The self deprecating attitude and culture in medicine is awful

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The other problem is with the structure of medical school. A good trade school teaches you the skills that employers want. On the other hand, only the 3rd (maybe the 4th) years of med school actually covers what residency PDs need.

For instance, the first year is filled with pointless low-yield information. Anatomy is useless without understanding the significance of the structures you're dissecting and awfully taught by anthropologists rather than clinicians.

Furthermore, rather than being sent straight to the wards during M1 and picking up useful clinical skills (such as putting in IVs), we're instead thrown into 1.5-2 years of low-yield lectures and treated like toddlers with the buzzards of professionalism hovering overhead. Lo and behold, we know jack **** when M3 starts.

Additionally, most of medical school is taught by IM docs and rather poorly at best. We don't need 30,000 small group sessions on sociology, quality improvement and community service. That's not what residency PDs care about. We don't need to be taught as M1's to do 50 page long H&Ps (an aberration on any other service but IM) rather than learning how to use the information in the EMR (eg utilizing previous consult notes to do a focused history and physical) so we can survive a busy night in the ED when over 9000 consults are being paged in our direction

We should go back to the old days where med students on the wards were actually functioning like interns and residents rather than spending 2 years memorizing low yield crap when B&B, Anki, UFAPS do a lot better work in shorter time and then spending 3rd year dealing with personality conflicts, glorified shadowing and other minimal things because liability
 
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Lawpy

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I really feel like part of the problem is that doctors don’t actually advocate for their profession. While the other medical personnel do. Not only advocate but also claim equivalency and even better care. While we sit here and argue about how we deserve less and don’t know much. That’s the problem and that’s why we still make less than 60,000 as residents working in a pandemic.

That's because a disturbingly significant fraction are only in it to maximize profits so they're willing to sabotage their colleagues, trainees and communities by selling their practice to private equity and "supervising" dozens of midlevels.
 
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MedicineZ0Z

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To be fair, I've seen plenty of med students do something very similar to this. I remember in late PGY1 being lectured and yelled at by a med student on a consult service, thinking, why is this resident (it was over the phone and they didn't identify themself) being such a douche, and why does his plan not make any sense. Come to find out, when the actual fellow came in with the recs that the person I talked to was a med student. That was the first of many interactions with med students who think they know better. At least when it's in person, I just walk away now.


Most RNs don't treat me like crap. I don't really see them doing it to med students too. Occasionally you get the crappy one, but you can usually spot them because they are the most insecure ones, who get overly flustered at even the idea of trying something they haven't done before.


The first 2 years are literally what differentiates you from those PAs and NPs. That base is important. No matter what field you go into at least some of that info will actually impact your practice. Being a surgeon would be a bit hard without all that low yield anatomy.
I feel like those are uncommon events. Overall, this is more about the general attitude and culture.
You need a good base, but just passing step 1 means you have a strong base. Knowing details of rare diagnoses should not be part of fundamentals.
We should go back to the old days where med students on the wards were actually functioning like interns and residents rather than spending 2 years memorizing low yield crap when B&B, Anki, UFAPS do a lot better work in shorter time and then spending 3rd year dealing with personality conflicts, glorified shadowing and other minimal things because liability
Pretty much this.
 
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Self deprecating....Humorous or modestly critical of oneself. I think like LeBron James saying I played OK when getting MVP. Not sure how the Title matches the theme of this thread.
I don't disagree that many students aren't treated well. Some do make it a challenge. I remember that many of the university students I would question, may not know the right answer, but were never in doubt about the answer they gave me. This would be an invitation for some aggressive teaching from me. Its easier to say, " I don't know". It will only sting for a moment, rather than try to BS way through it. Afterwards, they would respond, " I'm going to look that up", like they didn't believe me. I would respond, " Better late than never". Students attitude have a role in some of these stressful encounters. There are difficult attendings and residents, there are also difficult students.
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Show me a medical student who only triples my work, and I will kiss his feet.
Unfortunately, there are some SDNers in this thread who think too highly themselves , and would also make a thread about ham sandwiches into an attack on midlevels.

Back to the point of the thread, I winder if it's the current economic model of health care, rather than medical education, than drives this mindset that MS3's and MS4's are hinderences?
 
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Kuratz

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This self-depreciating attitude and condescension stems from:

1. Med students not being necessary to the functioning of the team
2. Med students not being able to be truly useful due to factors intrinsic to medical education (e.g. notes don't count; liability with extremely minor procedures like unsupervised IVs and drain pulls)
3. The transient and brief nature of rotations

Thus despite being highly educated, hard-working individuals med students find themselves often watching other people work with no capacity to help and yet are constantly being evaluated. It is a very awkward and frankly unsettling experience of purposelessness, even if you see your overall trajectory as having immense purpose. No better way to leach someone's confidence than to have them pay enormous sums of money to show up to a work-like situation where they are constantly being evaluated but cannot effectively contribute and cannot leave even if they are sitting in the resident room watching others do the actual work. If med students were allowed to have more responsibility, this would change.

As far as interns/residents go I'm not sure why there is such an inferiority complex. At that point they are critical to the team and have much more responsibility and by proxy, purpose. I mean on one hand I can totally appreciate how incredibly difficult the practice of medicine is and that even young attendings are still learning and should have a healthy level of humility, but on the other I don't know why so many trainees essentially lack confidence altogether despite actually often possessing a high volume of practical knowledge. Whether I know what to do or have no idea what the hell is going on I always approach the situation confidently and without timidity. Has always served me well and seems to do the same for the others who aren't afraid. I hate to be crass but truly physicians need to have some balls (lady balls too) and just ****ing be a leader. For God's sake it's part of your job description. People want to be led. Just ****ing do it.
 
