The self deprecating attitude and culture in medicine is awful

[Angus Avagadro]

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n = 1 freak incidents happen in every industry. I'm sure there's more to the story too.

Not a freak accident. 100% preventable. The poor student, who had to live with this was 100% unsupervised. Hard to believe, i know.

 

[Ho0v-man]

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.

And they do only a very small amount of what that person with 8 years post med school training does. They’re not performing the entire scope of what that person does by any stretch of the imagination.


If you think the first two years are fluff, I hope I’m misinterpreting your post.
See below for my opinions regarding clinical Ed. Feel free to search my post history for comments about my ideal medical school curriculum if your curious about specifics.

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?

not at all crazy. And I’d be all for it. Perhaps we’ve got our wires crossed here. I’m not in favor of the current system where we pay tons of money and don’t get EMR access half the time. I’d love to be in a more meaningful role earlier. However, that’s not the system we’re in. The original post was asking why med students are treated like we’re useless. It wasn’t asking if we should advocate for a revamp of our current educational model in which medical students are able to contribute more to patient care. I actually think the way we do clinical education could use a major overhaul. That doesn’t change what reality is today or why medical students currently don’t contribute much in the majority of clinical settings.

Also, we still do get some on the job training. You still learn suturing, note writing, treatment for common disease processes, etc. You just can’t take responsibility for it, hence the aforementioned uselessness.

 

[MedicineZ0Z]

And they do only a very small amount of what that person with 8 years post med school training does. They’re not performing the entire scope of what that person does by any stretch of the imagination.


If you think the first two years are fluff, I hope I’m misinterpreting your post.
See below for my opinions regarding clinical Ed. Feel free to search my post history for comments about my ideal medical school curriculum if your curious about specifics.

not at all crazy. And I’d be all for it. Perhaps we’ve got our wires crossed here. I’m not in favor of the current system where we pay tons of money and don’t get EMR access half the time. I’d love to be in a more meaningful role earlier. However, that’s not the system we’re in. The original post was asking why med students are treated like we’re useless. It wasn’t asking if we should advocate for a revamp of our current educational model in which medical students are able to contribute more to patient care. I actually think the way we do clinical education could use a major overhaul. That doesn’t change what reality is today or why medical students currently don’t contribute much in the majority of clinical settings.

Also, we still do get some on the job training. You still learn suturing, note writing, treatment for common disease processes, etc. You just can’t take responsibility for it, hence the aforementioned uselessness.

They staff EDs, clincs and ICUs all alone. You don't consider that full scope?

 

[mddoc]

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.

I worked in a hospital some years ago and if you saw how doctors treated staff, you would understand why they do that. Perhaps things have things have changed, but the doctor used to be a terror when he (usually he) would come on the floor.

 

[Lawpy]

Just condense preclinical to 1 yr-1.5 yr with a lot of clinical skills and EMR training integrated to it and make the clinical years close to intern/resident level experience. Med students being liable makes no sense when midlevels with less than half the knowledge and experience get to practice independently

 

[Ho0v-man]

They staff EDs, clincs and ICUs all alone. You don't consider that full scope?

ICU: They admit patients the ER has stabilized and the doc sees them in the am. A lot of these admits are more about just requiring constant nurse supervision (ie, an insulin drip) that can’t be done in the floor. Doc is supposed to be in house for anything more complicated than that.

ED: dude it’s fast track. It’s sinusitis, sprained ankles, and lac repairs. I’ve seen a midlevel try to run a code before. It’s embarrassing. Don’t pretend they’re really doing everything an ER doc does. I have anecdotal experience with an “ER” that is 100% staffed by NPs. It’s a band-aid station and EMS doesn’t take them anything more complicated than a paper cut.

Clinics:They either run everything mildly complicated by a supervising doc or there’s a greedy doc you should be mad at. These are the patients that are typically terribly managed.

I’m not saying any of these are right. In fact quite the opposite. If I had things my way, they wouldn’t exist at all. But please stop acting like midlevels are doing everything a fully trained physician does. It actually is an argument in favor of their training over ours, which I’m sure is not your intention.

