Teaching med students

[intmed2014]

Which topics are ideally high yield for me to teach my medical students? Most of them won't go into IM, but maybe broad strokes will help for their shelf exam.

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[Siggy]

For internal medicine? The bread and butter cases. Chest pain (STEMI, NSTEMI, UA, stable angina, non-cardiac, etc), heart failure, diabetes (including DKA and HHNK), pneumonia, sepsis/septic shock/severe sepsis/MODS, liver failure, TB, etc.

 

[HelpPleaseMD]

Which topics are ideally high yield for me to teach my medical students? Most of them won't go into IM, but maybe broad strokes will help for their shelf exam.

Chest pain, COPD/Asthma, DKA, Sepsis and its spectrum, Pneumonia, AKI, hyponatremia, hypertensive emergency, CVA, basic EKG

I think a quick overview of those topics will be a good starting point for med students going into any field

 

[Moko]

Things that I found helpful and high-yield: running through ACS and ACLS algorithms. How to manage COPD exacerbations, hypertension and diabetes/insulin in an inpatient setting. Working up acid-base disorders and general overview of antibiotic coverage. Reading x-rays and EKGs are also great exercises.

 

[Cytarabine]

Systematic interpretation of ekg and CXR and reinforcing that teaching by going over new ones on patients as they come in ("go through this cxr for me, take it step by step like we talked about and tell me what you see" then correct / reteach as appropriate). Point out good examples of physical exam findings (murmurs, rubs, crackles, wheeze, etc). Electrolyte disorders, fluid selection

 

[iskander07]

I just send them home at the earliest opportunity.

 

[GOLDMARK]

I just send them home at the earliest opportunity.

Students may appreciate this in the beginning, but then they end up complaining when grades come out because the residents have not had any meaningful interaction with the student to evaluate them (--> student receives average in every category). Students are also shortchanged in the end because haven't learned anything clinically useful. It's a double edged sword: students shouldn't be used for scut work (though this is hard since I know how useless we can be) but at the same time, they shouldn't be ignored either.

 

[iskander07]

Students may appreciate this in the beginning, but then they end up complaining when grades come out because the residents have not had any meaningful interaction with the student to evaluate them (--> student receives average in every category). Students are also shortchanged in the end because haven't learned anything clinically useful. It's a double edged sword: students shouldn't be used for scut work (though this is hard since I know how useless we can be) but at the same time, they shouldn't be ignored either.

I've yet to receive any complaints, my students have always rated me very highly. I also just mark all my students 4/5 or 5/5 entirely dependent on how we interact passing away time in the rounding room.

Honestly teaching takes time. It prolongs the already tortuously slow rounds. It's time taken away from doing all the paperwork that is the raison d'etre of internal medicine. If one of the other residents is doing handoff that means it's time out of my day that could be spent not in the hospital. If my paperwork is done and I'm just sitting around watching the clock for handoff time to come up then that's fine, but nobody's been interested enough to stick around. I sure wasn't when I was a med student.

 

[Gastrapathy]

Ignoring iskander.

Make them understand salt. Or even just a little bit about salt.

 

[HelpPleaseMD]

I've yet to receive any complaints, my students have always rated me very highly. I also just mark all my students 4/5 or 5/5 entirely dependent on how we interact passing away time in the rounding room.

Honestly teaching takes time. It prolongs the already tortuously slow rounds. It's time taken away from doing all the paperwork that is the raison d'etre of internal medicine. If one of the other residents is doing handoff that means it's time out of my day that could be spent not in the hospital. If my paperwork is done and I'm just sitting around watching the clock for handoff time to come up then that's fine, but nobody's been interested enough to stick around. I sure wasn't when I was a med student.

teaching will make you a better resident too. teaching about a case that you admitted takes 5 minutes tops. my experience when I was a med student was that I luved leaving early .... but I argue that a good resident can teach md students clinical pearls that they cannot simply pick up by reading uptodate or textbooks. also IT IS YOUR JOB.

 

[iskander07]

teaching will make you a better resident too. teaching about a case that you admitted takes 5 minutes tops. my experience when I was a med student was that I luved leaving early .... but I argue that a good resident can teach md students clinical pearls that they cannot simply pick up by reading uptodate or textbooks. also IT IS YOUR JOB.

There's nothing in my contract about teaching and my check doesn't come from the medical school so no, teaching is not my job.

 

[jl lin]

There's nothing in my contract about teaching and my check doesn't come from the medical school so no, teaching is not my job.

Honestly, I am glad I haven't seen this in most of the centers I have worked. Do you mean to say, however, if a student were to press you, you'd go the extra mile and teach? So you are saying, none of them have approached you in this regard?

Sort of disappointing. I mean I am sure there are days you can just send people home. But aren't there other days when there are good teaching opportunities? This made me feel 🙁

 

[HelpPleaseMD]

There's nothing in my contract about teaching and my check doesn't come from the medical school so no, teaching is not my job.

thankfully I never had the chance to encounter someone with your viewpoint when I was a medical student. There is nothing in your contract stating you should be promoted either...