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Lawpy

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This self-depreciating attitude and condescension stems from:

1. Med students not being necessary to the functioning of the team
2. Med students not being able to be truly useful due to factors intrinsic to medical education (e.g. notes don't count; liability with extremely minor procedures like unsupervised IVs and drain pulls)
3. The transient and brief nature of rotations

Thus despite being highly educated, hard-working individuals med students find themselves often watching other people work with no capacity to help and yet are constantly being evaluated. It is a very awkward and frankly unsettling experience of purposelessness, even if you see your overall trajectory as having immense purpose. No better way to leach someone's confidence than to have them pay enormous sums of money to show up to a work-like situation where they are constantly being evaluated but cannot effectively contribute and cannot leave even if they are sitting in the resident room watching others do the actual work. If med students were allowed to have more responsibility, this would change.

As far as interns/residents go I'm not sure why there is such an inferiority complex. At that point they are critical to the team and have much more responsibility and by proxy, purpose. I mean on one hand I can totally appreciate how incredibly difficult the practice of medicine is and that even young attendings are still learning and should have a healthy level of humility, but on the other I don't know why so many trainees essentially lack confidence altogether despite actually often possessing a high volume of practical knowledge. Whether I know what to do or have no idea what the hell is going on I always approach the situation confidently and without timidity. Has always served me well and seems to do the same for the others who aren't afraid. I hate to be crass but truly physicians need to have some balls (lady balls too) and just ****ing be a leader. For God's sake it's part of your job description. People want to be led. Just ****ing do it.

Ok tell me how and why did med students historically went from being essential members of the team to useless now? Because med students were working a lot of hours helping the team in the past (and even now when lucky enough to be part of a good team). I hate the notion of med students being useless when it hasn't been true
 

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Ok tell me how and why did med students historically went from being essential members of the team to useless now? Because med students were working a lot of hours helping the team in the past (and even now when lucky enough to be part of a good team). I hate the notion of med students being useless when it hasn't been true

When insurance companies started running the world and litigation took over. Right now today, I devote time to teaching medical students because it is the right thing to do. But billing tells me I can’t use their notes, I can’t trust their physical exam, and I can’t utilize any part of their history. Hospital tells me that if I am not present for the entire laceration repair, it is practicing medicine without a license as is telling a med student to tell the nurse to give a bolus of normal saline. In addition, I can do it all faster without them. So when the hospitals started making these rules, med students became worthless to the team.

And residencies are changing for the worse as well. Now, third year residents and many programs can’t function without attendings in the hospital and looking over their shoulder. This is drastically different than how it used to be.
 
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operaman

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Unfortunately, there are some SDNers in this thread who think too highly themselves , and would also make a thread about ham sandwiches into an attack on midlevels.

Back to the point of the thread, I winder if it's the current economic model of health care, rather than medical education, than drives this mindset that MS3's and MS4's are hinderences?
I think you’ve touched on a huge point. The EMR has probably done more to set back Med ed than anything else. It truly provides a hard stop to exclude students from actual patient care.

We had a hybrid of emr and paper charts in my MS3 year and there was a lot more for students to do. We prewrote all the daily paper notes, retrieved labs and imaging results, etc. It was pretty low level stuff but it was necessary and also kept us functioning as part of the team. It also forced us to walk around and be in the middle of patient care; now everyone just sits around the work room and table rounds and students sit around doing uworld questions while residents write notes.

I think schools could vastly expand the role of medical students within the EMR. Anything an MA can do should be fair game for a student. Most charts are riddled with inaccuracies and incomplete information - it would be very appropriate for students to take histories and update this stuff so it’s accurate. Shoot, we had pharmacy students who would update new inpatients home meds and holy crap did they find a lot of things!

I think we also need to make more of an effort to engage students and junior trainees in actual patient care. A student may not be ready to operate, but can they learn to set up an OR and prep and drape? I always hand the most junior person the marking pen because it tells me how prepared they are and they aren’t going to hurt anyone with it.

They are small things but it’s often those sort of tasks That build true competence. Every surgical intern has walked into an OR at midnight and had an off service circulator and scrub say “oh good you’re here doctor. I’ve never done this kind of case before. Tell me what you need.” I found those moments to be ones where my inexperience was immediately telling, but the setup had always been done by others and when it counted I didnt know the ins and outs of prepping for the case.

Maybe that’s part of why students and residents get a rep for not knowing much. Objectively these are some of the most accomplished intelligent adults in the world, but they are missing assorted key pieces of working knowledge even though they have a deeper conceptual understanding than anyone else in the room. The nurses and midlevels may lack the knowledge base but their training definitely focuses on more of the practical side of delivering care. Maybe we can help bridge this gap by having our students take a more active role in the nuts and bolts of things early on.
 
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hallowmann

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I feel like those are uncommon events. Overall, this is more about the general attitude and culture.
You need a good base, but just passing step 1 means you have a strong base. Knowing details of rare diagnoses should not be part of fundamentals.

Pretty much this.
I mean, it depends on the students. My point was that it happens, and I'd buy the story they mentioned based on my own experience.

As for passing Step 1, yeah, I agree. That's what MS1-2 is for, passing step 1. The post I was replying to implied that it was a useless part of medical education. It's not. There's a lot there.
 
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MedicineZ0Z

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This self-depreciating attitude and condescension stems from:

1. Med students not being necessary to the functioning of the team
2. Med students not being able to be truly useful due to factors intrinsic to medical education (e.g. notes don't count; liability with extremely minor procedures like unsupervised IVs and drain pulls)
3. The transient and brief nature of rotations

Thus despite being highly educated, hard-working individuals med students find themselves often watching other people work with no capacity to help and yet are constantly being evaluated. It is a very awkward and frankly unsettling experience of purposelessness, even if you see your overall trajectory as having immense purpose. No better way to leach someone's confidence than to have them pay enormous sums of money to show up to a work-like situation where they are constantly being evaluated but cannot effectively contribute and cannot leave even if they are sitting in the resident room watching others do the actual work. If med students were allowed to have more responsibility, this would change.

