The one IMPORTANT thing pre-meds are missing... Short and sweet.

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Planes2Doc

I enjoy the nightlife
Lifetime Donor
10+ Year Member
Joined
Jul 23, 2012
Messages
2,781
Reaction score
2,489
I've come a pretty long way since starting the pre-med journey. I'm now a PGY-1 internal medicine resident aspiring to do critical care. There is something that I realized only recently that is of utmost importance, and something that pre-meds do not even think about. What is it?

SYSTEMS-BASED PRACTICE

I won't go into details, but will ask you to try and answer two very important questions:

1. As an internal medicine resident, I want you to tell me why I do not need to feed the patient, bathe the patient, clean up the patient, administer the patient's medications before rounds. Also, why am I able to take my time jotting down labs and taking a leisurely stroll to the emergency department when there in a new admit?

2. I want you to self-reflect right now as a pre-med. I want you to be true to yourself and be realistic about your goals. I want you to look up systems-based practice and understand what it means in healthcare, and what it means to you right now as a pre-med aspiring to get into medical school. Now I want you to see how you can make your journey to getting into medical school better; given the challenges, competition, and possible severe consequences you may face if you don't make it in.

With that said, I want you to remember this: You can take it easy now and work hard for the rest of your life, or you can work hard now and take it easy for the rest of your life. The latter is the better option, and good luck to everyone.

Members don't see this ad.
 
Last edited:
  • Like
Reactions: 11 users
I've come a pretty long way since starting the pre-med journey. I'm now a PGY-1 internal medicine resident aspiring to do critical care. There is something that I realized only recently that is of utmost importance, and something that pre-meds do not even think about. What is it?

SYSTEMS-BASED PRACTICE

I won't go into details, but will ask you to try and answer two very important questions:

1. As an internal medicine resident, I want you to tell me why I do not need to feed the patient, bathe the patient, clean up the patient, administer the patient's medications before rounds. Also, why am I able to take my time jotting down labs and taking a leisurely stroll to the emergency department when there in a new admit?

2. I want you to self-reflect right now as a pre-med. I want you to be true to yourself and be realistic about your goals. I want you to look up systems-based practice and understand what it means in healthcare, and what it means to you right now as a pre-med aspiring to get into medical school. Now I want you to see how you can make your journey to getting into medical school better; given the challenges, competition, and possible severe consequences you may face if you don't make it in.

With that said, I want you to remember this: You can take it easy now and work hard for the rest of your life, or you can work hard now and take it easy for the rest of your life. The latter is the better option, and good luck to everyone.
I always appreciate your iconoclastic perspective on this strange system we're giving our lives to. I looked up systems based practice, and I'm still not totally sure what you're telling us though. Care to clarify?
 
  • Like
Reactions: 5 users
I always appreciate your iconoclastic perspective on this strange system we're giving our lives to. I looked up systems based practice, and I'm still not totally sure what you're telling us though. Care to clarify?

Thanks! I was hoping to leave this a bit more open-ended so people could reflect, but I'll explain where I'm coming from.

I was talking to one of the medical students today and he told me that he used to be a scribe. We discussed this for some time and I began to think about systems-based practice in medicine, and how there is a huge disconnect between pre-meds and physicians.

Every day there are multiple threads on ECs and employment. These are two big factors that people have complete control over, where they can do as much or as little as they like. Before medical school, I worked as a pizza delivery guy in high school, majored in economics with hopes of getting into investment banking, and revenue management at two different airlines. If I came up to an investment banker and told them that they absolutely need to be an executive assistant before becoming an investment banker, then I would be laughed at. If I came up to a pilot and told them they needed to be a flight attendant or baggage handler before becoming a pilot, then I would be laughed at. So, why are pre-meds trying to tell physicians what they need to do before becoming a physician. I'm not trying to sound condescending or to be an ass.

Here's where my examples come into play:

1. As an internal medicine resident, I want you to tell me why I do not need to feed the patient? This is done by the CNA.

Bathe the patient? This is done by the CNA.

Clean up the patient? This is done by the CNA.

Administer the patient's medications? This is done by the nurse unless you're an anesthesiologist.

Why am I able to take my time jotting down labs and taking a leisurely stroll to the emergency department when there in a new admit? The emergency medicine physicians and staff have the responsibility of stabilizing the patient and ruling out a life-threatening emergency. Once the patient leaves the emergency department, their job is done (unless it's the doctors on Chicago Med). Initial stabilization and rule out of conditions that will kill the patient are not my responsibility, they are the responsibility of the ED staff. And on the contrary, further treatment and interventions of the patient beyond the ED doors are not their responsibility.

