SDN blowing mid-level encroachment out of proportion or is it real?

[Steve_Zissou]

Step exams are misused and have disgustingly huge confidence intervals. Want a standardized exam? Make the med school version of the MCAT. A norm-referenced test with very small standard errors

If the proposed solution is a better standardized exam, I’m fine with that. I don’t know how to improve the current exam, but I also don’t think the alternatives will work better.

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[Lawpy]

I've felt similar for a long time. I think current medical training needs reform. Specifically, it needs to be shorter and streamlined considering what's going on with midlevels. Something has to give. An example is in the hospital in Wisconsin that replaced anesthesiologists with CRNAs. If CRNAs really end up working well and getting similar results as the previous anesthesiologists, then the medical system has failed those physicians and really needs reform. If results are worse, then the hospital will get tired of bad results and probably hire the physicians again.

Reduce med school to 3 years and overhaul residency training

 

[Lawpy]

If the proposed solution is a better standardized exam, I’m fine with that. I don’t know how to improve the current exam, but I also don’t think the alternatives will work better.

Yeah the current Steps are crap. Really need an MCAT-type exam for standardized tests to have any value. I have yet to see many arguments against this

 

[Lawpy]

It can be just one exam for residency purposes that tests a combination of preclinical and clinical knowledge. The exam would also be heavily g loaded and really depend on strong reasoning skills. I think this would be fair and Anki resistant.

 

[Cath Up]

Plenty of blame to go around but these generations have really shifted how attending physicians practice. As residents, there is still an opportunity to make a difference and learn medicine well but it takes an loud, firm personality and whatever you do don’t come in clueless because people hardly get over their first impressions.

It’s supposed to put Radiologists, PM&R people, Psychiatrists, Neurologist, etc. in medicine’s shoes to understand the basic work ups so when they’re consulted or asked to correlate radiographically, they understand where the medicine guy is coming from having been there little while ago.

What Efle is saying is that in practice he/she is not very interested in certain elements that people with more experience have especially since he/she isn’t going to be involved in doing them in the future.

A proposed solution is hospitalist tracks and primary care tracks that take a small group of residents who have committed to the generalist nature of medicine but even then there’s still people changing their minds/doing fellowships after and the tracks aren’t large enough to counterbalance the term someone else used as “army of NPs”.

Physiatrists <3

 

[elementaryschooleconomics]

Man, this thread is excellent, I need to come hang out in this part of SDN more.

I do agree with @efle that the current century-old system of medical training struggles to find relevance with how we practice today. My specialty (RadOnc) is a great example. Very little of what I do now is reflected in the general education I received in medical school, and I have often felt that my residency training experience was sort of "med school part two". This is very different when compared to my intern year experience in IM, which felt like a synthesizing/maturation of skills and knowledge I already acquired.

Obviously, it's impossible for me to say how much my general medical education affects the way I think and practice now. Am I a better doctor because of it? Or, would I be a better RadOnc if my general training was shortened and I was required to spend a similar amount of time in focused training? I think there's a balance out there that we can find, but the juggernaut of American medical training is hard to steer in any direction. Since I started med school in the mid-2000s, I have watched as many (most?) schools have revamped the pre-clinical curriculum (along with other changes) in an attempt to improve the experience, so perhaps this isn't all idle daydreaming.

Re: Step exams etc, I have mixed feelings about that, as I guess you could consider me a "late bloomer". I'm a first generation college kid from a low-middle class background and had no idea how any of this worked. Now, in my second decade after deciding to become a doctor, I can look back and see all the naïve mistakes I made along the way. The "hidden curriculum" is very real, and my legacy/wealthy friends were MUCH better at "playing the game" than I was. Having a ranked M1/M2 and a scored Step 1, along with other metrics, allowed me to differentiate myself and punch above my weight, Matching into a Radiation Oncology program at a prestigious academic medical center (you know, back when RadOnc was hyper-competitive 5+ years ago, haha) would have been very difficult (impossible?) if I didn't have things like my Step scores.

While I think the poster who said it was probably right, that I'm an outlier, I do worry about the kids like me who won't have some sort of mechanism to "stand out" if they didn't get into a "top" medical school, or whatever metric people are going to use once everything is Pass/Fail. I don't have an idea for an easy solution for that either...though I imagine one must exist.