 

[hallowmann]

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.

I guess the problem is that some of you see this as a constant and regular occurrence (e.g. disrespecting all med students based on the mistakes of a few, treating all med students like they're useless, etc.) and some of us simply don't have the same experience. People are individuals. My med students will be my colleagues, their education is important to me, so I involve them as much as I can in patient care, because those were the experiences I valued as a med student. I know a lot of people with the same sentiment.

While I get the backlash, I don't know if general disdain for med students is as universal as some of you are saying, because, again, most of my rotations involved me feeling valued as a member of the team and being involved in patient care. I was also never the one assuming I was important or knew better than the nurses, even when that was shown, because even if I theoretically knew more than them, it's not like I truly knew what to do with that info.

Maybe we're all talking about degree. I think it's stupid if med students don't get access to the EMR or their notes don't mean anything. I think it's stupid if all they're doing is standing around. I generally don't humiliate anyone or treat them with disdain. I'm not the one you need to worry about. I wouldn't be surprised if most of us commenting here fall into that category.

 

[Angus Avagadro]

Just condense preclinical to 1 yr-1.5 yr with a lot of clinical skills and EMR training integrated to it and make the clinical years close to intern/resident level experience. Med students being liable makes no sense when midlevels with less than half the knowledge and experience get to practice independently

Make preclinical 2 full years with the last 3 months for clinical prep classes. I never understood the summer off after M1

 

[Lawpy]

Make preclinical 2 full years with the last 3 months for clinical prep classes. I never understood the summer off after M1

2 yrs is excessive when several schools are doing just fine with 1.5 yr or 1 yr (plus with P/F Step 1 it's too long). The summer after MS1 is important for research or global health or probably just to enjoy the last vacation.

 

[MedicineZ0Z]

ICU: They admit patients the ER has stabilized and the doc sees them in the am. A lot of these admits are more about just requiring constant nurse supervision (ie, an insulin drip) that can’t be done in the floor. Doc is supposed to be in house for anything more complicated than that.

ED: dude it’s fast track. It’s sinusitis, sprained ankles, and lac repairs. I’ve seen a midlevel try to run a code before. It’s embarrassing. Don’t pretend they’re really doing everything an ER doc does. I have anecdotal experience with an “ER” that is 100% staffed by NPs. It’s a band-aid station and EMS doesn’t take them anything more complicated than a paper cut.

Clinics:They either run everything mildly complicated by a supervising doc or there’s a greedy doc you should be mad at. These are the patients that are typically terribly managed.

I’m not saying any of these are right. In fact quite the opposite. If I had things my way, they wouldn’t exist at all. But please stop acting like midlevels are doing everything a fully trained physician does. It actually is an argument in favor of their training over ours, which I’m sure is not your intention.

Nonsense. They are doing all the overnight ICU procedures, including bronchs, while unsupervised. They solo staff rural EDs and will "manage" a critically ill patient without a physician even being aware of the patient. And they are not running complex patients by a doctor in many clinics.

You may live in a state or area where midlevels are suppressed. In many parts of USA, that is not remotely the case. They literally operate like attendings.

 

[Ho0v-man]

Nonsense. They are doing all the overnight ICU procedures, including bronchs, while unsupervised. They solo staff rural EDs and will "manage" a critically ill patient without a physician even being aware of the patient. And they are not running complex patients by a doctor in many clinics.

You may live in a state or area where midlevels are suppressed. In many parts of USA, that is not remotely the case. They literally operate like attendings.

We’ll never see eye-to-eye. I hope one day you feel like more than an overtrained midlevel.

 

[kepler16b]

Or med students can be treated like very highly educated professionals. How about that?

Lmao you can't be serious dude. We should be treated with respect, yes, but demanding to be treated like a fully functioning doctor is laughable. We're learners, nothing more.

 

[Angus Avagadro]

2 yrs is excessive when several schools are doing just fine with 1.5 yr or 1 yr (plus with P/F Step 1 it's too long). The summer after MS1 is important for research or global health or probably just to enjoy the last vacation.