As far as interns/residents go I'm not sure why there is such an inferiority complex. At that point they are critical to the team and have much more responsibility and by proxy, purpose. I mean on one hand I can totally appreciate how incredibly difficult the practice of medicine is and that even young attendings are still learning and should have a healthy level of humility, but on the other I don't know why so many trainees essentially lack confidence altogether despite actually often possessing a high volume of practical knowledge. Whether I know what to do or have no idea what the hell is going on I always approach the situation confidently and without timidity. Has always served me well and seems to do the same for the others who aren't afraid. I hate to be crass but truly physicians need to have some balls (lady balls too) and just ****ing be a leader. For God's sake it's part of your job description. People want to be led. Just ****ing do it.

1. They won't be ever necessary, but they can help the team.
2. Where in USA do notes not count? I'm at an academic hospital in the south and med students do the bulk of note writing when they're with us. MS3s, MS4s, subIs - whatever. They will always write notes and do lots of them. I've also supervised med students doing lac repairs, LPs, paracentesis etc.
When insurance companies started running the world and litigation took over. Right now today, I devote time to teaching medical students because it is the right thing to do. But billing tells me I can’t use their notes, I can’t trust their physical exam, and I can’t utilize any part of their history. Hospital tells me that if I am not present for the entire laceration repair, it is practicing medicine without a license as is telling a med student to tell the nurse to give a bolus of normal saline. In addition, I can do it all faster without them. So when the hospitals started making these rules, med students became worthless to the team.

And residencies are changing for the worse as well. Now, third year residents and many programs can’t function without attendings in the hospital and looking over their shoulder. This is drastically different than how it used to be.
The medicare rules changed dude. Med student notes count now. We use them on everything from consult services to general services to clinic. It takes me 2 mins to edit and cosign.
And again, I (as a resident) supervise med students doing procedures all the time. Certain places I rotated at as a med student were similar (ex. I placed IJs, intubated etc all under resident supervision only). Other places didn't let students do jack. This is purely cultural and 100% the fault of those in charge (the attendings).

and yes a lot of residencies suck now. Blows my mind that people want to open MORE residencies when we don't even have quality training for half of the ones we have now.
 
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MedicineZ0Z

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I think you’ve touched on a huge point. The EMR has probably done more to set back Med ed than anything else. It truly provides a hard stop to exclude students from actual patient care.

We had a hybrid of emr and paper charts in my MS3 year and there was a lot more for students to do. We prewrote all the daily paper notes, retrieved labs and imaging results, etc. It was pretty low level stuff but it was necessary and also kept us functioning as part of the team. It also forced us to walk around and be in the middle of patient care; now everyone just sits around the work room and table rounds and students sit around doing uworld questions while residents write notes.

I think schools could vastly expand the role of medical students within the EMR. Anything an MA can do should be fair game for a student. Most charts are riddled with inaccuracies and incomplete information - it would be very appropriate for students to take histories and update this stuff so it’s accurate. Shoot, we had pharmacy students who would update new inpatients home meds and holy crap did they find a lot of things!

I think we also need to make more of an effort to engage students and junior trainees in actual patient care. A student may not be ready to operate, but can they learn to set up an OR and prep and drape? I always hand the most junior person the marking pen because it tells me how prepared they are and they aren’t going to hurt anyone with it.

They are small things but it’s often those sort of tasks That build true competence. Every surgical intern has walked into an OR at midnight and had an off service circulator and scrub say “oh good you’re here doctor. I’ve never done this kind of case before. Tell me what you need.” I found those moments to be ones where my inexperience was immediately telling, but the setup had always been done by others and when it counted I didnt know the ins and outs of prepping for the case.

Maybe that’s part of why students and residents get a rep for not knowing much. Objectively these are some of the most accomplished intelligent adults in the world, but they are missing assorted key pieces of working knowledge even though they have a deeper conceptual understanding than anyone else in the room. The nurses and midlevels may lack the knowledge base but their training definitely focuses on more of the practical side of delivering care. Maybe we can help bridge this gap by having our students take a more active role in the nuts and bolts of things early on.
They can always contribute if they're allowed to. Med student notes *do* count. And I fully agree that practical training is extremely weak right now. Much of what med students do rarely involves more than taking a history and presenting. A lot of it, again - is due to low quality attendings.
 

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They can always contribute if they're allowed to. Med student notes *do* count. And I fully agree that practical training is extremely weak right now. Much of what med students do rarely involves more than taking a history and presenting. A lot of it, again - is due to low quality attendings.
There’s an old adage in business that says: what gets measured gets done.

I think a big driver in faculty disengagement from teaching is that it isn’t really measured and tracked in any meaningful way. RVUs are tracked. Length of stay is tracked. Operative time is tracked. Billing and collections are tracked. Clinic utilization is tracked. Not surprisingly these are the same things that get attention and focus.

Teaching Med students on the wards isn’t really measured and followed. If there were some kind of incentive structure or accountability it might help. Find a way to give RVUs for teaching and I think you’d see a massive surge in it! As it is, time spent teaching actually detracts from the other things that are measured and rewarded.

I’d be really curious about faculty teaching compared by institutional compensation structure. I’ve definitely had my best teaching moments in school at VAs and public hospitals. These places tend to have a culture of letting students do more, but faculty are almost always salaried and not under the same pressure to generate revenue that other academic attendings are.
 
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MedicineZ0Z

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There’s an old adage in business that says: what gets measured gets done.

I think a big driver in faculty disengagement from teaching is that it isn’t really measured and tracked in any meaningful way. RVUs are tracked. Length of stay is tracked. Operative time is tracked. Billing and collections are tracked. Clinic utilization is tracked. Not surprisingly these are the same things that get attention and focus.