 

[Thesimplelifeofamyloid]

Look at the charting outcomes "top 40 NIH" proportions for competitive specialties now and 10+ years ago. Theyve been stable and similar to the overall proportion of the applicant pool. I have no idea where this myth came from that school prestige will be the new step score

Here you go!

https://www.nejm.org/doi/full/10.1056/NEJMp2006148

 

[Redpancreas]

Reduce med school to 3 years and overhaul residency training

You can do that or you can integrate practical skills more into medical school instead of emphasizing knowing what a Western blot does. I seriously wasted a good year in undergrad/med school combined learning the intracies of biochemistry which is now worth nothing.

 

[Redpancreas]

What does this have to do with letting an NP perform your lap chole over an R2?

They shouldn't be allowed to but if someone has been around a situation with far more experience this is the kind of stuff that happens. I have been trying to say this for 2 years on these boards but people disagree with me.

Patient care experience is the proprietary currency in medical education, not basic science taught by tenured PhDs. We need to get medical students doing practical things and assessing those practical components in a standardized manner early. If someone told you you needed to learn how to design a video game or learn to invest in the stock market what wold you do? Watching extensive lectures on theory with minimal practical components or actually dive in and use YouTube videos as you go when you get stuck? If we do this, students will not be so useful on wards that NPs/PAs would be rendered useless over time. Instead we create systems where we use such abstract metrics to assess medical student performance that we almost invited PAs/NPs into the spot they're in.

 

[Lem0nz]

They shouldn't be allowed to but if someone has been around a situation with far more experience this is the kind of stuff that happens. I have been trying to say this for 2 years on these boards but people disagree with me.

Patient care experience is the proprietary currency in medical education, not basic science taught by tenured PhDs. We need to get medical students doing practical things and assessing those practical components in a standardized manner early. If someone told you you needed to learn how to design a video game or learn to invest in the stock market what wold you do? Watching extensive lectures on theory with minimal practical components or actually dive in and use YouTube videos as you go when you get stuck? If we do this, students will not be so useful on wards that NPs/PAs would be rendered useless over time. Instead we create systems where we use such abstract metrics to assess medical student performance that we almost invited PAs/NPs into the spot they're in.

I see this a lot - the 'students will replace PAs/NPs' mentality if we have more, or they're better, or... whatever. This is incorrect thinking and is very, very frequently extrapolated to "well look in ______ medical system in ________ other country that doesn't have PAs/NPs, they do just fine!"

American medicine does not have a robust medical education system in over half of its hospitals. The ones that do frequently have patchworks of residencies. Its nice of us to think that we can use students and/or residents to replace midlevels, but we can't, because students and residents don't exist in the majority of specialties in the majority of places. So then the argument becomes "wwaaahhhh, surgeon go brr and should be able to do his job by himself" but this is also a stupid argument because in any place that has students and residents the surgeon literally is not doing the work by himself, he is utilizing extensions through the medical education system.

Far too much of medical education is making its arguments in the context of medical education. We have to and MUST include the bigger picture in these discussions. Whatever proposed systemic changes you're asking for, proposing, or making needs to account for the wide swaths of medicine that has different resources and needs to university academic ivory tower.

And the solution is NOT to simply have everyone teach and pump out more medical students and residencies because that very much will destroy the job market like we already have for EM/rad-onc/path. I don't know that midlevels are better. I really don't know what the solution is. I know which ones won't work though. Some people aren't meant to be teachers and the current system does not encourage, promote, or actively train all doctors to teach.

 

[efle]

Here you go!
View attachment 335151

https://www.nejm.org/doi/full/10.1056/NEJMp2006148

More important? Sure. But will it be among the highest importance factors? Not a chance. The NRMP survey of PDs has also been asking if "graduate of a highly regarded medical school" is important, and its consistently landed closer to the bottom of the pack (while Step is near-universal #1)

 

[Steve_Zissou]

Man, this thread is excellent, I need to come hang out in this part of SDN more.

I do agree with @efle that the current century-old system of medical training struggles to find relevance with how we practice today. My specialty (RadOnc) is a great example. Very little of what I do now is reflected in the general education I received in medical school, and I have often felt that my residency training experience was sort of "med school part two". This is very different when compared to my intern year experience in IM, which felt like a synthesizing/maturation of skills and knowledge I already acquired.

Obviously, it's impossible for me to say how much my general medical education affects the way I think and practice now. Am I a better doctor because of it? Or, would I be a better RadOnc if my general training was shortened and I was required to spend a similar amount of time in focused training? I think there's a balance out there that we can find, but the juggernaut of American medical training is hard to steer in any direction. Since I started med school in the mid-2000s, I have watched as many (most?) schools have revamped the pre-clinical curriculum (along with other changes) in an attempt to improve the experience, so perhaps this isn't all idle daydreaming.