1 yr preclinical? Hard to imagine removing 6 mos of didactic will be in students best interest on boards or clinicals. But, I could be wrong.

 

[MLNS]

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

My dad’s stories from his med school experience are nuts. He had more autonomy as a MS3 then the senior residents do in my program

 

[throwaway1224]

I guess the problem is that some of you see this as a constant and regular occurrence (e.g. disrespecting all med students based on the mistakes of a few, treating all med students like they're useless, etc.) and some of us simply don't have the same experience. People are individuals. My med students will be my colleagues, their education is important to me, so I involve them as much as I can in patient care, because those were the experiences I valued as a med student. I know a lot of people with the same sentiment.

While I get the backlash, I don't know if general disdain for med students is as universal as some of you are saying, because, again, most of my rotations involved me feeling valued as a member of the team and being involved in patient care. I was also never the one assuming I was important or knew better than the nurses, even when that was shown, because even if I theoretically knew more than them, it's not like I truly knew what to do with that info.

Maybe we're all talking about degree. I think it's stupid if med students don't get access to the EMR or their notes don't mean anything. I think it's stupid if all they're doing is standing around. I generally don't humiliate anyone or treat them with disdain. I'm not the one you need to worry about. I wouldn't be surprised if most of us commenting here fall into that category.

Definitely not attacking you. You sound like an excellent clinician educator. I wish more physicians were like you. However, I think between insurance, EMR, midlevel proliferation med student clinical education has deteriorated significantly since your time. My rotations have been about 50/50 between 'respected member of the team, get lots of hands on experience' and 'glorified shadowing, with no respect or responsibility.' And I'm at a mid-tier USMD known for letting medical students get hands-on experience.

 

[Goro]

2 yrs is excessive when several schools are doing just fine with 1.5 yr or 1 yr (plus with P/F Step 1 it's too long). The summer after MS1 is important for research or global health or probably just to enjoy the last vacation.

Aren't the 1 or 1.5 year preclinical curriculum schools mostly doing that for Primary Care specialty tracks?

 

[DrRiker]

It helps if you dgaf, put your head down and do your work, care for your patients and be a decent human being. That way you're clearly not partaking in this nonsense. Being honest about what you know (and don't know) and willingness to learn cuts through most of the BS you've mentioned. Imagine this scenario:

Patient's IV is beeping all the time and you have no idea what to do. So you tell the nurse. She rolls her eyes, tells you how she's busier than you can even fathom, and huffs to walk over to the patient's room.

One could:
1. Leave, call that nurse a bit*h, stew, and feel dejected

or

2. Say "Can I tag along and see how you handle this so I can learn what to do/not do next time? That way, I can learn and you won't be bothered"

I'll say that these similar situations have happened countless times, and genuine honesty and candor aligns everyone with the main goal. This literally happened to me when I was a third-year, and, lemme tell you, that nurse was the one going out of her way to save me a cupcake after a party, teach me how to start an IV, and was grateful to have a medical student on the floor (even though I didn't know my a$$ from my elbow)

However, there does exist a proportion of med students who fit into this "useless" role (either willingly or unwillingly) because that seems to be "what's expected of them."

This is true. However, I do think there is some degree of hazing. The “I went through this, so I earned the right to put you through this” mentality. Being an honest, diligent learner doesn’t circumvent purely malicious behavior. Just because academics weren’t necessarily jocks doesn’t mean they are free of toxic, fraternity like mentality.

 

[Matthew9Thirtyfive]

Aren't the 1 or 1.5 year preclinical curriculum schools mostly doing that for Primary Care specialty tracks?

Not necessarily. My school is 1.5 year preclinical for everyone. I know other schools are too. Not sure about the 1 year schools.

 

[DrRiker]

Aren't the 1 or 1.5 year preclinical curriculum schools mostly doing that for Primary Care specialty tracks?

I think UMich has a shortened preclinical curriculum. Yale, too? It’s been a couple years since I looked into these.