It seems weird to write this, because it's hard to not come off as an ass looking like you're trying to pass off work to others. But everyone in the hospital has their place, from janitors to volunteers to techs to nurses to doctors to administrators. Everyone has their job duties, and performing them helps keep the complex system working efficiently. I'm not going to start littering trash all over the hospital because that's rude, but I'm not going to pick up a dust pan and broom and spend hours cleaning the rooms while I'm supposed to write notes and orders for the patient. The same thing with an investment banker, they aren't going to wipe down the bathrooms or sell coffee in-between projects. The same thing with a pilot, they are not going to be serving passengers food or loading/unloading luggage. Everyone has their place.

And this is what pre-meds are losing sight of. They are going off an doing every which thing in an ultra-competitive process. There are countless threads about jobs and ECs. People would start to get annoyed and call me a broken record if I keep trying to have philosophical discussions in every single thread. Plus, there is a repeating pattern with these threads. These are often new accounts with few posts, and then they drop off. Unfortunately this tends to be people getting burned in the pre-med process, and the results can be catastrophic.

So before pre-meds make these choices, they should take the time to self-reflect and see what their ultimate goals are...

Are you trying to be a chief scribe at Scribe America? Scribing is like teaching a 15 year old that just got their learner's permit how to drift the car. 4th year medical students and even some residents still have trouble with H&Ps. Medical school starts you at step 0, you will not be at a disadvantage if you don't do this.

Are you trying to be the next Mother Teresa and then treat other pre-meds in a condescending way? If you need to go on SDN and ask what volunteer gig is better, then it means you wouldn't have done it in the first place. You don't see me going on a forum asking if getting Mexican food for dinner or using a Canon SLR versus a Nikon will negatively affect my chances for a fellowship? You do the things you're passionate about naturally without even thinking about it. That's okay. Don't get wrapped up thinking that you're an ass if you have less than 100 volunteer hours. Plus, when is the last time you ever heard a pre-med ask about how they can help more people? Everyone is always asking about how to help themselves, and that's totally fine.

What about a CNA? You get hands-on experience, right? You're performing patient care duties that physicians do not do. Not because physicians are mean and don't like doing work, but because in the systems-based practice environment, physicians are looking at the history, physical exam findings, and labs that help them create a treatment plan for the patient. Therefore, while you'll see patients and do finger sticks and clean their poop, you won't be analyzing all of the aforementioned things like a physician would. I got a lot of interaction with people by doing photography on the side, but you don't see me telling people that they need to become professional photographers in order to become physicians.

Long story short. I came here to help people. It's a gratifying feeling. I don't only want to help patients, but I want to help pre-meds. I want them to make the best possible choices in this incredibly unforgiving process so they don't get burned.

Sorry, I got carried away there... tl;dr

1. Just because you don't enjoy volunteering doesn't mean that you're not a good person.
2. You are not required to be a scribe, EMT, CNA, or any other entry-level clinical job to be successful in medical school. Just try to be a good person, follow the Golden Rule, and you'll be okay since you start at step zero.
3. Just because you don't enjoy Gross Anatomy doesn't mean you can't become a surgeon.
4. Labradoodles are one of the greatest inventions of all time.
 
  • Like
Reactions: 34 users
Members don't see this ad :)
Thanks. I don't disagree with anything you're saying. A friend of mine got lost down the "I'm going to be the best scribe in the city" well, she didn't study enough for orgo or the MCAT because of it and she's still paying for it. Which is sad, because I honestly think she would make a good physician.

However, I can't follow your advice to not consider myself an ass if I don't have X hours of volunteering. I'm one of thousands of nobody premed spermatids trying to impregnate the medical school egg, so I am compelled to conform.
 
  • Like
Reactions: 8 users
How would you compare pre-med, medical school, and residency with regards to frustration, busy work, and being unhappy with not being able to do what you want.
 
1. Just because you don't enjoy volunteering doesn't mean that you're not a good person.
2. You are not required to be a scribe, EMT, CNA, or any other entry-level clinical job to be successful in medical school. Just try to be a good person, follow the Golden Rule, and you'll be okay since you start at step zero.
3. Just because you don't enjoy Gross Anatomy doesn't mean you can't become a surgeon.
4. Labradoodles are one of the greatest inventions of all time.

As a scribe with 1.5 years of experience, I would still recommend scribing. But after people hit 1000 hours I would seriously advise dropping to the minimum shifts or finding a different job. It's a great experience but has significant diminishing returns. I doubt adcoms give anyone bonus points for scribing 6000+ hours vs 1000 hours.
 
  • Like
Reactions: 1 user
I do see some value in volunteering just because it gives you empathy for the nurses and CNAs. And it's fun to interact with patients. Like this week there was a blind elderly gentleman from Jamaica who may have been a little delerius. He asked me for help, saying everyone on staff was ignoring him. He asked for a bag, so I got him a patient belonging bag. Then he said he actually wanted a back pack. The HUC overheard and told me a nurse had offered to buy him one, and that he had already been told this. I reminded him about it and explained that the nurse would bring him one in the next day or two, so there was no need to worry.