Teaching Med students on the wards isn’t really measured and followed. If there were some kind of incentive structure or accountability it might help. Find a way to give RVUs for teaching and I think you’d see a massive surge in it! As it is, time spent teaching actually detracts from the other things that are measured and rewarded.

I’d be really curious about faculty teaching compared by institutional compensation structure. I’ve definitely had my best teaching moments in school at VAs and public hospitals. These places tend to have a culture of letting students do more, but faculty are almost always salaried and not under the same pressure to generate revenue that other academic attendings are.
Oh I don't think teaching is going to be a priority. I'm just tired of people wanting to open more residencies when we don't even have nearly enough qualified instructors to teach our current trainees. By and large, training programs across the board need to stop opening (of course, includes those silly midlevel programs too).
 
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This self-depreciating attitude and condescension stems from:

1. Med students not being necessary to the functioning of the team
2. Med students not being able to be truly useful due to factors intrinsic to medical education (e.g. notes don't count; liability with extremely minor procedures like unsupervised IVs and drain pulls)
3. The transient and brief nature of rotations

Thus despite being highly educated, hard-working individuals med students find themselves often watching other people work with no capacity to help and yet are constantly being evaluated. It is a very awkward and frankly unsettling experience of purposelessness, even if you see your overall trajectory as having immense purpose. No better way to leach someone's confidence than to have them pay enormous sums of money to show up to a work-like situation where they are constantly being evaluated but cannot effectively contribute and cannot leave even if they are sitting in the resident room watching others do the actual work. If med students were allowed to have more responsibility, this would change.


This is the most accurate statement here.


And overall, yes, there is a lot of self deprecation that goes on, and it gets tiresome.
 

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You really think passing step 1 and going through a few SP encounters makes you as useful as a PA whose been doing the job for a few years? you’ve got a higher knowledge base than them for sure. But they’re familiar with a lot of hospital protocols we’re not at the beginning of MS3. They’ve also just seen the natural progression of the few things they’ve been trained to manage on an inpatient that you haven’t as an MS3. Now by the end of MS3 or early MS4, yeah you’re kicking their butts and the only thing they’re better at is using the EHR and knowing specifically what certain docs want.
Two disagreements:

1. That logic is mid-level logic. Midlevels don't all come out with 'several years of experience.' A first week of their job, straight out of school, midlevel will be given more responsibility than any M3 or M4 (and often even the interns). They are also treated much, much better and given much more respect from even the attending physicians, let alone administration and other healthcare workers.

2. While I agree that medical students become much more capable and useful as they progress through M3 and M4 (and at good medical schools are given increased responsibility), the culture of disrespect does not end. They are still treated as idiots who know nothing and many internalize this and propagate it.

Essentially, if the bar for being an 'idiot who knows nothing' is the attending physician with years of experience in their field, then there are a plethora of 'idiots who know nothing' in the hospital. If responsibility and respect follow based on knowledge and capability (which imo it should), then medical students are much higher up that totem pole.
 
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To be fair, I've seen plenty of med students do something very similar to this. I remember in late PGY1 being lectured and yelled at by a med student on a consult service, thinking, why is this resident (it was over the phone and they didn't identify themself) being such a douche, and why does his plan not make any sense. Come to find out, when the actual fellow came in with the recs that the person I talked to was a med student. That was the first of many interactions with med students who think they know better. At least when it's in person, I just walk away now.
There are a plethora of examples of hubris and stupidity within NPs, PAs, RNs, etc. Inability/unwillingness to recognize your limitations and seek help when needed is a personal flaw, not a professional flaw. But here lies the difference:

If you ever read an article where a mid-level messed up (ex: neurology case in TX), look at the comments. Their colleagues are quick to defend their profession and highlight how one mistake by one person does not define a profession. Yet physicians are quick to highlight the mistakes of those below them (med students, interns, residents) and bash them. The result: nurses have such a better reputation with administration, the general public, other healthcare fields, policy makers, etc.
 
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The level of entitlement in this thread is amazing. BuT iM gOiNg To Be A dOcToR! Okay? Doesn’t mean you know your behind from a hot rock when it comes to actual clinical knowledge or how to apply all those fun factoids you learned your first 2 years of med school. It’s not self deprecating to assume you know nothing about actual real life medicine as a 3rd year because in the majority of cases you don’t. 4th year med students are just slightly less in the way, but still are not vital members of the healthcare team. Humility needs to make a comeback in medical education
 
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The level of entitlement in this thread is amazing. BuT iM gOiNg To Be A dOcToR! Okay? Doesn’t mean you know your behind from a hot rock when it comes to actual clinical knowledge or how to apply all those fun factoids you learned your first 2 years of med school. It’s not self deprecating to assume you know nothing about actual real life medicine as a 3rd year because in the majority of cases you don’t. 4th year med students are just slightly less in the way, but still are not vital members of the healthcare team. Humility needs to make a comeback in medical education

What a world we live in where not wanting to be treated like a child and asking to be given the respect an adult learner and professional school student should get is called “entitlement.”
 
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What a world we live in where not wanting to be treated like a child and asking to be given the respect an adult learner and professional school student should get is called “entitlement.”

Respect is earned not given. MS3’s and MS4’s earn the respect of their preceptors and residents through their actions and showing they’re not going to endanger patients. Its not simply anointed to you because hey look at me I’m in med school!
 
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Matthew9Thirtyfive

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Respect is earned not given. MS3’s and MS4’s earn the respect of their preceptors and residents through their actions and showing they’re not going to endanger patients. Its not simply anointed to you because hey look at me I’m in med school!

Smh at the idea that a human being shouldn’t be treated with respect just for being a fellow person.
 
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operaman

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Two disagreements:

1. That logic is mid-level logic. Midlevels don't all come out with 'several years of experience.' A first week of their job, straight out of school, midlevel will be given more responsibility than any M3 or M4 (and often even the interns). They are also treated much, much better and given much more respect from even the attending physicians, let alone administration and other healthcare workers.