 

[Candidate2017]

Why do attendings take jobs that involve resident and student supervision? It certainly isn't the low pay. Besides research or a genuine interest in teaching, a fair number are attracted to having underlings do their work/take call (academic jobs advertise this as a major benefit) and the ego stroke of power over trainees/students.

I run my own plan 95% of the time. But there's the occasional attending who drops in for 2 minutes like god's gift, treats me like an idiot, questions my judgment and changes my entire plan (that other attendings had previously agreed with). As much as I'd like to say, "STFU no one agrees, you'd implode in the real world without me doing your work, get the F out of here and let me weigh my sign-on offers in peace," there is only one acceptable response: "Yes, mea culpa, thank you kind sir for sharing your infinite wisdom with a worthless peon."

 

[hallowmann]

Aren't the 1 or 1.5 year preclinical curriculum schools mostly doing that for Primary Care specialty tracks?

1.5 yrs is a newer model a lot of schools are implementing with a bigger focus on clinical exposure. The school here is doing this, and they have students taking Step 1 in Jan of 3rd year and Step 2 in like April-June of that year. Seems to work well for everyone honestly. Students are often very involved in rotations (not counting this year with COVID) and they are pretty good for the most part.

Why do attendings take jobs that involve resident and student supervision? It certainly isn't the low pay. Besides research or a genuine interest in teaching, a fair number are attracted to having underlings do their work/take call (academic jobs advertise this as a major benefit) and the ego stroke of power over trainees/students.

I run my own plan 95% of the time. But there's the occasional attending who drops in for 2 minutes like god's gift, treats me like an idiot, questions my judgment and changes my entire plan (that other attendings had previously agreed with). As much as I'd like to say, "STFU no one agrees, you'd implode in the real world without me doing your work, get the F out of here and let me weigh my sign-on offers in peace," there is only one acceptable response: "Yes, mea culpa, thank you kind sir for sharing your infinite wisdom with a worthless peon."

Unless the bolded is hyperbole, some of you work with malignant af attendings. The attending might seriously question my plan (as opposed to just offer another option) at most once every 6 mos with me, with the rest of the time attendings basically signing off and saying, sounds like a reasonable plan. Granted I do see this way more off-service, but I expect that given that they don't know me from Adam. This usually goes away within a week when they realize I'm competent. Maybe I'm just lucky here. This means even more that people need to pay attention to fit and culture of a place for residency interviews.

 

[Matthew9Thirtyfive]

1.5 yrs is a newer model a lot of schools are implementing with a bigger focus on clinical exposure. The school here is doing this, and they have students taking Step 1 in Jan of 3rd year and Step 2 in like April-June of that year. Seems to work well for everyone honestly. Students are often very involved in rotations (not counting this year with COVID) and they are pretty good for the most part.

This is basically how our school works.

 

[Angus Avagadro]

1.5 yrs is a newer model a lot of schools are implementing with a bigger focus on clinical exposure. The school here is doing this, and they have students taking Step 1 in Jan of 3rd year and Step 2 in like April-June of that year. Seems to work well for everyone honestly. Students are often very involved in rotations (not counting this year with COVID) and they are pretty good for the most part.



Unless the bolded is hyperbole, some of you work with malignant af attendings. The attending might seriously question my plan (as opposed to just offer another option) at most once every 6 mos with me, with the rest of the time attendings basically signing off and saying, sounds like a reasonable plan. Granted I do see this way more off-service, but I expect that given that they don't know me from Adam. This usually goes away within a week when they realize I'm competent. Maybe I'm just lucky here. This means even more that people need to pay attention to fit and culture of a place for residency interviews.

When I was training, only the Residents could write orders. Attendings were not allowed. This would force them to talk to the resident if something was to be changed. Agreed, it was a long time ago, but this forced attendings to interact with house staff.

 

[Lawpy]

When I was training, only the Residents could write orders. Attendings were not allowed. This would force them to talk to the resident if something was to be changed. Agreed, it was a long time ago, but this forced attendings to interact with house staff.

