Stepping on Toes during Rotations?

[dantt]

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I'm wondering what your thoughts are on proper etiquette for seeing rare/interesting cases and patients when there are other students present.

I've always thought if the patient and attending physicians are okay with having more than 1 student present during a case or at least observing a patient with an interesting condition, it's okay for one to be present. However, I have heard a lot of students are very uncomfortable with having other students around because they feel they are being compared with the other student whether the other student is taking a participatory role or just merely observing and then they're extra pressured to ask "intelligent" questions.

Personally, my thoughts are if the patient and the attending are okay with it but the other student is uncomfortable with it, too bad. It's the way medical school and medicine are and I shouldn't have to bend over backwards and sit on the sidelines just because the other student is uncomfortable with it. Interesting cases or patients don't "belong" to any student and especially if the attending physicians and patients are okay with having multiple students observe, anybody should feel free to join in.

 

[SouthernSurgeon]

I'm wondering what your thoughts are on proper etiquette for seeing rare/interesting cases and patients when there are other students present.

I've always thought if the patient and attending physicians are okay with having more than 1 student present during a case or at least observing a patient with an interesting condition, it's okay for one to be present. However, I have heard a lot of students are very uncomfortable with having other students around because they feel they are being compared with the other student whether the other student is taking a participatory role or just merely observing and then they're extra pressured to ask "intelligent" questions.

Personally, my thoughts are if the patient and the attending are okay with it but the other student is uncomfortable with it, too bad. It's the way medical school and medicine are and I shouldn't have to bend over backwards and sit on the sidelines just because the other student is uncomfortable with it. Interesting cases or patients don't "belong" to any student and especially if the attending physicians and patients are okay with having multiple students observe, anybody should feel free to join in.

I've bolded the two troubling parts of your post. These kind of actions and or sentiments are the ones that are not "okay."

Of course it is okay to observe and learn from an interesting case - that's how rounds work actually. But you don't need to PRESENT the patient to learn about them.

If an interesting case comes up and your fellow student is the one seeing the patient, talk to them after rounds one day and say - "hey do you mind if I come see them with you and hear a bit more about disease ____" or say "what was that cool exam finding you were talking about - could you show me?"

By doing things like that you get the learning without being a bad team-player.

 

[DeadCactus]

I've bolded the two troubling parts of your post. These kind of actions and or sentiments are the ones that are not "okay."

Of course it is okay to observe and learn from an interesting case - that's how rounds work actually. But you don't need to PRESENT the patient to learn about them.

If an interesting case comes up and your fellow student is the one seeing the patient, talk to them after rounds one day and say - "hey do you mind if I come see them with you and hear a bit more about disease ____" or say "what was that cool exam finding you were talking about - could you show me?"

By doing things like that you get the learning without being a bad team-player.

Maybe I'm misinterpreting, but I think they meant being physically present in the room rather than presenting the case in rounds or wherever...

 

[dantt]

Maybe I'm misinterpreting, but I think they meant being physically present in the room rather than presenting the case in rounds or wherever...

That's correct, merely being present during an interesting surgery for example and either scrubbing and not assisting or peering over the surgeons shoulders on steps. Should be okay, right? Some students are really bothered by that but I think they should just grow up.

 

[alphaholic06]

That's correct, merely being present during an interesting surgery for example and either scrubbing and not assisting or peering over the surgeons shoulders on steps. Should be okay, right? Some students are really bothered by that but I think they should just grow up.

Why would you want to scrub on a case that another student was scrubbed into? There's only so much room around the table.

 

[dantt]

Why would you want to scrub on a case that another student was scrubbed into? There's only so much room around the table.

Most kinds of cases there's room for 4...so surgeon, scrub, and potentially 2 students. Once in awhile for a truly rare case, you'll see 6 scrubbed in (usually see multiple attendings or residents). The reality is most of the time you won't see anything unless you're scrubbed. Of course if there's no room to scrub its a waste of your time to try to see something and in that case I wouldn't try to edge in.

 

[illixir]

I think it's really bad form to scrub in on another student's case. The only reason you scrub in is actually so that you can get to do some stuff. If all you want to do is watch there's plenty of time and room to get to see the good parts without having to scrub and be sterile the entire time. If you scrub in on another student's case there's also the chance the attending or resident have you do something which would be even worse since the other student should be getting to do that. If you really insist on scrubbing and wasting the gown and gloves and you don't want to step on the other student's toes then you should make it clear to the attending and resident that it is not your case, and you are just watching, and don't do anything at all when the other student could be doing it. Usually the attending will tell you not to scrub when he knows you're just gonna be watching.

 

[SouthernSurgeon]

That's correct, merely being present during an interesting surgery for example and either scrubbing and not assisting or peering over the surgeons shoulders on steps. Should be okay, right? Some students are really bothered by that but I think they should just grow up.

Very bad form to scrub on another student's case.

Honestly you shouldn't even be in the OR for another student's case unless you are there to update your resident or attending on various goings-on (patient status changes on the floor, important new labs, etc).

There is plenty of learning to go around. When you are scrubbed in for a case that is your chance for face-time and 1:1 learning from attendings and chief residents. It is not acceptable to try and "steal" that time from your fellow students.

The other thing is that you cannot ignore that there is an evaluative side to third year. When another student is scrubbed in that is one of the main times they are being evaluated. By scrubbing in you are (a) affecting their evaluation and (b) setting up a competitive environment

 

[Jolie South]

Most kinds of cases there's room for 4...so surgeon, scrub, and potentially 2 students. Once in awhile for a truly rare case, you'll see 6 scrubbed in (usually see multiple attendings or residents). The reality is most of the time you won't see anything unless you're scrubbed. Of course if there's no room to scrub its a waste of your time to try to see something and in that case I wouldn't try to edge in.

Umm, you're missing residents, unless you're on a rotation with a private service. Some attendings don't want more than 4 people scrubbed, so if there are 2 residents on a big case you're going to be watching unscrubbed anyways.

I would always ask the student with the attending, "hey, I hear you have a XXX case going today. I haven't seen one. Would you mind if I scrubbed too?" Then, I'd have that student introduce me to the attending and see if it was ok.

 

[alphaholic06]

Umm, you're missing residents, unless you're on a rotation with a private service. Some attendings don't want more than 4 people scrubbed, so if there are 2 residents on a big case you're going to be watching unscrubbed anyways.

I would always ask the student with the attending, "hey, I hear you have a XXX case going today. I haven't seen one. Would you mind if I scrubbed too?" Then, I'd have that student introduce me to the attending and see if it was ok.

My point exactly.

If it's something you really want to see why don't you ask your fellow student if you can trade cases.

 

[cpants]

When one of those rare cases comes along, it is definitely ok to ask to be in the room. It might be your only chance to see something, and it is good to be interested. A couple of rules of thumb:

1. Don't ask or attempt to scrub on another student's patient. It's ok to watch, but just stand next to the anesthesiologist and keep your mouth shut. This isn't your time to get facetime with the attending.

2. Can't emphasize this enough...keep your mouth shut. Don't answer any pimp questions unless specifically directed to you. Don't ask any questions.

3. Run it by the players beforehand. I know this is so and so's patient, but since this is so rare, would it be ok if I just watched? It's not a bad idea to clear it with your fellow student too. Most people wont' care. If he protests, you have a decision to make. If it's so juicy that it can't be missed, then you may have to go for it anyway. If he's really uncomfortable, and it's not that rare, know when to walk away.

4. Which leads us to--don't abuse it. If it's a patient with complete situs inversus or something, cool. If it's a hernia, not cool. Use your judgment, and determine if this is something that would truly be a shame to miss out on before you butt in.