone else for the day, made me sit with her while she typed up the rounding list each afternoon. Didn't require or want any info from me and wouldn't accept my offer to type up the list myself. I was just supposed to sit and watch her type and couldn't go home until she was done. She was a painfully slow typist and would also stop to make personal phone calls, so this process usually added 1.5-2 hours to my day.

3) Made me chart round with her again in the afternoon, after already pre-rounding at 5am and then rounding with the team at 6:30. My entire job was to get the chart from the rack that we both passed, sit quietly while she wrote, and then return the chart as we both passed the rack again. I was not to ask questions or talk. At all.

4) Made me walk at the end of the group (which I was okay with, because I was low woman on the totem pole), but I was also responsible for getting all the charts when we got to the nurses' station and would get yelled at if I didn't have them ready by the time she and the attending sat down. Except she, the attending, and the other residents would block the hallway so I couldn't go around them to get to the nurses' station before they did, so I either had to try to edge around them (and get yelled at) or be slow getting the charts (and get yelled at).

5) Made me get on the elevator last (again, standing at the end of the line) but then would get mad when I exited the elevator first (since I was standing closest to the door). So she'd push me aside, sometimes into other people or against the wall so that she could exit first.

I have more, but that's enough. It was a very long month. Thankfully the rest of my clinical experiences were much better.

 

[AlexMorph]

This. Oh my goodness, I had the same experience during third year, and yes, it was an IMG. Like you said, I think it's just a hierarchy thing that's taught at some schools. Things my upper level did:

1) Walked into the small room, counted the number of people (5), made 4 copies of the day's schedule on the machine that was right there in the room, handed a copy to the intern and said, "Make a copy for the medical student." Also, I'd been on the rotation for 3 weeks at that point, so she really should have had some idea what my name was. I was the only student, after all.

2) After dismissing everyone else for the day, made me sit with her while she typed up the rounding list each afternoon. Didn't require or want any info from me and wouldn't accept my offer to type up the list myself. I was just supposed to sit and watch her type and couldn't go home until she was done. She was a painfully slow typist and would also stop to make personal phone calls, so this process usually added 1.5-2 hours to my day.

3) Made me chart round with her again in the afternoon, after already pre-rounding at 5am and then rounding with the team at 6:30. My entire job was to get the chart from the rack that we both passed, sit quietly while she wrote, and then return the chart as we both passed the rack again. I was not to ask questions or talk. At all.

4) Made me walk at the end of the group (which I was okay with, because I was low woman on the totem pole), but I was also responsible for getting all the charts when we got to the nurses' station and would get yelled at if I didn't have them ready by the time she and the attending sat down. Except she, the attending, and the other residents would block the hallway so I couldn't go around them to get to the nurses' station before they did, so I either had to try to edge around them (and get yelled at) or be slow getting the charts (and get yelled at).

5) Made me get on the elevator last (again, standing at the end of the line) but then would get mad when I exited the elevator first (since I was standing closest to the door). So she'd push me aside, sometimes into other people or against the wall so that she could exit first.

I have more, but that's enough. It was a very long month. Thankfully the rest of my clinical experiences were much better.

o jeez...this is absolutely disgusting

 

[officedepot]

.

 

[Buzz Me]

There's a little of both...new M3s often aren't used to be talked to in a firm/harsh manner, and some residents just aren't good as teachers.

 

[jace's mom]

sorry about that. IMGs suck hard to have as residents.

But I also want to add that I think M3s can be extremely hypersensitive to the point that literally anything that is done "to them" is taken in a negative manner. Anything they have to do is seen as scut. Now in the case above there are clearly things that are suspect such as sitting and watching the IMG type stuff when everyone else got to go home, only making 4 copies instead of 5, etc. But I have to think that maybe some of the things like "getting yelled at" is very very subjective so I personally always take such statements with a huge grain of salt. I've interacted with residents with a history of "yelling" only to find that I never got that impression...

I definitely agree with you in most cases, so I hesitated to add my story for that reason. However, I think my case was a bit different for a couple of reasons:

1) This was the ONLY rotation during third or fourth year in which these kind of events took place. All my other rotations were just fine.
2) I'm older than the typical med student and had a career before this, so I have some experience with difficult bosses and coworkers. I'm too old to fall apart because somebody looks at me wrong. In fact, the whole month I worked for her, I never once complained or snapped. I just kept my head down, did every single thing she told me to do (and did it well), and was very, very glad to move on at the end of the rotation.