Is it possible to make that happen now? Because its really looking like training in old days is better than training now

 

[hallowmann]

When I was training, only the Residents could write orders. Attendings were not allowed. This would force them to talk to the resident if something was to be changed. Agreed, it was a long time ago, but this forced attendings to interact with house staff.

I mean, my attendings are allowed to write orders, but most do it so rarely that now with higher volumes on the inpatient service with COVID, we have faculty struggling to learn the inpatient system and having to ask interns how to order things. Its easier for us honestly when we are the only ones putting in orders, because when the attendings do, they often take longer and forget a lot of basic orders that prevent the RNs from calling us through the night. The more recent attendings can do basically anything in the system, but the rest struggle on the inpatient side. The outpatient side is different, but honestly, they don't even try to put in orders because its just extra work for them.

 

[Angus Avagadro]

Is it possible to make that happen now? Because its really looking like training in old days is better than training now

I think if students lobbied their school, it might happen. Attendings who didn't follow the rules lost resident coverage. It requires a very supportive DME at the hospital.

 

[CocoMelon0531]

Rule 1: It’s never the med student fault
Rule 2: it’s never the intern fault
Rule 3: it’s always the fault of the senior and attending

All of the teams that I have been on even as an intern are smooth for those reasons. All med students even as a third year will have an opportunity by their second week to chart review new admits, collaborate with me on important key history and physical exam findings, independently interview the patient/do physical exam under my supervision, discuss A/P back in the team room, present independently to the attending, and write their notes, which will most of the time be copied and pasted without much changes. Not planning to change my approach.

As for the other field people walking around like hot stuff, lol who cares. There have been plenty of occasions when I pretended to be the dumb resident and blamed myself for the problem to dissipate tension. Have to play the game and keep calm.

 

[Weirdy]

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

Hey man,

I get where you're coming from but I think the point they're trying to get across, and albeit not stating or realizing it explicitly, is that not everyone has the same standard you've stated. And sometimes we as students have to give them (whoever) a chance to trust us before they actually trust/respect us.

On clerkships for podiatry. Equivalent to your sub-I. This is my 6th one in a different city/state/hospital. Every time I come into an OR and try to be helpful (and not in the gunner kind of way) I get looks from scrub techs or circulating nurses that say "Wtf is this kid doing here?".

Even if I know how to set up an OR and scrub in, I still have to bite my tongue and put the ball in their court- so they would even give me a chance to show them - "Hey, you can trust me. I'm not trying to make more work for you. I have some experience and if I don't know something, I'll straight up ask you before I do any damage."

80% of the time it only takes 1 case for them to trust me and let me get away with more responsibilities. Helping transport the patient, helping set up the OR, even small **** like grabbing gloves or loading local or injecting. I never grab off their table, and even if they know me and are the type to let me do it, I always say "Hey, is it alright if I grab XYZ off your table?" when they're busy doing something else.

The other 20% are people who do not treat anyone like an adult.
Example: Go into the OR, I've been here 3 days and some of the staff already know me. My name tag is pinned to my chest like a f*ckin golden retreiver.

"Hello, my name is Weirdy. I will be scrubbing in today with Dr. XYZ. Can I grab my gloves and the resident's for you?"

"Do you know where they are?"
"Yes."
"I doubt that. Just stay where you are."
Proceeds to go back to her story with the other scrub tech opening sets.

Alrighty, maybe she's just having a rough day. I'm just the dumba*s med student on a new rotation to them. I get it.

Scrub tech who's opening asks for another gown, he's seen the entire interaction, recognizes me from previous case.
"Yes, I can get that for you."
"NO. I don't want you rummaging through my closet."

Alrighty. She's just one of those types of people. I get it. I go position lights.

"You realize xyz resident just came in to adjust those and now you're moving them right?"
"Oh I'm sorry. I didn't realize they were already in here." I put them back to where it was.
"Just saying. They already set them up and now you're moving it."