Re: Step exams etc, I have mixed feelings about that, as I guess you could consider me a "late bloomer". I'm a first generation college kid from a low-middle class background and had no idea how any of this worked. Now, in my second decade after deciding to become a doctor, I can look back and see all the naïve mistakes I made along the way. The "hidden curriculum" is very real, and my legacy/wealthy friends were MUCH better at "playing the game" than I was. Having a ranked M1/M2 and a scored Step 1, along with other metrics, allowed me to differentiate myself and punch above my weight, Matching into a Radiation Oncology program at a prestigious academic medical center (you know, back when RadOnc was hyper-competitive 5+ years ago, haha) would have been very difficult (impossible?) if I didn't have things like my Step scores.

While I think the poster who said it was probably right, that I'm an outlier, I do worry about the kids like me who won't have some sort of mechanism to "stand out" if they didn't get into a "top" medical school, or whatever metric people are going to use once everything is Pass/Fail. I don't have an idea for an easy solution for that either...though I imagine one must exist.

I have had a similar experience regarding the “late bloomer” bit. Immigrant, spent my early life in ghettoes and poorly funded southern public schools. Parents who worked all the time and lacked the funds, the time, and the knowledge to help me develop the skills that allowed my more affluent classmates to succeed early on. Step 1 has been my chance to move ahead of the pack, as will step 2 be a second chance to “punch above my weight.”

 

[Matthew9Thirtyfive]

Patient care experience is the proprietary currency in medical education, not basic science taught by tenured PhDs. We need to get medical students doing practical things and assessing those practical components in a standardized manner early. If someone told you you needed to learn how to design a video game or learn to invest in the stock market what wold you do? Watching extensive lectures on theory with minimal practical components or actually dive in and use YouTube videos as you go when you get stuck?

I don’t think a preclinical curriculum that focuses on the nitty gritty of every biochemical pathway is really necessary and useful. But there absolutely needs to be a clinically-oriented basic science education (preferably mostly taught by MDs like at my school). In just the past 10 weeks, it has been extremely obvious the lack of that knowledge in midlevels, and if there wasn’t a resident or attending around it wouldn’t have been great.

 

[FutureInternist]

Here's a few, no particular order -

I think the current system was designed 100 years ago to set people up to become well rounded GPs, and is barely applicable these days outside primary care folks.

Extensive research experience should not be a de facto requirement to go into small surgical fields. I have friends doing full time research years that plan never to touch research again. It's mostly a ratrace to rack up small impact projects that nobody will read instead of meaningful work on long term projects. Dumb.

Residency application caps need to happen ASAP.

Step 2 should also be pass fail like the bar/other licensing exams, step 1 will be and CS was.

Plus some spicy speculations - like that NPs will probably come out noninferior for bread and butter primary care patients if we do the studies, or that theres nothing in an MD that makes someone better at learning procedures. At least, nothing in my MD I can appreciate.

Oh one more good one - people who choose medicine for the "wrong reasons" like a stable, high income, interesting job are more likely to have their expectations met than the altruists are.

Theres probably more I'm forgetting

This is basically what they do in UK, and a bunch of Asian countries.
The last 2 years of high school are akin to the fist 2 of college - Bio, Organic Chem, Physics, Calculus etc (if you are on medicine path).
Then its 2 years of classes and then up to 4 years of rotations.
So med school ends up being 6 years, but you didn’t have to take a bunch of BS classes in college that you will never use again.
I can see the benefit of taking government, Eng Lit, and I LOVED my theater elective....but 2 extra years of attending pay would have been better 😏

 

[efle]

This is basically what they do in UK, and a bunch of Asian countries.
The last 2 years of high school are akin to the fist 2 of college - Bio, Organic Chem, Physics, Calculus etc (if you are on medicine path).
Then its 2 years of classes and then up to 4 years of rotations.
So med school ends up being 6 years, but you didn’t have to take a bunch of BS classes in college that you will never use again.
I can see the benefit of taking government, Eng Lit, and I LOVED my theater elective....but 2 extra years of attending pay would have been better 😏

It sounds like for a radiologist, it's the last 5 years of a 14 year education and training pathway that teaches you the job. That's insane. I also loved college and honestly med school wasnt too bad. But I'd def rather have the option to reach FIRE a decade sooner!

