The ill-prepared student

[JustPlainBill]

Part of the problem is an Arms Race between testing and test prep companies.

<snip>

However, I think with time, and demands of residency (the chief is not going to reshuffle the schedule to fit your needs, having a meeting or two with the program director if patient care suffers due to work ethics, realizing you can't rest on your laurels if you want that coveted fellowship in a desirable location, etc. I once had an intern ask on rounds why the senior residents and fellows don't have to pre-round ... the look on the seniors and fellow's faces were priceless ... no verbal answer needed to be given. (believe it or not, I already know the patients, their numbers, vitals, etc. It's what I do in the morning when I arrive, but before I show up to "round"). That intern grew up quickly during intern year and when she returned as a senior resident the following year, was a strong senior (and realized as a senior, she had to pre-round on all the patients before rounds started, as a check/backup for the interns).

<snip>

I'll never forget a similar situation -- I was chief of service for our inpatient service and I had an intern who never quite got it --- he was a nice guy, personable, kind of a party animal who got away with things because of his ability to schmooze, his family was known to some of the attendings personally and to a few of the PGY2's.....

When I took over, I ordered pre-rounds 1/2 hour prior to attending rounds, notes done by attending rounds so that we could get floor work done by 2 after lunch and pick one intern to stay late and give the other one an early afternoon off. No big deal.

Well, this particular intern, the first day comes rolling in about a half hour AFTER I get there and doesn't start seeing his patients until about a half hour before pre-rounds start and has zero notes ready by attending rounds. As I'm pre-rounding with the team, he starts questioning why we're pre-rounding, he knows his patients, everyone on the team knows them and pre-rounding is just for me, etc. I had enough coffee on board not to slap him down hard at that point, told him what I wanted done and left it at that.

He managed to schmooze his way out of knowing WTF was going on with his patients and looking things up on the fly during attending rounds --- I got a few looks from the attending and knew what had to be done.

Over the course of the rest of the afternoon the behavior did not improve.

Next morning, he starts to pull the same stunt -- the other intern is watching what's going on --- the guy left me no choice -- I calmly waited until he got asked about something that I had been contacted about, had put in the chart, and ordered a few studies and a consult. It was in the chart and if he would've been ready at pre-rounds, he would have known about it --- when the attending asked if that was it on this patient and he replied that it was, I lowered the boom on him. I don't think he'd ever had his butt chewed or been talked to in that manner before in his life, especially in front of his peers -- was it a poor leadership decision on my part -- probably, you counsel in private, praise in public -- but this guy had an attitude that needed correction and he refused --- wound up writing him up as he acted like a petulant child afterwards and we kept having to sweep up after him.

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[costales]

LOL. Reminds me of an intern who called a consult without doing his homework - he put the call on speaker:

Specialist: "What school did you go to, son?"
Intern: "XYZ School of Medicine, Sir"
Specialist: "Do they teach r*t$%ds over there?"​

Needless to say, it was a rude awakening for him.

 

[PCPalltheway]

An interesting editorial by a chief resident at an academic medical center, recently published on NEJM Journal Watch.

http://blogs.jwatch.org/general-med.../the-era-of-the-ill-prepared-medical-student/

I think it would be wrong to generalize an entire class or generation, as there are hard working students, but I've definitely seen my share of poorly prepared disinterested students. Usually poorly prepared students lead to poorly prepared interns

As the author of the article, I am grateful you shared this piece here! I can tell you that my intention for writing it had more to do with a critique of the system of education than the entire next generation of students. I definitely appreciate many of the comments that bring new critiques into the conversation including admissions criteria, EMR culture and subjectivity of evaluation systems.

@the students who read this--- keep your heads up and recognize that, unfortunately, the education you desire is one that you have to be aggressive in acquiring. It will not be fed to you despite that being a natural expectation of your training and tuition payments. It isn't fair, it just is what it is... but you still have control over your individual pedagogy and you can still make it happen.

~Yousaf