She really would yell, too - at me or the interns. The poor interns even more, actually. She got into a couple of good screaming matches with them while we were all standing at the nurses' station. To be fair to her, though, the interns were on a prelim year and really hated medicine, so they weren't trying to work as hard as they probably should have.

 

[sineapse]

This. Oh my goodness, I had the same experience during third year, and yes, it was an IMG. Like you said, I think it's just a hierarchy thing that's taught at some schools. Things my upper level did:

1) Walked into the small room, counted the number of people (5), made 4 copies of the day's schedule on the machine that was right there in the room, handed a copy to the intern and said, "Make a copy for the medical student." Also, I'd been on the rotation for 3 weeks at that point, so she really should have had some idea what my name was. I was the only student, after all.

2) After dismissing everyone else for the day, made me sit with her while she typed up the rounding list each afternoon. Didn't require or want any info from me and wouldn't accept my offer to type up the list myself. I was just supposed to sit and watch her type and couldn't go home until she was done. She was a painfully slow typist and would also stop to make personal phone calls, so this process usually added 1.5-2 hours to my day.

3) Made me chart round with her again in the afternoon, after already pre-rounding at 5am and then rounding with the team at 6:30. My entire job was to get the chart from the rack that we both passed, sit quietly while she wrote, and then return the chart as we both passed the rack again. I was not to ask questions or talk. At all.

4) Made me walk at the end of the group (which I was okay with, because I was low woman on the totem pole), but I was also responsible for getting all the charts when we got to the nurses' station and would get yelled at if I didn't have them ready by the time she and the attending sat down. Except she, the attending, and the other residents would block the hallway so I couldn't go around them to get to the nurses' station before they did, so I either had to try to edge around them (and get yelled at) or be slow getting the charts (and get yelled at).

5) Made me get on the elevator last (again, standing at the end of the line) but then would get mad when I exited the elevator first (since I was standing closest to the door). So she'd push me aside, sometimes into other people or against the wall so that she could exit first.

I have more, but that's enough. It was a very long month. Thankfully the rest of my clinical experiences were much better.

You know what, I think you are right about this being part of an IMG's training. Reading through some of this stuff you guys consider as an absolute waste of time is totally expected, even here in a 'Western' country with a pretty high standard of medical care.

Here's my take on things: the way our training works is that it follows a very rigid hierarchical apprentice model. You are expected to do nothing but observe and very occasionally do some usually menial task as a medical student. You are not considered part of the team. I have had some truly awful times as a third year, such as being put in the back of a clinic room for 8 hours, looking at the back of a patient and at the doctor observing outpatients. Can't even switch off for a few minutes as the attending/consultant is staring straight at you.

As a junior doctor, unless on call, your job revolves around tasks such as:

Updating a list of patients
Booking scans
Making referrals
Writing what is dictated to you by the seniors into a note.
Filling out blood request forms

Independent medical decision making is very very limited.

Here's a sample of what I did today:

-Turn up in the ED and observe some doctors do a clerking. If I do see a patient, it is meaningless and has to be redone by someone so it is a waste of time anyway and just irritates the nurse allocaters.
-Did bloods repeatedly. Started IVs all day.
-Fetched gloves for a doctor.
-Fetched gauze for a nurse for a wound.
-Dipped some urine.
-Drew up an IV drug
-Went and got two cokes from the shop for a nurse.
-Pushed a patient to a different department.
-Looked at some X-Rays.
-Hunted round the Department for some missing notes for a doctor
All this as a senior medical student

(The procedural stuff like bloods or IVs and especially the drug drawing up are seen as 'interesting' things to do by the person offering them.)

Suffice to say, I was blown away when I did a sub-I in the US. The single main reason I want to do a residency in the US is to get away from all this crap that surrounds training here.

 

[scotchtapetest]

My favorite bit of BS scutwork assigned to me by an illustrious surgery prelim (a night float resident who came in late, mind you):

"Oh, it's 1 am and you've been up all night on call? Go round on all the patients on the floor, write down all the new labs and vitals for the patients on note sheets so that I can fill in the blanks and sign them. And then get coffee for me when I wake up... I'm going to go take a nap".