 

[Steve_Zissou]

Apparently, this is what the ACGME thinks about NPs supervising residents during codes

 

[Matthew9Thirtyfive]

Apparently, this is what the ACGME thinks about NPs supervising residents during codes

View attachment 335209

I’m sure the program will claim they are delegating the task and are indirectly supervising.

 

[Lem0nz]

I hope this ends well. I have doubts.

 

[Ho0v-man]

APSHO Supports Full Scope-of-Practice Regulation for Advanced Practitioners in Open Letter to President Biden

/PRNewswire-PRWeb/ -- The Advanced Practitioner Society for Hematology and Oncology (APSHO) sent an open letter to President Biden requesting support for...

www.prweb.com

A heme onc society created by midlevels is addressing Biden about FPA.

Literally half of my outpatient heme onc rotation work was NP referrals for anemia (I.e. please interpret my iron studies) or polycythemia in a pt who probably has sleep apnea. The heme onc NP didn’t know what TTP or DIC even was.

To be fair, they seem to be just supporting increased access to primary care, but that’s always what they say.

 

[Señor S]

To be fair, they seem to be just supporting increased access to primary care, but that’s always what they say.

Eh, wouldn't be so sure. From the letter

Similar shortages have been projected for cancer care because the physician supply cannot match the demand of increased numbers of patients with new cancer diagnosis, those undergoing treatment, and long-term cancer survivors (ASCO, 2017; Yang et al, 2014). A collaborative workforce study between APSHO, the American Society of Clinical Oncology (ASCO), the American Academy of Physician Assistants (AAPA), the Association of Physician Assistants in Oncology (APAO), and the Oncology Nursing Society (ONS) examined the role of APs in oncology in the United States (Bruinooge et al., 2018). Conclusions from this study note that with the growing complexity of care, an AP independent model in a collaborative practice setting increased access to quality cancer care.

These midlevel lobbying organizations are always going to be cagey and vague about what they're really asking for in these open letters. Everything is couched in euphemisms and meaningless cliches ("practicing to the top of their license") specifically to obfuscate the reality, which is that they want to be doing what physicians do, independently and without the "formality" of going to medical school or completing residency. That's what they're asking for, I think: they want to independently practice oncology, with no official supervision by a physician, and to be paid the same as a physician to do so.

Now I don't know how powerful this organization really is; Google seems to indicate that their headquarters is a suite in an office park in New Jersey, which makes me think that this is a fringe organization without the members, money or clout to effectuate any real change...for now.

 

[DrStephenStrange]

 

[aaronrodgers]

o m g they know how to play the perfect villain

 

[ohmanwaddup]

Saw this today and I was beyond appalled at how mask off the entire statement was.

I also did an internal cheer when I saw how the ASA response was pretty classy and a hard backhand at the same time

ASA President Responds to AANA Statement ‘CRNAs: We are the Answer’

 

[Aheadbyacentury]

ASA President Responds to AANA Statement ‘CRNAs: We are the Answer’

No n eed to respond Just back the AAs 100 percent and every dollar you spend fighting crna lobby just spend it on AA legislation in all 50 states

 

[popopopop]

Made the mistake of going to the AANA's site and skimming the actual document. There's so much to dissect in this paragraph that I can't even write out. Every time I read about scope creep, I swing between sadness and anger.

 

[Lem0nz]

The ASA response was fantastic and if that were the response by every anti-midlevel group and crowd I would be 1000% behind that movement. Unfortunately it is rarely that classy. :\

Edit: That ASA response was from 2019. Did they respond again?

 

[Señor S]

The ASA response was fantastic and if that were the response by every anti-midlevel group and crowd I would be 1000% behind that movement. Unfortunately it is rarely that classy. :\

Disagree. If anything it epitomizes the problem with any attempts to stop encroachment, namely that many physicians are so dependent on midlevels to do their work that they're utterly terrified of saying or doing anything to upset them.

If this fight can be won (which at this point I doubt), it will not be won by "taking the high road." I'd plan for an ugly, mean-spirited "us against them" PR battle royale (which is actually what the AANA is already doing); otherwise plan for us non-surgeons to continue to slide into complete irrelevance.

 

[ohmanwaddup]

The ASA response was fantastic and if that were the response by every anti-midlevel group and crowd I would be 1000% behind that movement. Unfortunately it is rarely that classy. :\

Edit: That ASA response was from 2019. Did they respond again?