What does this have to do with being a physician? Absolutely nothing, in my opinion. It's not like I could check his electrolytes or read his chart. But it made me feel good, and I think it made him feel a little better that at least someone was listening to him and taking him seriously. So that's nice.
 
  • Like
Reactions: 5 users
Also, why am I able to take my time jotting down labs and taking a leisurely stroll to the emergency department when there in a new admit?
Because you are the lazy resident the ED hates who doesn't understand their role in the grand scheme of things and thinks their time is more important than everyone else's including the patient you are admitting as well as everyone else in the waiting room who is waiting for that bed. Didn't you go into medicine to help people? Well get your ass to the ED and start helping.
 
  • Like
Reactions: 12 users
Because you are the lazy resident the ED hates who doesn't understand their role in the grand scheme of things and thinks their time is more important than everyone else's including the patient you are admitting as well as everyone else in the waiting room who is waiting for that bed. Didn't you go into medicine to help people? Well get your ass to the ED and start helping.

It's a two way street, and I think this was misinterpreted. I take the time to take down all of the labs to make sure I know what I'm seeing and what I'm getting myself into. I at least have a pretty good idea of what I'm seeing before I even leave my part of the hospital. It's more helpful to gather the information that is and should be available from the ED before seeing the patient than starting from step one. I can do a whole lot more interpreting the data first and then starting my H&P with this newly gathered information, and this is why I strongly prefer ED admits over direct admits from a PCP office. Just recently I've ordered a D-Dimer and then CTA on a PE that was missed by the ED. This was before even seeing the patient. My point is that the emergency department is not going to have to call every other attending or resident service to stabilize a patient because that is their job, just as we aren't going to call ED physicians or residents to leave the ED to do stuff in our part of the hospital. If specialties stopped sh*tting on each other and blaming one another for being lazy and not giving a crap, things would actually be better for the patients.

And I'm not sure how the system in your hospital is, but it's the ED and only the ED physician that decides whether to admit or not. The orders are put in for bed type, and we are called. The moment that happens, I bring up the EMR and start jotting labs down. Depending on how fast the staff are able to move the patient, I have encountered patients in the ED and sometimes on the floor. I have gotten to the ED while they were being transferred up. We have nothing to do with that, and it only has to do with the staff. All I'm saying is that while the patient is within the confines of the ED, it is the ED staff's responsibility to make sure the patient is stable.
 
Last edited:
  • Like
Reactions: 1 user
How would you compare pre-med, medical school, and residency with regards to frustration, busy work, and being unhappy with not being able to do what you want.

We all have to do things that we don't want to do no matter what. Some we have control over, and others we don't. We are adults, not little children. We don't throw hissy fits when we are supposed to do something that is required by job. The point I was making is pre-meds tend to do a whole lot of things that they (genuinely) don't want to do, that they DO NOT have to do, and this will usually makes things worse and not better.
 
Sorry, but I don't see your point.

What about it? Also, do you disagree with systems-based practice? If so, you do realize it's an ACGME core competency, and not something I'm pulling out of my ass.

https://knowledgeplus.nejm.org/blog/acgme-core-competencies-systems-based-practice/

As follows:

  • Work effectively in various health care delivery settings and systems relevant to their clinical specialty
  • Coordinate patient care within the health care system relevant to their clinical specialty
  • Incorporate considerations of cost awareness and risk/benefit analysis in patient care
  • Advocate for quality patient care and optimal patient care systems
  • Work in interprofessional teams to enhance patient safety and improve patient care quality
  • Participate in identifying systems errors and in implementing potential systems solutions
 
As a scribe with 1.5 years of experience, I would still recommend scribing. But after people hit 1000 hours I would seriously advise dropping to the minimum shifts or finding a different job. It's a great experience but has significant diminishing returns. I doubt adcoms give anyone bonus points for scribing 6000+ hours vs 1000 hours.

I'm not saying it's not helpful. It can be as helpful or not to anyone. I'm just saying that it is not necessary for success in medical school, and no one would be at a disadvantage for not having done it.
 
I'm not saying it's not helpful. It can be as helpful or not to anyone. I'm just saying that it is not necessary for success in medical school, and no one would be at a disadvantage for not having done it.

The disadvantage is that it is hard to get into medical school without some volunteering and some clinical exposure. The admissions situation just gets more difficult every year. You were admitted >5 years ago. Times have changed.
 
  • Like
Reactions: 14 users
Members don't see this ad :)
I'm not saying it's not helpful. It can be as helpful or not to anyone. I'm just saying that it is not necessary for success in medical school, and no one would be at a disadvantage for not having done it.
We don't want people to enter medical school and then realize that they simply don't like being around sick and injured people.