I will leave it at that

 

[Raryn]

There's nothing in my contract about teaching and my check doesn't come from the medical school so no, teaching is not my job.

It was understood to be an expectation of you when you took a job at an academic program.

 

[CatFactorial]

To all the folks who are a little cranky-pants, in general, interns are supposed to get the work done as efficiently as possible. Teaching is more the responsibility of the upper levels. So, this guy isn't wrong when he says it's not really his job. He's only wrong when he tries to spell "islander."

However teaching my med students the basic stuff is the best way to review it for my own purposes (usually I'm rusty prior to reviewing it before discussing with the studs). So by sending all your guinea pigs home you're doing yourself a disservice in the long run. Embrace your inner sadist!

 

[PDIsani]

If they want to learn, they can go ask the attendings.

 

[IMreshopeful]

There's nothing in my contract about teaching and my check doesn't come from the medical school so no, teaching is not my job.

You are at an academic institution. Your job is to learn, and also teach if you have medical students, because it is implied. Thank the lord my residents were, unlike you, interested in teaching, otherwise they would never have inspired me to enter IM as a career. Sometimes I wonder if our residency selection process for academic institutions is flawed...

 

[IMreshopeful]

To all the folks who are a little cranky-pants, in general, interns are supposed to get the work done as efficiently as possible. Teaching is more the responsibility of the upper levels. So, this guy isn't wrong when he says it's not really his job. He's only wrong when he tries to spell "islander."

However teaching my med students the basic stuff is the best way to review it for my own purposes (usually I'm rusty prior to reviewing it before discussing with the studs). So by sending all your guinea pigs home you're doing yourself a disservice in the long run. Embrace your inner sadist!

There is a LOT that an intern can teach a sub-I/AI on service which is practical day-to-day stuff. It is not true that interns can't teach. I love teaching students as a resident, but as an intern, although I had less time, we would always take the opportunity to showcase something cool or interesting when it came up ("hey come over here and check out this guy's JVD. Now you'll know how to recognize it!" etc).

Common topics that I try to teach my students are many of the ones listed above - COPD, ACS/chest pain, DKA/HHNK, sepsis criteria, acute stroke, EKG learning. I also personally like teaching about RTAs (when I can remember them myself), syncope workup, GI bleed workup, liver failure.

Also when patients are decompensating or coding I always bring my students along. One of the most important things a student can learn, IMO, is when a person is sick or dying and what to do to stop it.

 

[iskander07]

You are at an academic institution. Your job is to learn, and also teach if you have medical students, because it is implied. Thank the lord my residents were, unlike you, interested in teaching, otherwise they would never have inspired me to enter IM as a career. Sometimes I wonder if our residency selection process for academic institutions is flawed...

It was understood to be an expectation of you when you took a job at an academic program.

If it's not spelled out in the contract that I signed then it's not part of the job. If my check came from the school then you might be able to make an argument, but nothing in the contract I signed and nothing in orientation said anything about expectations of teaching. It's not my job, period. I wouldn't have gone to medical school if all I wanted to do with my life was teach.

I'm not a dick about it, I answer questions and help out when I'm asked but I don't punish myself and the students by keeping both of us there with unnecessary "teaching time" that nobody wants to suffer through.

 

[Nivakia]

my argument back in residency was simple, I was a terrible teacher, I had bad communication skills and therefore I am would be a bad role model.

 

[rokshana]

It was understood to be an expectation of you when you took a job at an academic program.

probably not at an academic program...

 

[Nivakia]

The concept of teaching is broad. You can teach when you give a presentation at morning report. The kind of teaching they are referring to is one on one, 1 -2 hour of your time discussing a topic that you haven't fully mastered yet. It is a disaster.

 

[NontradICUdoc]

What I tend to do is find out what they are interested in and try to tie in the internal medicine topic to that which the student is interested in going into. For example, for students interested in surgery, we discuss blood pressure control peri operatively and post operative problems, acute kidney issues, pre operative clearance, etc.

 

[smartparts]

What I tend to do is find out what they are interested in and try to tie in the internal medicine topic to that which the student is interested in going into. For example, for students interested in surgery, we discuss blood pressure control peri operatively and post operative problems, acute kidney issues, pre operative clearance, etc.

You sir, are the only real teacher in this lot.

I still remember the resident that asked me why I liked ID and sat down to teach me about tick-borne diseases. I remember exactly zero of the countless goons who taught me about chest pain between seeing patients.

 

[HelpPleaseMD]

right....i only need to learn what I am interested in. lets ignore basic chest pain work up. chest pain?? no big deal. I'll call cards

 

[IMreshopeful]

What I tend to do is find out what they are interested in and try to tie in the internal medicine topic to that which the student is interested in going into. For example, for students interested in surgery, we discuss blood pressure control peri operatively and post operative problems, acute kidney issues, pre operative clearance, etc.