The we are the answer CRNA document is from 2019 as well

 

[Neopolymath]

The ASA has been playing nice forever. Look at what it got them. One wonders what ASA dues are for at this point. Local pacs and state chapters of the ASA don't act like the national org and have the results to show for it.

Hate to even bring up politics but the ASA reminds me of one party speaking about decorum all the time while the other party proverbial stands on their opponent's neck whenever they get a chance to do so. I'll let you guess which party has gotten results for their constituents.

"Le classy" physician is a pointless act.

 

[sunshinefl]

Made the mistake of going to the AANA's site and skimming the actual document. There's so much to dissect in this paragraph that I can't even write out. Every time I read about scope creep, I swing between sadness and anger.

View attachment 335703

That’s so gross. They want to have unlimited SRNA students, and to let them practice independently in the OR? STUDENTS? Omg!

 

[Ho0v-man]

That’s so gross. They want to have unlimited SRNA students, and to let them practice independently in the OR? STUDENTS? Omg!

Meanwhile an M4 can’t trim a toenail unsupervised lol

 

[Lawpy]

Meanwhile an M4 can’t trim a toenail unsupervised lol

Physician lobbying is garbage unfortunately

 

[ohmanwaddup]

Meanwhile an M4 can’t trim a toenail unsupervised lol

and at the same time, we are demonized for not doing things.

Simultaneous "get out of the way!" and "You need to act more enthusiastic!"

And then when you actually get a chance.... "What do you mean you can't do this perfectly the first time! why aren't you holding that right!"

 

[sunshinefl]

and at the same time, we are demonized for not doing things.

Simultaneous "get out of the way!" and "You need to act more enthusiastic!"

And then when you actually get a chance.... "What do you mean you can't do this perfectly the first time! why aren't you holding that right!"

Oof, the memories.

 

[efle]

Meanwhile an M4 can’t trim a toenail unsupervised lol

I'm glad I paid $1000/week to shadow and do scutwork, itll make me way better at reading cross sectional imaging

I'm a broken record on this topic but it always feel like more of the criticism should be directed towards our outdated education/training pathways

 

[Ho0v-man]

and at the same time, we are demonized for not doing things.

Simultaneous "get out of the way!" and "You need to act more enthusiastic!"

And then when you actually get a chance.... "What do you mean you can't do this perfectly the first time! why aren't you holding that right!"

This was everyday of my surgery rotation. I just gave up halfway. Gonna get screamed at anyway so might as well not bother haha.

 

[Ho0v-man]

I'm glad I paid $1000/week to shadow and do scutwork, itll make me way better at reading cross sectional imaging

I'm a broken record on this topic but it always feel like more of the criticism should be directed towards our outdated education/training pathways

I agree wholeheartedly. But then even though we agree generally, both of us have debated at length which parts schools be cut out/reformed and have drastically different opinions despite going into the same specialty. So we’re all doomed.

 

[VA Hopeful Dr]

I agree wholeheartedly. But then even though we agree generally, both of us have debated at length which parts schools be cut out/reformed and have drastically different opinions despite going into the same specialty. So we’re all doomed.

I think everyone, even us dinosaur attendings, agree that clinical rotations should be much more than shadowing. That seems an easy place to start.

 

[Lem0nz]

I think everyone, even us dinosaur attendings, agree that clinical rotations should be much more than shadowing. That seems an easy place to start.

How do we change that? That trend is getting worse, not better. Attendings and residents have less time and experience, not more. More clinical demands that can definitely necessitate us just getting things done so we aren’t all staying late.

 

[VA Hopeful Dr]

How do we change that? That trend is getting worse, not better. Attendings and residents have less time and experience, not more. More clinical demands that can definitely necessitate us just getting things done so we aren’t all staying late.

There's the rub. For truly academic attendings, if they consistently get bad evaluations from students then work with them on improving. If it continues to be a problem, fire/remove from teachings students.

The really tricky part is us non-academic folks. Many schools, including the one I precept for, aren't so flush with attendings that they can stop sending students to everyone who doesn't do a good job. This is the only real concern I have with the massive expansion of schools.

 

[Lem0nz]

There's the rub. For truly academic attendings, if they consistently get bad evaluations from students then work with them on improving. If it continues to be a problem, fire/remove from teachings students.

The really tricky part is us non-academic folks. Many schools, including the one I precept for, aren't so flush with attendings that they can stop sending students to everyone who doesn't do a good job. This is the only real concern I have with the massive expansion of schools.