What are you going to say when asked how you know you are suited for a life of caring for the sick and suffering? “That you just know”? Imagine how that will go over!

From the wise LizzyM”: I am always reminded of a certain frequent poster of a few years ago. He was adamant about not volunteering as he did not want to give his services for free and he was busy and helping others was inconvenient. He matriculated to a medical school and lasted less than one year. He's now in school to become an accountant.

As our learned colleague Tenk has pointed out, Medicine is a service profession.

Here's another way of looking at it: would you buy a new car without test driving it? Buy a new suit or dress without trying it on??

We're also not looking for merely for good medical students, we're looking for people who will make good doctors, and 4.0 GPA robots are a dime-a-dozen.

I've seen plenty of posts here from high GPA/high MCAT candidates who were rejected because they had little patient contact experience, so your line of thinking is not helpful.
 
  • Like
Reactions: 5 users
Personally, scribing looks like a complete waste of time and effort. Sure some may enjoy it, but I’d simply suggest volunteering at a hospice or free health clinic for meaningful clinical experience while also volunteering to help those less fortunate.
 
  • Like
Reactions: 1 user
The disadvantage is that it is hard to get into medical school without some volunteering and some clinical exposure. The admissions situation just gets more difficult every year. You were admitted >5 years ago. Times have changed.

I'm still all for volunteering. The jump from volunteering to these clinical jobs is significant, at least commitment-wise. I see lots of threads on here regarding not being able to handle the hours. I saw first hand my lab partner back in physics that would doze off because of overnight EMT shifts. I have seen too many people not only destroy their medical school chances, but also chances for other high-paying jobs by investing too much into it.

That's why I would love to see volunteering become an actual requirement. Once hours start getting verified, you'll see hour commitments plummet, but the quality of work go up. That should help give more than adequate exposure for pre-meds that you and @Goro value, while still being kind to their schedules. Volunteering once or twice weekly can also allow people to simultaneously do a "backup" track for business, so there is a viable fallback option in case medical school doesn't work out. It's better to end up with a $50,000/year analyst position after graduation than a $10/hour scribe position after graduation if medical school doesn't work out.

It's a shame that times are changing and not for the better. Admissions is more competitive, more schools are still popping up (there is still way excess demand for seats than supply), and residency spots are more or less staying stagnant. It's only a matter of time until medical school starts to become like law school, as more MS-4s are getting squeezed out and going unmatched.
 
Last edited:
  • Like
Reactions: 1 user
Pretty high soapbox from someone who has only been a resident for 5 months.
 
  • Like
Reactions: 4 users
I wish I had a CNA to do all of that, because in the ICU that's all me.


Sent from my iPhone using SDN mobile
 
  • Like
Reactions: 4 users
Because you are the lazy resident the ED hates who doesn't understand their role in the grand scheme of things and thinks their time is more important than everyone else's including the patient you are admitting as well as everyone else in the waiting room who is waiting for that bed. Didn't you go into medicine to help people? Well get your ass to the ED and start helping.

Louder for the ones in the back!!


Sent from my iPhone using SDN mobile
 
Go to some med school admissions sites and they're up front about what they want. See U UT as an exmaple
I'm still all for volunteering. The jump from volunteering to these clinical jobs is significant, at least commitment-wise. I see lots of threads on here regarding not being able to handle the hours. I saw first hand my lab partner back in physics that would doze off because of overnight EMT shifts. I have seen too many people not only destroy their medical school chances, but also chances for other high-paying jobs by investing too much into it.

That's why I would love to see volunteering become an actual requirement. Once hours start getting verified, you'll see hour commitments plummet, but the quality of work go up. That should help give more than adequate exposure for pre-meds that you and @Goro value, while still being kind to their schedules. Volunteering once or twice weekly can also allow people to simultaneously do a "backup" track for business, so there is a viable fallback option in case medical school doesn't work out. It's better to end up with a $50,000/year analyst position after graduation than a $10/hour scribe position after graduation if medical school doesn't work out.

It's a shame that times are changing and not for the better. Admissions is more competitive, more schools are still popping up (there is still way excess demand for seats than supply), and residency spots are more or less staying stagnant. It's only a matter of time until medical school starts to become like law school, as more MS-4s are getting squeezed out and going unmatched.
 
  • Like
Reactions: 1 users
I'm still all for volunteering. The jump from volunteering to these clinical jobs is significant, at least commitment-wise. I see lots of threads on here regarding not being able to handle the hours. I saw first hand my lab partner back in physics that would doze off because of overnight EMT shifts. I have seen too many people not only destroy their medical school chances, but also chances for other high-paying jobs by investing too much into it.