Right because if they go into surgery they're never ever going to have patients with chest pain or a GI bleed or HTN or pretty much anything you encounter in medicine right?

I don't see the point of teaching preop risk stratification because it's regardless going to be a medicine or cards consult for them (only being a little facetious).

Point is that I don't see the point of tailoring it to the interests of the student strictly. You can occasionally point it out sure but I think ultimately the point is to make them well rounded.

 

[iskander07]

Right because if they go into surgery they're never ever going to have patients with chest pain or a GI bleed or HTN or pretty much anything you encounter in medicine right?

I don't see the point of teaching preop risk stratification because it's regardless going to be a medicine or cards consult for them (only being a little facetious).

Point is that I don't see the point of tailoring it to the interests of the student strictly. You can occasionally point it out sure but I think ultimately the point is to make them well rounded.

It's easy, consult hospital medicine to consult cardiology or GI.

If a student wants to go into surgery, they're time is better spent making the connections and studying for the shelf/step 2/whatever that's going to get them there. They're wasting time hanging out in the hospital wards.

 

[IMreshopeful]

It's easy, consult hospital medicine to consult cardiology or GI.

If a student wants to go into surgery, they're time is better spent making the connections and studying for the shelf/step 2/whatever that's going to get them there. They're wasting time hanging out in the hospital wards.

Suit yourself. Too bad the surgical services didn't think that way when I was a med student - and thankfully so, since I would never have learned basic trauma management or basics of L&D had I been told to "go home" because I wasn't interested in it as a career.

 

[smartparts]

right....i only need to learn what I am interested in. lets ignore basic chest pain work up. chest pain?? no big deal. I'll call cards

they have didactics on things like chest pain.

 

[iskander07]

Suit yourself. Too bad the surgical services didn't think that way when I was a med student - and thankfully so, since I would never have learned basic trauma management or basics of L&D had I been told to "go home" because I wasn't interested in it as a career.

You mean two things you will never come across or be expected to deal with in internal medicine?

 

[IMreshopeful]

You mean two things you will never come across or be expected to deal with in internal medicine?

So you shouldn't at least have a sense of the process that happens in labor and peripartum or what is involved at a basic level in trauma management because that's the very basic level of medical knowledge?? In that case why bother learning anything in school not directly related to your career? Hell you could extend that argument as far back as high school

But whatever. Your mentality towards this is clearly different than mine.

 

[NontradICUdoc]

Right because if they go into surgery they're never ever going to have patients with chest pain or a GI bleed or HTN or pretty much anything you encounter in medicine right?

I don't see the point of teaching preop risk stratification because it's regardless going to be a medicine or cards consult for them (only being a little facetious).

Point is that I don't see the point of tailoring it to the interests of the student strictly. You can occasionally point it out sure but I think ultimately the point is to make them well rounded.

To start with, relax and calm down. If you look at the rest of what I said, you would note the letters "etc.". I do not have the time, nor the patience to list every little topic that I covered with my students while I was a resident or cover now as a fellow if they are in the ICU. If you do not see the point of tailoring anything to the students then that is your judgement call on how or if you want to teach them. This is MY style. It does not have to be your style. In my experience, tailoring the lessons to tie into what they are interested in has the effect of engaging the student and helping them learn and not just memorize. But that is MY take. If you want to drone on a lecture as dry as can be and try to keep your students awake, go right ahead.

You need to pay more attention to detail before you make snide comments like this.

 

[Nivakia]

You guys are arguing what to teach people when these days it's their book smarts that get them the jobs rather than clinical knowledge and wisdom. Time have changed people.

 

[IMreshopeful]

To start with, relax and calm down. If you look at the rest of what I said, you would note the letters "etc.". I do not have the time, nor the patience to list every little topic that I covered with my students while I was a resident or cover now as a fellow if they are in the ICU. If you do not see the point of tailoring anything to the students then that is your judgement call on how or if you want to teach them. This is MY style. It does not have to be your style. In my experience, tailoring the lessons to tie into what they are interested in has the effect of engaging the student and helping them learn and not just memorize. But that is MY take. If you want to drone on a lecture as dry as can be and try to keep your students awake, go right ahead.

You need to pay more attention to detail before you make snide comments like this.

You didn't listen to what I wrote either, no need to get offended, I was merely throwing in a little harmless sarcasm. I'm saying that in my opinion tailoring it to their interests alone is not going to help them learn. And when did I say I would drone on in a boring lecture (since we are calling people snide)? Usually I'd relate it to active pathology on a patient that's come in or provide a case and have them explain their thought process and work up. I don't like chalkboard talks either.

Hey everyone can do what they want. Don't need to make it personal.

 

[IMreshopeful]

You guys are arguing what to teach people when these days it's their book smarts that get them the jobs rather than clinical knowledge and wisdom. Time have changed people.

You might be right but pretty much all that book larnin' at least in my experience goes out the window when confronted with a difficult clinical situation like patients going downhill fast. It probably helps to see it in action too