2. While I agree that medical students become much more capable and useful as they progress through M3 and M4 (and at good medical schools are given increased responsibility), the culture of disrespect does not end. They are still treated as idiots who know nothing and many internalize this and propagate it.

Essentially, if the bar for being an 'idiot who knows nothing' is the attending physician with years of experience in their field, then there are a plethora of 'idiots who know nothing' in the hospital. If responsibility and respect follow based on knowledge and capability (which imo it should), then medical students are much higher up that totem pole.
I think your final point gets to another truth underlying all of this: the bar for being an idiot who knows nothing actually is the experienced attending. Even now as an inexperienced attending I feel like I’m still finding my stride and running many things more senior mentors.

Midlevels and nurses probably do come out of training closer to expected level if mastery than we do because their expected level is very different than ours. A new PA or NP may know little but after a few months of highly supervised training I’m only expecting them to function in a limited and still supervised role. A medical student or resident is expected to become a fully independent attending in the near future so I’m going to be expecting a different level of performance from them.

I think we can do this while treating everyone with dignity and respect, but nothing changes the underlying truth that no matter how gifted an MS3 is, they are exponentially farther from their eventual expected level of mastery than any nurse or midlevel at a similar experience level.
 
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Ho0v-man

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Two disagreements:

1. That logic is mid-level logic. Midlevels don't all come out with 'several years of experience.' A first week of their job, straight out of school, midlevel will be given more responsibility than any M3 or M4 (and often even the interns). They are also treated much, much better and given much more respect from even the attending physicians, let alone administration and other healthcare workers.

2. While I agree that medical students become much more capable and useful as they progress through M3 and M4 (and at good medical schools are given increased responsibility), the culture of disrespect does not end. They are still treated as idiots who know nothing and many internalize this and propagate it.

Essentially, if the bar for being an 'idiot who knows nothing' is the attending physician with years of experience in their field, then there are a plethora of 'idiots who know nothing' in the hospital. If responsibility and respect follow based on knowledge and capability (which imo it should), then medical students are much higher up that totem pole.
Perhaps there’s a disconnect here. I’m saying that a new M3 should not expect to be more valuable to a team than a midlevel. They’re not. That midlevel has done their licensing and is trained on the job before ever being set loose. I referenced a cardiology midlevel in an above post. You really think the cards group was letting them go full steam straight out of school? No! New hire mid levels to that group are watched like hawks for months despite only being allowed to do a few things when that period is over. The M3 does not provide as much value as that midlevel.

I’m all for being more respectful to everybody. But at the end of the day, respect is earned. And med students by design of our flawed system have a hard time earning respect. Your grades and step scores aren’t going to garner more respect from an attending than a midlevel who admits a patient so he/she doesn’t have to. Granted, in an ideal system, a med student could do that too. However, in our current system, me writing an H&P doesn’t save a ton of time even if it’s perfect bc the attending still has to go down to the ER and talk to the patient, read my entire note/plan, and put in orders bc I’m not allowed.
 
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Respect is earned not given. MS3’s and MS4’s earn the respect of their preceptors and residents through their actions and showing they’re not going to endanger patients. Its not simply anointed to you because hey look at me I’m in med school!
This so much. I think a big problem here is that a lot of posters think they should be given a higher level of respect than nurses/mid levels bc they survived the holy hell that is preclinical med Ed. Sorry boys and girls. That just means you’re allowed to continue training. All that you’ve done at that point is literally what every single person training you has done. You’ve still got a lot more to prove. There’s a lot of arrogant med students out there and I can’t imagine how much worse it would be if we started putting them on a pedestal bc they’ve met a generic licensing requirement.

TLDR; your high step scores don’t help the attending go home on time.
 
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Matthew9Thirtyfive

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This is a BS response and you know it. Nobody is talking about respect as a human we’re talking about respecting your role in the medical team

The posters in this thread talking about getting respect are literally talking about not being treated like a 3 year old. Is it such a difficult concept that a person should be treated with decency just for being a person and be treated like a member of the team even if they are lower on the totem pole? I'm all about "respect is earned" but there is a baseline of respect every human being deserves. If I'm working with someone who is a complete idiot, I might not respect them professionally, but I'm not going to treat them like a piece of ****. What is so controversial about that?
 
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I think we can do this while treating everyone with dignity and respect, but nothing changes the underlying truth that no matter how gifted an MS3 is, they are exponentially farther from their eventual expected level of mastery than any nurse or midlevel at a similar experience level.

This is the whole point. For some reason, the idea of treating an MS3 like an adult is bonkers to some people.
 
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slowthai

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The posters in this thread talking about getting respect are literally talking about not being treated like a 3 year old. Is it such a difficult concept that a person should be treated with decency just for being a person and be treated like a member of the team even if they are lower on the totem pole? I'm all about "respect is earned" but there is a baseline of respect every human being deserves. If I'm working with someone who is a complete idiot, I might not respect them professionally, but I'm not going to treat them like a piece of ****. What is so controversial about that?

This is really the main point here. I'm working on a research project with a pretty accomplished attending. This person 100% treats me like I'm a colleague, even though I have done nothing worthy of this person's respect. It speaks to a level of humility that is pretty rare. I have always desired to be this kind of person. It's the model for how the attending-trainee relationship should be.
 
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This is really the main point here. I'm working on a research project with a pretty accomplished attending. This person 100% treats me like I'm a colleague, even though I have done nothing worthy of this person's respect. It speaks to a level of humility that is pretty rare. I have always desired to be this kind of person. It's the model for how the attending-trainee relationship should be.

Exactly. I heard Reza Manesh say something once on a podcast that his mentor told him everyone in medicine is smart, you distinguish yourself by being kind. That's great advice, but when I think about it more, it's kind of sad. It goes back to the heart of this thread. The fact that you can distinguish yourself in medicine by being kind is sad because it means that a lot of people aren't.
 