Screw you, I hope you never match categorical.

I think whether some tasks are scutwork or not depend on the intent/reason why they were assigned. I don't think telling med students to copy down labs for the pts on the team is necessarily scutwork. There is much to be learned by following lab trends in response to therapy. Even the act of looking up labs can be valuable especially for an early M3. Also, if it will take the med student 1hr to do this, the intern/resident should "make that up" at least partially to the student by teaching him/her about the lab trends or something relevant. Now if the reason is purely to reduce the house staff's work then that's scutwork.

This is how I was trained by most of my inters/residents and as (hopefully) a future intern/resident I fully intend to practice this way. BTW, I feel sorry for anyone (and their pts) who has to rely on a M3 to do their work for them.

On a side note, I also think med students are partially to blame as well. Some of us are so fearful of bad evals that do anything... I once had a resident who told (actually ordered) me to go get coffee for him (and it wasn't b/c I was going to get coffee or b/c he was too busy, we were both sitting down studying) and I flat out refused to do it. He got mad, but the next day he got over it and he actually had much more respect for me after that. I also had many colleagues who would get scutted all the time on the same rotations that some of us were very rarely scutted on just b/c interns/residents knew they would take it.

 

[PTPoeny]

The opposite end of the spectrum is when the residents won't let students do something by claiming they do not want to scut us out. It's february of M3 and I haven't ever placed a foley or iv because every single time I have offered I've been told by my resident that they "didn't want to scut me out like that".

 

[partydoc]

The opposite end of the spectrum is when the residents won't let students do something by claiming they do not want to scut us out. It's february of M3 and I haven't ever placed a foley or iv because every single time I have offered I've been told by my resident that they "didn't want to scut me out like that".

Tell them you still want to do it even if it's "scut". Better to practice now than during your intern year.

 

[officedepot]

.

 

[ArcGurren]

I think whether some tasks are scutwork or not depend on the intent/reason why they were assigned. I don't think telling med students to copy down labs for the pts on the team is necessarily scutwork. There is much to be learned by following lab trends in response to therapy. Even the act of looking up labs can be valuable especially for an early M3. Also, if it will take the med student 1hr to do this, the intern/resident should "make that up" at least partially to the student by teaching him/her about the lab trends or something relevant. Now if the reason is purely to reduce the house staff's work then that's scutwork.

This is how I was trained by most of my inters/residents and as (hopefully) a future intern/resident I fully intend to practice this way. BTW, I feel sorry for anyone (and their pts) who has to rely on a M3 to do their work for them.

On a side note, I also think med students are partially to blame as well. Some of us are so fearful of bad evals that do anything... I once had a resident who told (actually ordered) me to go get coffee for him (and it wasn't b/c I was going to get coffee or b/c he was too busy, we were both sitting down studying) and I flat out refused to do it. He got mad, but the next day he got over it and he actually had much more respect for me after that. I also had many colleagues who would get scutted all the time on the same rotations that some of us were very rarely scutted on just b/c interns/residents knew they would take it.

The bolded part I think is the key. If you're going to have someone help you with a task because it makes things more efficient and/or there's a teaching point involved, that's fine. Telling a student to do things so you can get an extra hour of sleep after walking in late on your night float where you haven't done jack is not okay.

 

[ArcGurren]

awesome you have some balls dude. I would love to hear how that convo went.

I would be way to afraid to do that. Not sure why I should be afraid but I just don't want to start trouble I guess. I once had a resident go and make me buy her some lipstick at the store downstairs in the hospital (she gave me the money) but she asked nicely and was working pretty hard while I was doing nothing so I went ahead and did it. Personally didn't really care that much then. But she actually turned out to be a huge biatch so in hindsight I def wish I would have said something but at the time it was my first day with her and she seemed really nice...

I mean, part of it has to be your self-respect. I refused to sacrifice my grade in one of my rotations for my self-respect and I still ended up with a crummy eval and missing Honors in that clerkship. I ended up with a tad more self-respect afterwards and refused to take any BS in my previous clerkship, studied hard for my shelf, still got great comments from my attendings, and managed to get Honors. It's all about perspective.