Speed and efficiency of seeing patients as a 4th yr med student

[vtucci]

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Hi all.

I was wondering if the attendings and residents out there can give me an idea of how long you would expect a 4th year medical student to work up the various complaints in the ED. Feel free to list complaints out (e.g., chest pain, abd. pain, SOB, AMS etc). I am striving to improve my efficiency and know that all of this gets better with practice and we improve from 3rd to 4th year and then to interns and residents. It is about striking the right balance between being thorough and being efficient.

How many patients do you expect students to average on a shift? I saw for residents that many programs have 1-2 as a average per hour.

 

[SoCuteMD]

I can't give input as a resident or an attending. What I've been told by residents and by the people I'm working with is that to remember that as a med student you end up making more work for the attending and so even if you CAN see patients faster than you are, you might not want to do so. I find myself chugging along at one patient for every 45 minutes I work. That doesn't mean I SPEND 45 minutes with each patient - but I'll go see a patient, write it up, present my patient, discuss any new results on my OTHER patients, go check on any patients who need to be eyeballed and then pick up a new one somewhere towards the end of that sequence.

The time I spend with patients varies. If it's a fast track type patient and fast track is closed - maybe 10 mins. If it's a complex patient who is definitely going to be admitted AND there's a language barrier it can reach upwards of 30. I could probably spend less time on that one, but I know that I'll have to present the patient to the admitting resident as well and I like to have the little details that make medicine residents happy when I call them.

 

[southerndoc]

When I was a senior resident, I never wanted a medical student carrying more than 3 patients at any one time. I usually tell them to max out at 2, and to always check with me before signing up for a new patient. After I get comfortable with their abilities to handle multiple patients, I then tell them they can see more.

It's a lot of work for a senior resident or attending to supervise a medical student.

I don't really expect them to see so many patients/hour. I would rather them take their time, read up on their patients, research, etc. Of course this doesn't mean you should be playing solitaire during the shift. If you have 2-3 patients all the time, then you should be all set.

The worst scenario is when a medical student can't juggle the patients he/she is carrying. I will almost always know lab results and x-ray results before you, but will often purposefully wait until you present them to me so you can interpret them and come up with a plan. I will only intervene in critical cases, and often it's to point out that lab results are back and ask you on the spot what you think.

 

[Rendar5]

I asked a similar question when I was doing my home EM rotation and got some useful answers: http://forums.studentdoctor.net/showthread.php?t=529796
My experience was pretty much what Southern described. Carried 2-3 pt's at a time and just stayed on top of them. Once or twice I carried more with residents who knew me better, but that was the exception.

 

[kungfufishing]

Remember there is a difference between rapidly acquiring new patients and efficiently progressing workup, therapy, and dispo. I would agree with the above (and post pad) that it is a lot better to just see a couple people and really know them well.

 

[USAF MD '05]

Agree with KungFuFishing. My "best" medical students were not always the ones trying to stack up patients to impress me with their numbers, but were the ones who learned quickly to focus on the important parts of an ED HandP and remembered that this isn't medicine. The ones that patient stacked seemed to never have info on their patients, or I consistently beat them to the mark looking up x-rays, labs, etc... I want you to know your patients well, repeatedly eyeball them for status changes and keep on top of their studies. If you can do this well with 1 or 2 patients at a time, that is all I expect. The time for crushing numbers and ignoring your patients once the workup has started will come soon enough. (J/K, kind of....)

That being said, I had some studs who would routinely take almost a half hour or more for every complaint. That ain't gonna fly. Focused H and P should be your mantra. You will learn how to do that after a few times of me asking for info that you forgot, and completely ignoring other parts of your presentation. Good luck, Steve

 

[vtucci]

Thanks all.

That has been my experience thus far and wanted to see how it measured up to what occurs at other programs.

Best wishes to everyone.