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RamsFan&FutureDO

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The posters in this thread talking about getting respect are literally talking about not being treated like a 3 year old. Is it such a difficult concept that a person should be treated with decency just for being a person and be treated like a member of the team even if they are lower on the totem pole? I'm all about "respect is earned" but there is a baseline of respect every human being deserves. If I'm working with someone who is a complete idiot, I might not respect them professionally, but I'm not going to treat them like a piece of ****. What is so controversial about that?

I wasn’t implying people should be treated as if they’re 3 maybe others were, but I was not. We all know those doctors who make students lives a living hell and I’d imagine we all dislike them the same. However, don’t take that admission and ignore my underlying point which is that there’s a pervasive attitude amongst medical students as being more important to a healthcare team than they really are. It’s that “look at me I’m going to be a doctor but I want that same respect even before I get to that point” mentality that needs to go. When you have the potential to harm innocents, in this case patients, your feelings and ego need to be checked at the door either by you or the person responsible for you
 
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I wasn’t implying people should be treated as if they’re 3 maybe others were, but I was not. We all know those doctors who make students lives a living hell and I’d imagine we all dislike them the same. However, don’t take that admission and ignore my underlying point which is that there’s a pervasive attitude amongst medical students as being more important to a healthcare team than they really are. It’s that “look at me I’m going to be a doctor but I want that same respect even before I get to that point” mentality that needs to go. When you have the potential to harm innocents, in this case patients, your feelings and ego need to be checked at the door either by you or the person responsible for you

I think we're talking past each other. The people in this thread are mostly talking about just being treated like an adult and like they are on the team, even if it is as a low member of the team. I don't think most people here are saying a med student should be treated like they are an attending or anything special.

I do agree with what @operaman was saying in that a PA or RN who has graduated should get the respect a working MLP or RN deserves, as they are done training. Med students deserve a baseline respect and should be treated like they are future colleagues, since we are. But this "I deserve more respect than this person because X" **** is childish.
 
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1. They won't be ever necessary, but they can help the team.
2. Where in USA do notes not count? I'm at an academic hospital in the south and med students do the bulk of note writing when they're with us. MS3s, MS4s, subIs - whatever. They will always write notes and do lots of them. I've also supervised med students doing lac repairs, LPs, paracentesis etc.
One of my school’s rotation sites is a place where notes don’t count (another hospital in the south). My classmates are telling me they write their notes in a google doc, and the resident skims and then deletes them. Only the residents are allowed to write notes in the EMR and most completely ignore the med students’ notes.

I am hearing from a lot of my classmates that they get to do absolutely nothing and are pretty much just sitting on their hands all day. My site lets me write notes and do procedures, and I feel like my initiative is rewarded. If I ask, “Can I do that?” the answer more often than not is “yes.” At least out of my school’s rotation sites, it seems like mine is in the minority.
 

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There are a plethora of examples of hubris and stupidity within NPs, PAs, RNs, etc. Inability/unwillingness to recognize your limitations and seek help when needed is a personal flaw, not a professional flaw. But here lies the difference:

If you ever read an article where a mid-level messed up (ex: neurology case in TX), look at the comments. Their colleagues are quick to defend their profession and highlight how one mistake by one person does not define a profession. Yet physicians are quick to highlight the mistakes of those below them (med students, interns, residents) and bash them. The result: nurses have such a better reputation with administration, the general public, other healthcare fields, policy makers, etc.
So just to clarify, you're asking physicians to encourage or defend stupidity or unsafe practices committed by students or fellows physicians regardless of the damage, the way NPs do for their colleagues in article comments? No thanks.

I have no problem with med students being treated like adults with significant accomplishments (that's how I treat them) and I try my best to give docs in other fields the benefit of the doubt (e.g. I know what its like being in the ED, so I don't fight admits that aren't completely worked up the way others do), but I'm not going to sing the praises of people very clearly in the wrong when they don't even know how dangerous or problematic their behavior is.
 
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slowthai

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I wasn’t implying people should be treated as if they’re 3 maybe others were, but I was not. We all know those doctors who make students lives a living hell and I’d imagine we all dislike them the same. However, don’t take that admission and ignore my underlying point which is that there’s a pervasive attitude amongst medical students as being more important to a healthcare team than they really are. It’s that “look at me I’m going to be a doctor but I want that same respect even before I get to that point” mentality that needs to go. When you have the potential to harm innocents, in this case patients, your feelings and ego need to be checked at the door either by you or the person responsible for you

Hmm, I have really never seen this attitude. What I see more of is the insanely annoying instagram (and now tik tok) influencers posting cringeworthy content. #blessed. I figure that the people that demonstrably continue with this attitude out in real life will get ripped a new one by any given attending
 
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Matthew9Thirtyfive

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So just to clarify, you're asking physicians to encourage or defend stupidity or unsafe practices committed by students or fellows physicians regardless of the damage, the way NPs do for their colleagues in article comments? No thanks.

I have no problem with med students being treated like adults with significant accomplishments (that's how I treat them) and I try my best to give docs in other fields the benefit of the doubt (e.g. I know what its like being in the ED, so I don't fight admits that aren't completely worked up the way others do), but I'm not going to sing the praises of people very clearly in the wrong when they don't even know how dangerous or problematic their behavior is.

Right but that’s all we’re asking. Is to be treated like an adult. No one is asking to have their mistakes ignored. It’s possible to point out mistakes without humiliating people.
 
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All MS3s are by default idiots who don't know how to tie their shoes and interns are useless and nurses protect patients from them.

^^ This is the mentality that circulates in healthcare essentially but it's mostly led by doctors/residents/med students themselves. No other profession has such an intense self deprecating attitude when it comes to knowing how to do your job as medicine. Nursing, dentistry, PT, any other healthcare profession? Not even remotely close. Polar opposite if anything. NPs on day 1 have the confidence of a veteran attending. RNs in their first month will be critical of patient plans. Dunning kruger? Absolutely.