That's why I would love to see volunteering become an actual requirement. Once hours start getting verified, you'll see hour commitments plummet, but the quality of work go up. That should help give more than adequate exposure for pre-meds that you and @Goro value, while still being kind to their schedules. Volunteering once or twice weekly can also allow people to simultaneously do a "backup" track for business, so there is a viable fallback option in case medical school doesn't work out. It's better to end up with a $50,000/year analyst position after graduation than a $10/hour scribe position after graduation if medical school doesn't work out.

It's a shame that times are changing and not for the better. Admissions is more competitive, more schools are still popping up (there is still way excess demand for seats than supply), and residency spots are more or less staying stagnant. It's only a matter of time until medical school starts to become like law school, as more MS-4s are getting squeezed out and going unmatched.

Some students need to work in college. I agree that they need to be smart about the jobs they choose and the hours they work. Some will want to work in a job that has a patient care component because they like working with patients. I interviewed someone this week who worked as a nurses aide for a yr while in college and still had a GPA and MCAT that was in the top 1% of applicants.

Applicants should be smart about what they choose but all else equal, someone who has been a scribe or an EMT-B is going to be more impressive to most adcoms than someone who folded sweaters at Gap.
 
  • Like
Reactions: 5 users
I'm so confused. I feel like the two messages here are:

  • Bust ass as a premed and get into med school, because being a doc is a much cushier job than most
  • Don't overwork yourself as a premed
???
 
  • Like
Reactions: 3 users
What resident has time to reply throughout the day with paragraphs? Even if you are off, there are way better things to do than sit here and talk to a bunch of toxic premeds.
 
PGY-1..that awkward year when you are facing medicine head on and confidence is at a minimum. A reality check it is and quite scary when one ponders "what did I get myself into and how could I have prepared for all this way back as a premed". Don't worry, it will be an hard but enlightening experience and once a PGY-2 and PGY-3, you will feel in control. There is really nothing as premed to prepare one for all this responsibility. Its all "baby steps" - learn to roll over, then crawl, stand up and fall, stagger, walk awkwardly, then finally run with confidence. I don't think anything really one can do or volunteer as premed will prepare you for the post-medical school years. Just focus on getting in and the rest will fall into place. it's quite a ride!
 
  • Like
Reactions: 2 users
Pretty high soapbox from someone who has only been a resident for 5 months.

Well hey, it's better than getting ignored or never hearing from people further down the process. The most meaningful thing any attending said to me as a pre-med was during one of my volunteer shifts. I was having an asthma exacerbation and the attending said, "Put on a mask if you're going to keep on coughing."

There's no need to be condescending. I'm not asking people to bow down to me or to praise my thoughts as gospel. I'm trying to provide some insight, and people can take it for what it is. I learned a lot from my last employer, where you should treat others the way you like to be treated. I have met a lot of toxic people, especially in medicine, and apparently in this thread, and I strive to make things better for other people that are making the journey I once did.
 
Some students need to work in college. I agree that they need to be smart about the jobs they choose and the hours they work. Some will want to work in a job that has a patient care component because they like working with patients. I interviewed someone this week who worked as a nurses aide for a yr while in college and still had a GPA and MCAT that was in the top 1% of applicants.

Applicants should be smart about what they choose but all else equal, someone who has been a scribe or an EMT-B is going to be more impressive to most adcoms than someone who folded sweaters at Gap.

I totally agree with this. I've met some exceptional people, not necessarily in medicine, that have been able to hold numerous jobs and do well. That's not usually the norm. Usually you see the opposite occurring.
 
Pointing out that emergency medicine doctors are responsible for stabilization of patients must me make worse than Hitler.

Of course that's what they are responsible for, I didn't say they weren't. So why are you quoting my response to another persons post?


Sent from my iPhone using SDN mobile
 
I 100% agree with this.
The amount of work I haven't had to do in medical school to look good just because I was a scribe for a few years is beautiful. Took me 2s to write up an H&P after our required hospital sessions that our preceptor said was the best one they've had submitted to them. I generally know what the Dx is when we do our PBLs and what the key things to look into are - even if I don't fully know the 'whys' yet, it really helps me frame our discussion and decide what we're going to look into. My scribing experience has allowed me to coast with less work in our preclinicals, and every clinical requirement we've had has felt like a breeze and gotten me compliments/high marks. Scribing remains the single most valuable thing I did before med school, and honestly I think I learned more in those 1.5yrs of scribing and taking my own classes than I have here in medical school. As a med student, I am less involved and less useful than I was as a scribe, and this is at a school that really goes out of its way to keep students involved and engaged. Sure, I can do things like scrub in and run camera now that I'm officially in med school (though not as much as I will in actual clinicals, hopefully), but otherwise I was better off when I got to actually do the charting and be the main person monitoring the doc's workflow over a shift.
 
  • Like
Reactions: 6 users
I'm so confused. I feel like the two messages here are:

  • Bust ass as a premed and get into med school, because being a doc is a much cushier job than most
  • Don't overwork yourself as a premed
???