Exactly. That's going to be me next year too. I'm starting a practice in a large system that has medical students who rotate and is also starting a general surgery residency, but the system (while non-profit) is not a university or an academic setting. A tertiary referral center with a huge patient population, yes. But our priorities are clinical demands first, GME second, UME as an afterthought. UME and GME can honestly be full time jobs on their own and those two things are not things we get paid to do. My president was surprised when I asked him if my contract could have protected time to attend the surgical residencies educational conference and M&M - he was like "Why? What's that got to do with taking care of cancer patients?" Not in a negative way. He just didn't understand how surgical residencies work.

On the bright side, in surgery at least, these things are usually actually fairly synergistic at the GME level. At the UME level though, it definitely slows you down. Other than the altruistic and enjoyment of teaching and being able to walk a student through a procedure the first time or let them get hands on experience - its a time sink that provides no tangible benefit. The short rapid fire rotating of 3-4 weeks if you're lucky, but often time 1-2 weeks and the level of investment to not get paid anything and have it directly detract from your available time to take care of patients and do all of these other things is... an issue.

 

[Lawpy]

We need to pay attendings to teach med students. I don't care how expensive it is, the costs will be absorbed when deeper reforms take place (such as kicking administrators out)

 

[VA Hopeful Dr]

We need to pay attendings to teach med students. I don't care how expensive it is, the costs will be absorbed when deeper reforms take place (such as kicking administrators out)

I do get paid. Doesn't make me do a good job.

 

[Captain_Falcon]

I do get paid. Doesn't make me do a good job.

Would there be a thoeoretical $ amount that lends you enough time to focus energy on teaching? (Like, not needing to see 18 patients a day for overhead and your regular salary)

 

[VA Hopeful Dr]

Would there be a thoeoretical $ amount that lends you enough time to focus energy on teaching? (Like, not needing to see 18 patients a day for overhead and your regular salary)

18? Psh, I'm angry with anything less than 25.

Don't tell the school this, but I would do this for free. I actually offered that to the med school I graduated from, never heard back, so e-mailed the local DO school which offers a stipend.

For outpatient FM, its really not hard to be a decent preceptor. Let students see patients independently and discuss the patients they see. Let them come up with a plan and discuss why you make any changes. I assign a pertinent article every day that we talk about the next day. Last night was the ADA diabetes treatment algorithm. I will teach/let them do some procedures: cryo, knee injections. If they're really good, sometimes biopsies and ingrown toenails.

 

[Captain_Falcon]

18? Psh, I'm angry with anything less than 25.

Don't tell the school this, but I would do this for free. I actually offered that to the med school I graduated from, never heard back, so e-mailed the local DO school which offers a stipend.

For outpatient FM, its really not hard to be a decent preceptor. Let students see patients independently and discuss the patients they see. Let them come up with a plan and discuss why you make any changes. I assign a pertinent article every day that we talk about the next day. Last night was the ADA diabetes treatment algorithm. I will teach/let them do some procedures: cryo, knee injections. If they're really good, sometimes biopsies and ingrown toenails.

I guess it is time to pop the question: "Will you be my preceptor?"

 

[VA Hopeful Dr]

I guess it is time to pop the question: "Will you be my preceptor?"

I have no idea how this sort of thing works, but if you have the ability to do rotations with VCOM I'd be happy to.

 

[Captain_Falcon]

I have no idea how this sort of thing works, but if you have the ability to do rotations with VCOM I'd be happy to.

Unfortunately not (I'm in the midwest), Thank you for your generosity though!

 

[Lawpy]

Med students slowing down attendings is a problem. I don't really have solutions other than early clinical exposure starting MS1...

But even with early clinical exposure, i don't know how much it'd help. I'll say i have a deep hatred for the idiot gunners who waste everyone's time flexing their preclinical knowledge and asking dumb questions that can be looked up

 

[Matthew9Thirtyfive]

How do we change that? That trend is getting worse, not better. Attendings and residents have less time and experience, not more. More clinical demands that can definitely necessitate us just getting things done so we aren’t all staying late.

I mean...is it really that hard? Maybe it’s because we’re military so there aren’t the same incentives, but I have yet to do a rotation that was mostly shadowing. All of my rotations so far have expected me to be an active participant in the care of my patients, interviewing them myself, writing their notes, doing minor procedures on them myself, etc. Why is it so hard to get this kind of experience at other schools?