But that doesn't mean we need to walk around like we don't know anything.
Its symptomatic of the time we live in. Just like nurse on resident bullying is 100% accepted and the converse will land you in the chairman's office getting a talking to...
 
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MedicineZ0Z

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Two disagreements:

1. That logic is mid-level logic. Midlevels don't all come out with 'several years of experience.' A first week of their job, straight out of school, midlevel will be given more responsibility than any M3 or M4 (and often even the interns). They are also treated much, much better and given much more respect from even the attending physicians, let alone administration and other healthcare workers.

2. While I agree that medical students become much more capable and useful as they progress through M3 and M4 (and at good medical schools are given increased responsibility), the culture of disrespect does not end. They are still treated as idiots who know nothing and many internalize this and propagate it.

Essentially, if the bar for being an 'idiot who knows nothing' is the attending physician with years of experience in their field, then there are a plethora of 'idiots who know nothing' in the hospital. If responsibility and respect follow based on knowledge and capability (which imo it should), then medical students are much higher up that totem pole.
^^ This post is 100% spot on. Literally by definition with all the new midlevel schools, most of them are very young and very new. On day 1, they indeed are treated with incredible respect - on par with a PGY3. Yet their level of education is below that of a MS3. It's nuts.

One of my school’s rotation sites is a place where notes don’t count (another hospital in the south). My classmates are telling me they write their notes in a google doc, and the resident skims and then deletes them. Only the residents are allowed to write notes in the EMR and most completely ignore the med students’ notes.

I am hearing from a lot of my classmates that they get to do absolutely nothing and are pretty much just sitting on their hands all day. My site lets me write notes and do procedures, and I feel like my initiative is rewarded. If I ask, “Can I do that?” the answer more often than not is “yes.” At least out of my school’s rotation sites, it seems like mine is in the minority.
That's an institutional problem. Not a system problem. Maybe tell the bosses to change that? It actually makes med students into productive team members, saves residents a lot of time and effort and is good for med student learning.

The level of entitlement in this thread is amazing. BuT iM gOiNg To Be A dOcToR! Okay? Doesn’t mean you know your behind from a hot rock when it comes to actual clinical knowledge or how to apply all those fun factoids you learned your first 2 years of med school. It’s not self deprecating to assume you know nothing about actual real life medicine as a 3rd year because in the majority of cases you don’t. 4th year med students are just slightly less in the way, but still are not vital members of the healthcare team. Humility needs to make a comeback in medical education
Oh shush.
 
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throwaway1224

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So just to clarify, you're asking physicians to encourage or defend stupidity or unsafe practices committed by students or fellows physicians regardless of the damage, the way NPs do for their colleagues in article comments? No thanks.

I have no problem with med students being treated like adults with significant accomplishments (that's how I treat them) and I try my best to give docs in other fields the benefit of the doubt (e.g. I know what its like being in the ED, so I don't fight admits that aren't completely worked up the way others do), but I'm not going to sing the praises of people very clearly in the wrong when they don't even know how dangerous or problematic their behavior is.
Their colleagues are quick to defend their profession and highlight how one mistake by one person does not define a profession.
Re-read the above please. I'm arguing taking anecdotal stories and generalizing to medical students are dumb and not worthy of responsibility and respect is wrong. Not that we should defend individual mistakes. I explicitly said individual mistakes are important to highlight and correct.

Two points:

1. Medical students as a group should not lose respect and responsibility based on the anecdotal mistakes of a few. If one off mistakes are worthy of loss of respect and responsibility, then there is not a profession in the hospital worthy of respect or responsibility.

2. Any criticism and bashing of our trainees should be directed explicitly to the person being corrected and related only to the mistake. Our public bashing of our trainees is causing them to be viewed negatively by other members of the healthcare team, patients/families, and the general public. And it is killing us politically.
 
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biobukowski

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I have to respectively disagree with one aspect of your thoughtful post. Medical students require supervision until signed off by a responsible superior. I personally am aware of a case at a teaching hospital where a med student in the ER was sent to repair a small scalp laceration on a toddler. Probably some steri strips would have sufficed, maybe a scar underneath the hair. Not much happening in the ER so the med student was dispatched . The child was restrained, surgical drapes applied, and the repair begins. The student relaxed after the crying under the drapes finally quieted down after 20 min or so. After completing the repair, the student took off the drapes to find a blue, unresponsive, suffocated toddler. Resuscitation efforts failed. This is why all students require supervision and follow up. They are learning after all. Cutting corners is not without risk.

As someone having done pedi residency I find this post dubious. in a peds ER, no way a child gets draped for a lac repair like that, and there is most often a child life specialist playing with the kid during the procedure. It is doubtful you would drape a child in such a way that you don’t monitor their breathing, and doubtful that a resident would not do the repair.

But, lots of stupid things happen in adult ERs with kids. I was once sent a kid from an adult ER with “(single) blue finger” with concerns for vascular compromise, and all I had to do was rub the blue marker off him.

TLDR: this likely happened in an adult ER, unlikely to be handled by a med student in a pediatric setting because of how unfamiliar they would be with a toddler/infant.
 
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VA Hopeful Dr

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Right but that’s all we’re asking. Is to be treated like an adult. No one is asking to have their mistakes ignored. It’s possible to point out mistakes without humiliating people.
Hold on now, that wasn't the deal when I signed up to teach...
 
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Any criticism and bashing of our trainees should be directed explicitly to the person being corrected and related only to the mistake. Our public bashing of our trainees is causing them to be viewed negatively by other members of the healthcare team, patients/families, and the general public. And it is killing us politically.

Yep. The general perception of the public is that medical students and interns (and even residents to an extent) are incompetent, dangerous people who will kill you if you let them take care of you.
 