Getting into medical school has a lot more uncertainty than getting into residency assuming you're at a US MD or DO school. If you do awful in medical school, you may match into primary care even though you might have wanted emergency medicine. If you do awful as a pre-med with all of your eggs in one basket, you might end up underemployed when all is said and done. Overworking yourself as a pre-med can lead to what I just mentioned.
 
What resident has time to reply throughout the day with paragraphs? Even if you are off, there are way better things to do than sit here and talk to a bunch of toxic premeds.

I try to give back when I can. Pay it forward by giving people what you wish people gave you. I'm blessed to be at a residency with no malicious people so far, and I've been so happy here that I forgot how toxic some environments are.
 
Of course that's what they are responsible for, I didn't say they weren't. So why are you quoting my response to another persons post?

I quoted it since the original post by @dilaudid was a personal attack calling me lazy, even though the point of my post was to show how systems-based practice functions. Emergency medicine doctors are responsible for stabilization so that I don't have to drop everything I'm doing and run at full speed the second I get a page from the ED, so that I can take whatever time I need to gather the information about the patient. I misinterpreted what you said by thinking it was another attack on me, and I was wrong. I apologize, this was my mistake, and I did not intend for it to come out this way.
 
  • Like
Reactions: 1 users
Of course that's what they are responsible for, I didn't say they weren't. So why are you quoting my response to another persons post?


Sent from my iPhone using SDN mobile
...because your 'response' was supporting and echoing the sentiment quoted? Your post literally boiled down to "repeat this statement, but more emphatically."

I quoted it since the original post by @dilaudid was a personal attack calling me lazy, even though the point of my post was to show how systems-based practice functions. Emergency medicine doctors are responsible for stabilization so that I don't have to drop everything I'm doing and run at full speed the second I get a page from the ED, so that I can take whatever time I need to gather the information about the patient. I misinterpreted what you said by thinking it was another attack on me, and I was wrong. I apologize, this was my mistake, and I did not intend for it to come out this way.
In what planet was it not another attack on you?
 
  • Like
Reactions: 1 user
PGY-1..that awkward year when you are facing medicine head on and confidence is at a minimum. A reality check it is and quite scary when one ponders "what did I get myself into and how could I have prepared for all this way back as a premed". Don't worry, it will be an hard but enlightening experience and once a PGY-2 and PGY-3, you will feel in control. There is really nothing as premed to prepare one for all this responsibility. Its all "baby steps" - learn to roll over, then crawl, stand up and fall, stagger, walk awkwardly, then finally run with confidence. I don't think anything really one can do or volunteer as premed will prepare you for the post-medical school years. Just focus on getting in and the rest will fall into place. it's quite a ride!

Well said!
 
The amount of work I haven't had to do in medical school to look good just because I was a scribe for a few years is beautiful. Took me 2s to write up an H&P after our required hospital sessions that our preceptor said was the best one they've had submitted to them. I generally know what the Dx is when we do our PBLs and what the key things to look into are - even if I don't fully know the 'whys' yet, it really helps me frame our discussion and decide what we're going to look into. My scribing experience has allowed me to coast with less work in our preclinicals, and every clinical requirement we've had has felt like a breeze and gotten me compliments/high marks. Scribing remains the single most valuable thing I did before med school, and honestly I think I learned more in those 1.5yrs of scribing and taking my own classes than I have here in medical school. As a med student, I am less involved and less useful than I was as a scribe, and this is at a school that really goes out of its way to keep students involved and engaged. Sure, I can do things like scrub in and run camera now that I'm officially in med school (though not as much as I will in actual clinicals, hopefully), but otherwise I was better off when I got to actually do the charting and be the main person monitoring the doc's workflow over a shift.

I'm really glad that it has worked out well for you and that it's helping you with your H&Ps. I'm also glad you were able to get a lot of information from scribing and be able to process it well.
 
...because your 'response' was supporting and echoing the sentiment quoted? Your post literally boiled down to "repeat this statement, but more emphatically." In what planet was it not another attack on you?

Because I don't understand how my response was was supporting and echoing the sentiment quoted? If someone can explain to me a better way to handle admissions, then I'm all ears.
 
Because you are the lazy resident the ED hates who doesn't understand their role in the grand scheme of things and thinks their time is more important than everyone else's including the patient you are admitting as well as everyone else in the waiting room who is waiting for that bed. Didn't you go into medicine to help people? Well get your ass to the ED and start helping.

I’ve never been to an institution where admission to the floor doesn’t happen until the intern sees the patient in the ER. Sometimes I can get to them in the ER but the majority of the time they are already on the floor by the time I get to them. Honestly sounds like where you work has some systems issues
 
  • Like
Reactions: 1 user
We don't want people to enter medical school and then realize that they simply don't like being around sick and injured people.

