student trouble????

[denise]

I have a question. It has only been 2 years since I was a 3rd year student, but maybe things have changed that fast!

#1. In the hospital you are working, do the PGY1 have students under them. If yes, do the PGY1 inform the student(s) what to do (as in rounds, H&P, lab checks)?

#2. In the OR, who decides on the "scrub schedule" And if there are no surgery residents, does the resident/intern on the service assign the students to the rooms?

#3 Are the students involved with case presentations, am report and other things?

Well, I was just wondering, becasue I have been running into a group of students (3rd yr), who just come out and tell me what they are going to do and when. I am just beside myself!! <img border="0" title="" alt="[Frown]" src="frown.gif" />

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[UHS2002]

Well, I am a MS4 and I can tell you how things have been for me:

#1 Most hospitals will let PG1s supervise students, a few will not assigne students to PGY1s based on the premise that interns are plenty busy trying to keep their head above water and they don't need the added responsibility. Of all my rotations, the former was the case in all but one hospital. As a matter of fact, I have had rotations where the attending would tell me that the MS3 was in part my responsibility and to assign H&Ps and patients to the MS3 as I saw necessary.

#2 Don't know, always had surgery residents around. The non surgery residents on the service and the med students were pretty much treated the same by surgery residents and faculty.

#3 Yes, fully involved with all the things you mentioned, just like the residents.

Ultimately, it is the senior man's (or woman's)responsibility to assign work, in such a way that it will be fair and educational to all. That is MS4s over MS3s, PGY1s over med students, PGY2s over all of the above and so on. Medicine is a hierarchical profession, and with a lot of good reasons.

 

[Jim Picotte]

The students should have a clerkship director and I'd ask the director what is expected of the students relating to your above questions. There are places (not saying that your program is one of them) that if the residents were in total control, all the students would be doing is scut and not much learning so there is usually guidelines to follow so its best to just ask their coordinator or director.

 

[Freeeedom!]

I ABSOLUTELY want students next year (as a PGY1)...not only will they HELP ME, but I can teach them what I needed to know as a ms3,ms4!!

 

[vyc]

hey so i'm not in med school yet and don't understand this whole hierarchy.
can someone lay it all out for me?

all the acronyms. and stuff like what's a 'head resident,' how does one become that, etc.

 

[Neurogirl]

The order of the hierarchy is as follows:

1. Attendings (top of the food chain)
2. Fellows (post residency, subspecialty training)
3. Chief Resident (last yr of residency)(the chief is usually appointed, but some programs allow all the seniors to take turns)
4. Residents (PGY-2,3,4) (PGY=Post Grad Year)
5. Interns (PGY-1) (first year of residency)
6. Nurses
7. Janitors, Food Service Personnel, etc.
8. Medstudents (MS-1&2 classroom, MS-3&4 clinical clerkships)(bottom of the food chain)
9. Premeds (not even part of the food chain...which explains why attendings are so nice to them) <img border="0" title="" alt="[Eek!]" src="eek.gif" />

 

[NuMD97]

One of the co-program directors actually had a formal meeting with the housestaff on just this issue after a lot of negative rating reviews were made by the medical students apparently. He wanted the interns to supervise the MS-3s while the MS-4s were to be the responsibility of the team resident.

At least on paper it was a nice theory.

 

[vyc]

thanks neurogirl!
so attendings are done with all their training?

 

[Acro Yali]

Yes, attendings are done with their tranings. They are actually employees of the hospital. I also agree with everything neurogirl said, maybe except for how pre-med are treated nicely by attendings---I had some bad personal experiences with them when I was in undergrad. But, I have been treated extremely well by attendings and fellows at my school. Hopefully, things will continue to be this way.

 

[denise]

Well at least now I know it must be the group of students that are here. For a second, I was starting to believe the students when they told me at the big university hospitals the students get to pick and choose as they please, even in surgery. Then again, I knew something was weird when they have been at my community hospital for now seven months and they are only 3rd years. So, I doubt they really know how it works

 

[dr.evil]

denise, you're getting the raw end of the deal. the students should be helping you out. The 3rd year students were usually there to help out the interns with whatever needed to be done. 4th years were usually in direct control of the chief or upper level.

OR schedule was usually the responsibility of the students themselves. All cases had to be covered by a student and it was up to them/us to make sure that happened.

I found students had different responsibilities at different institutions when it came to case presentations, am report, and such. This was mainly due to different classes and time constraints the clerkship director had planned for them.

Crack a whip and get those guys/girls to help you out a little more but don't be so bossy that they resent you and wouldn't pee in your ear if your brain were on fire.

 

[surg]

Where I am, the students are with the service that they are on. The team is expected to cover a certain amount of work, which includes getting a student and a resident (whenever possible, and believe me, it better be an act of God or really incredibly bad scheduling for it not to be possible) to every case, but we usually let the students decide who goes to which case unless there is a problem. Students split up all the patients on the service and are responsible for knowing their care plans and helping to ensure that they are executed. They also write the progress not each day for the patients that they are covering (we try not to exceed 8/student whenever possible). H&P's? Not usually, but the rotation does require a certain number of H&P's reviewed by an attending or chief resident to turn in at the end of the rotation, so they end up doing some.
Students are there to help in all aspects of care, and do participate in the scut, but we try to shield them somewhat from the scut that really needs to be done by an intern (chasing down consultants, etc.). Case presentations? If I'm feeling up to it. Maybe 1 a month/student. The way I see it, I can usually judge more about them from their day to day activities than I can from 1 high pressure presentation. On some of the rotations though they do a presentation for the attendings/residents before clinic.
The suggestion to talk to the clerkship director is a good one. Over the years a fairly detailed do/don't list has been compiled (details number of calls, in-house/home call, etc.) that should be expected of students here and we are responsible for knowing these guidelines. If your institution does not have these, they should go about making some immediately.