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I’m saying that a new M3 should not expect to be more valuable to a team than a midlevel. They’re not. That midlevel has done their licensing and is trained on the job before ever being set loose. I referenced a cardiology midlevel in an above post. You really think the cards group was letting them go full steam straight out of school? No! New hire mid levels to that group are watched like hawks for months despite only being allowed to do a few things when that period is over. The M3 does not provide as much value as that midlevel.
Here lies my disagreement. Why should physicians train midlevels 'on the job' but not their own trainees?? Medical students could do everything a new midlevel can do and more...why should we not 1. be allowed to do so and 2. be treated with similar regard?
 
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Matthew9Thirtyfive

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New hire mid levels to that group are watched like hawks for months despite only being allowed to do a few things when that period is over.

If only that were universally true. But it's not. M3s and 4s are not very valuable to the team in most places in part because they aren't allowed to be.
 
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MedicineZ0Z

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Yep. The general perception of the public is that medical students and interns (and even residents to an extent) are incompetent, dangerous people who will kill you if you let them take care of you.
And nurses are there to save the patients from them.
 
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Here lies my disagreement. Why should physicians train midlevels 'on the job' but not their own trainees?? Medical students could do everything a new midlevel can do and more...why should we not 1. be allowed to do so and 2. be treated with similar regard?
This isn’t a point I’m arguing. The on the job training starts in residency. Also, the med student is on service for a month. By the time they start to learn the ropes, they go off to a different service.

So let’s say we have a new MS3 and a new midlevel. The midlevel already has a year of clinical training doing the very basic stuff and the MS3 doesn’t. The mid levels training isn’t the same quality of a med students, but it certainly beats the zero clinical experience a new M3 has. So they’re already a little ahead here. And they’re not expected to get too much more knowledgeable. They’re supposed to get really efficient at the few things they’re entrusted with. Meanwhile, your attendings/residents are pumping you on the finer details of stuff they don’t expect the midlevel to ever learn.

However, after a month, these two are potentially pretty comparable. But then that med student goes and does 5 months in completely different fields. The M3 now comes back to that same rotation the midlevel has been at for six months. It’s only logical that they’d be more efficient. I mean, do you really think in this scenario you’d be as good as delivering babies as a midwife, for example? Of course not. And that’s okay. Your job is to learn. Theirs is to move the meat.
 

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This isn’t a point I’m arguing. The on the job training starts in residency. Also, the med student is on service for a month. By the time they start to learn the ropes, they go off to a different service.

So let’s say we have a new MS3 and a new midlevel. The midlevel already has a year of clinical training doing the very basic stuff and the MS3 doesn’t. The mid levels training isn’t the same quality of a med students, but it certainly beats the zero clinical experience a new M3 has. So they’re already a little ahead here. And they’re not expected to get too much more knowledgeable. They’re supposed to get really efficient at the few things they’re entrusted with. Meanwhile, your attendings/residents are pumping you on the finer details of stuff they don’t expect the midlevel to ever learn.

However, after a month, these two are potentially pretty comparable. But then that med student goes and does 5 months in completely different fields. The M3 now comes back to that same rotation the midlevel has been at for six months. It’s only logical that they’d be more efficient. I mean, do you really think in this scenario you’d be as good as delivering babies as a midwife, for example? Of course not. And that’s okay. Your job is to learn. Theirs is to move the meat.
Pushing back and deferring training is literally why we have endless fellowships yet let midlevels do attending work on day 1 out of school.
So you are literally arguing in favor of a crap system.

Things that should be taught in ms1-2 are learned in ms3-ms4. Things that should be learned in ms3-4, are now learned in intern year. And what should be learned in residency gets pushed into the future aka fellowships. Creates this never ending spiral of training. Then we let midlevels in the back door and let them bypass the insane 8 years of post med school training that a doctor has done.

And you know residents do a good amount of rotations where they aren't there for too long, right? It's the same concept. So a lot of residency nowadays is fluff and a waste of time depending on where you are.
 
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This isn’t a point I’m arguing. The on the job training starts in residency. Also, the med student is on service for a month. By the time they start to learn the ropes, they go off to a different service.
I guess the question is, why is the on-the-job training beginning in residency? What the he|| is the point of M3-M4 if we don't provide it starting then?

Is it crazy to think that a person with an MD should have had at least some level of on the job training before they start intern year?
 
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I guess the question is, why is the on-the-job training beginning in residency? What the he|| is the point of M3-M4 if we don't provide it starting then?

Is it crazy to think that a person with an MD should have had at least some level of on the job training before they start intern year?
Cause people love to drink the kool aid.
 

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As someone having done pedi residency I find this post dubious. in a peds ER, no way a child gets draped for a lac repair like that, and there is most often a child life specialist playing with the kid during the procedure. It is doubtful you would drape a child in such a way that you don’t monitor their breathing, and doubtful that a resident would not do the repair.

But, lots of stupid things happen in adult ERs with kids. I was once sent a kid from an adult ER with “(single) blue finger” with concerns for vascular compromise, and all I had to do was rub the blue marker off him.

TLDR: this likely happened in an adult ER, unlikely to be handled by a med student in a pediatric setting because of how unfamiliar they would be with a toddler/infant.
Sorry if you find this post dubious. I was a consultant on the case for the med mal carrier representing the ER doc. It happened. I believe it was an adult ER. The family wouldn't settle until the hospital dropped the non disclosure clause. They immediately called the media after the settlement.
 
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MedicineZ0Z

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Sorry if you find this post dubious. I was a consultant on the case for the med mal carrier representing the ER doc. It happened. I believe it was an adult ER. The family wouldn't settle until the hospital dropped the non disclosure clause. They immediately called the media after the settlement.
n = 1 freak incidents happen in every industry. I'm sure there's more to the story too.
 
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