True, I agree with this.

What are you going to say when asked how you know you are suited for a life of caring for the sick and suffering? “That you just know”? Imagine how that will go over!

As I mentioned above, there are other ways to do this without necessarily picking up commitments that can significantly impact your grades and MCAT score.

From the wise LizzyM”: I am always reminded of a certain frequent poster of a few years ago. He was adamant about not volunteering as he did not want to give his services for free and he was busy and helping others was inconvenient. He matriculated to a medical school and lasted less than one year. He's now in school to become an accountant.

That's sad and does happen. This happened in my class. It will happen no matter what since there are so many factors that drive someone into medicine. From passion to your parents.

As our learned colleague Tenk has pointed out, Medicine is a service profession.

Very true.

Here's another way of looking at it: would you buy a new car without test driving it? Buy a new suit or dress without trying it on??

No I wouldn't. I don't buy clothes online but I know people that do. I like to know things before I buy them.

We're also not looking for merely for good medical students, we're looking for people who will make good doctors, and 4.0 GPA robots are a dime-a-dozen.

Yes. I'm looking for this too. I've met really smart people that can't communicate with others if their lives depended on it, no pun intended. I would love to find better ways to help find applicants, and I actually spoke to our PD today about trying to find research regarding this topic. I'd be interested to see how this process can be made better. Also, I am for certain activities or methods that would show an interest and commitment to medicine. I'm all for clinical volunteering, but am against jobs that would conflict with school and the MCAT.

I've seen plenty of posts here from high GPA/high MCAT candidates who were rejected because they had little patient contact experience, so your line of thinking is not helpful.

I'm not and never was suggesting getting rid of all EC/experience requirements. On the contrary, I want things to be switched around, such as making volunteering an official requirement. Also, I am trying to give people another perspective regarding the pre-med process. I have seen people put all of their eggs in one basket and fail. It's something you don't read about very much here because the members on this site that fail will probably stop posting immediately.

I'm a first generation American. My parents fled the Soviet Union with $100 in their pockets and just a few suitcases because they wanted to escape the religious persecution of Jews in that country. They taught me a lot about being grateful and not taking things for granted. They also taught me that no one owes me anything. Such is the case with college. Plenty of people today have enough trouble finding well-paying jobs. Enough people are underemployed or even unemployed living in their parent's basement. No one is going to give them a cushy job just for having a diploma. People with soft science majors and poor grades would likely have a hard time finding a good job. I honestly want to help people so that they can make the best choices possible to avoid finding themselves underemployed or unemployed. Once someone is in medical school, then that's great. But for the people that try and can't make it, it really sucks.

But overall, I agree with what you were saying. I do not think that there is an all or nothing approach to the medical school admissions process, and instead, it should be somewhere in the middle.
 
I want you to look up systems-based practice and understand what it means in healthcare, and what it means to you right now as a pre-med aspiring to get into medical school.

This seriously made me laugh out loud, very high soapbox for someone less then a year in.

The point I was making is pre-meds tend to do a whole lot of things that they (genuinely) don't want to do, that they DO NOT have to do, and this will usually makes things worse and not better.

People do scribing/volunteering not because they think it is part of being a physician, but because one or the other is almost a expected EC, not having it will likely make you stand out in the wrong way.

I was hoping to leave this a bit more open-ended so people could reflect

I be honest, everything in this thread suggests your that resident. I think you should reflect on how you sound.
 
  • Like
Reactions: 1 user
I’ve never been to an institution where admission to the floor doesn’t happen until the intern sees the patient in the ER. Sometimes I can get to them in the ER but the majority of the time they are already on the floor by the time I get to them. Honestly sounds like where you work has some systems issues
Many academic centers have this system. Most community hospitals do not because they move the meat faster. The “get them to the floor” model is far superior, I agree. Luckily I only work academic on occasion.
 
  • Like
Reactions: 1 user
I’ve never been to an institution where admission to the floor doesn’t happen until the intern sees the patient in the ER. Sometimes I can get to them in the ER but the majority of the time they are already on the floor by the time I get to them. Honestly sounds like where you work has some systems issues

Hmm... I have seen admit orders coming from ED physicians to the admitting team, the hospitalist putting in admit orders, the senior resident putting in admit orders, or putting in admit orders myself. It's not often that the ED physicians will do this, but I know that the emergency program director here does that. Regardless of who puts the orders in, I am not blindly seeing a patient. I will already have labs, imaging, and other testing at my disposal. Therefore, upon receiving an admit notice, I will stop what I'm doing and look up the patient's chart and try to figure out what's going on. During that time I am able to put in my own orders even when the patient is still in the ED. It seems to be more efficient to already know what is going on thanks to the previous work already done by the ED physician, then coming in blindly and ignore everything that was already done while the patient was in the emergency department. I'll also reiterate what I said earlier. By leisurely stroll, I am not saying that I will take a coffee break. I meant it literally that I do not have to run as fast as humanely possible because the emergency department's job is to stabilize the patient. I am not sure how that makes anyone lazy.
 
The amount of work I haven't had to do in medical school to look good just because I was a scribe for a few years is beautiful. Took me 2s to write up an H&P after our required hospital sessions that our preceptor said was the best one they've had submitted to them. I generally know what the Dx is when we do our PBLs and what the key things to look into are - even if I don't fully know the 'whys' yet, it really helps me frame our discussion and decide what we're going to look into. My scribing experience has allowed me to coast with less work in our preclinicals, and every clinical requirement we've had has felt like a breeze and gotten me compliments/high marks. Scribing remains the single most valuable thing I did before med school, and honestly I think I learned more in those 1.5yrs of scribing and taking my own classes than I have here in medical school. As a med student, I am less involved and less useful than I was as a scribe, and this is at a school that really goes out of its way to keep students involved and engaged. Sure, I can do things like scrub in and run camera now that I'm officially in med school (though not as much as I will in actual clinicals, hopefully), but otherwise I was better off when I got to actually do the charting and be the main person monitoring the doc's workflow over a shift.

Scribing may help you at the start but the only way to truly get great at them is to pump out thousands of them doing it on your own. At the end of the day I doubt even 5 years of scribing would make any longer term difference.
 
Hmm... I have seen admit orders coming from ED physicians to the admitting team, the hospitalist putting in admit orders, the senior resident putting in admit orders, or putting in admit orders myself. It's not often that the ED physicians will do this, but I know that the emergency program director here does that. Regardless of who puts the orders in, I am not blindly seeing a patient. I will already have labs, imaging, and other testing at my disposal. Therefore, upon receiving an admit notice, I will stop what I'm doing and look up the patient's chart and try to figure out what's going on. During that time I am able to put in my own orders even when the patient is still in the ED. It seems to be more efficient to already know what is going on thanks to the previous work already done by the ED physician, then coming in blindly and ignore everything that was already done while the patient was in the emergency department. I'll also reiterate what I said earlier. By leisurely stroll, I am not saying that I will take a coffee break. I meant it literally that I do not have to run as fast as humanely possible because the emergency department's job is to stabilize the patient. I am not sure how that makes anyone lazy.

I usually don’t read much of the H+p done in the ED and just jot down what they done. I feel like otherwise it biases my decision making.

I can usually get the skeleton orders in fairly easily and flesh them out after my H+p. I’m with you though, I take my time and think through my chief complaint, my differential and what questions I need to answer with the H+p. I like to be prepared when I enter the room.
 
  • Like
Reactions: 1 user
This seriously made me laugh out loud, very high soapbox for someone less then a year in.

Yeah okay, so we should probably ignore any medical student in that case too since their opinion is worthless.

People do scribing/volunteering not because they think it is part of being a physician, but because one or the other is almost a expected EC, not having it will likely make you stand out in the wrong way.

Expected? Back when I was applying, scribing was unheard of. I really would like to avoid people having to pile on these activities on top of school and the MCAT, as stated in the thread. People used to show commitment through volunteering and shadowing. That was enough, I'm not sure why all of these jobs started becoming the norm.

I be honest, everything in this thread suggests your that resident. I think you should reflect on how you sound.

That's nice.
 
  • Like
Reactions: 1 user
Many academic centers have this system. Most community hospitals do not because they move the meat faster. The “get them to the floor” model is far superior, I agree. Luckily I only work academic on occasion.

That does sound frustrating, I would hate that system. As I said above I generally like to take my time with my H+ps
 
I usually don’t read much of the H+p done in the ED and just jot down what they done. I feel like otherwise it biases my decision making.

I can usually get the skeleton orders in fairly easily and flesh them out after my H+p. I’m with you though, I take my time and think through my chief complaint, my differential and what questions I need to answer with the H+p. I like to be prepared when I enter the room.

Same here. I don't like to make biased decisions. I got slammed for that when I was a medical student. Labs and imaging can lead the way, but the H&P should be from scratch unless the patient is obtunded.
 
Yeah okay, so we should probably ignore any medical student in that case too since their opinion is worthless.

I have literally never seen a medical student lecture about SYSTEMS-BASED PRACTICE to get into medical school.

Expected? Back when I was applying, scribing was unheard of. I really would like to avoid people having to pile on these activities on top of school and the MCAT, as stated in the thread. People used to show commitment through volunteering and shadowing. That was enough, I'm not sure why all of these jobs started becoming the norm.

I think you don't understand that people are concerned about EC's in order to become more competitive. This is not something unique to medicine but life.
 
  • Like
Reactions: 1 users
Top