Entire case went like this. Not only were they treating me like this the entire time, they were even sh*tting on the attending and resident during the case, rushing them, asking them if that's the proper tool they wanted. Everyone picked up on it. They lit her up soon as they realized and everyone laughed at her expense intraop. Here's the sad part- she didn't even realize why they were lighting her up. No self-awareness whatsoever of why they were making jokes at her expense.

Common sense and respect isn't common to everyone.

If playing the game right now gets the job done faster and makes me some friends, even if it makes me look like a self-deprecating bottom of the totem pole **** eating student, then I'll keep playing that game until respect and trust are earned.

 

[Weirdy]

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.

Would love it if that were actually true.

Had an attending tell me explicitly during exit interviews after a 1 month clerkship

"I was very iffy about you at first. The previous 3 students from your school were very entitled and lazy."

Explains why it felt like I was being shunned that 1st week.

It only takes 1 as*hole, or in my case 3 in a row, to ruin your chance.

I want to believe what you say. I just can't based on what I've seen in real life.

 

[Matthew9Thirtyfive]

Hey man,

I get where you're coming from but I think the point they're trying to get across, and albeit not stating or realizing it explicitly, is that not everyone has the same standard you've stated. And sometimes we as students have to give them (whoever) a chance to trust us before they actually trust/respect us.

On clerkships for podiatry. Equivalent to your sub-I. This is my 6th one in a different city/state/hospital. Every time I come into an OR and try to be helpful (and not in the gunner kind of way) I get looks from scrub techs or circulating nurses that say "Wtf is this kid doing here?".

Even if I know how to set up an OR and scrub in, I still have to bite my tongue and put the ball in their court- so they would even give me a chance to show them - "Hey, you can trust me. I'm not trying to make more work for you. I have some experience and if I don't know something, I'll straight up ask you before I do any damage."

80% of the time it only takes 1 case for them to trust me and let me get away with more responsibilities. Helping transport the patient, helping set up the OR, even small **** like grabbing gloves or loading local or injecting. I never grab off their table, and even if they know me and are the type to let me do it, I always say "Hey, is it alright if I grab XYZ off your table?" when they're busy doing something else.

The other 20% are people who do not treat anyone like an adult.
Example: Go into the OR, I've been here 3 days and some of the staff already know me. My name tag is pinned to my chest like a f*ckin dog.

"Hello, my name is Weirdy. I will be scrubbing in today with Dr. XYZ. Can I grab my gloves and the resident's for you?"

"Do you know where they are?"
"Yes."
"I doubt that. Just stay where you are."
Proceeds to go back to her story with the other scrub tech opening sets.

Alrighty, maybe she's just having a rough day. I'm just the ******* med student on a new rotation to them. I get it.

Scrub tech who's opening asks for another gown, he's seen the entire interaction, recognizes me from previous case.
"Yes, I can get that for you."
"NO. I don't want you rummaging through my closet."

Alrighty. She's just one of those types of people. I get it. I go position lights.

"You realize xyz resident just came in to adjust those and now you're moving them right?"
"Oh I'm sorry. I didn't realize they were already in here." I put them back to where it was.
"Just saying. They already set them up and now you're moving it."

Entire case went like this. Not only were they treating me like this the entire time, they were even sh*tting on the attending and resident during the case, rushing them, asking them if that's the proper tool they wanted. Everyone picked up on it. They lit her up soon as they realized and everyone laughed at her expense intraop.

Common sense and respect isn't common to everyone.

If playing the game right now gets the job done faster and makes me some friends, even if it makes me look like a self-deprecating bottom of the totem pole **** eating student, then I'll keep playing that game until respect and trust are earned.

Yeah none of that is okay. Like I get that it takes time for people to learn that you know what you’re doing and trust you. And as a medical student, we most of the time don’t know what we’re doing until we’re almost done with the rotation anyway.

But that in no way whatsoever justifies someone talking down to you. I wouldn’t even talk to a child like that, because I’m not an dingus. All we are asking for us to be treated like adults. That’s not something you should have to earn.

 

[Matthew9Thirtyfive]

Would love it if that were actually true.

Had an attending tell me explicitly during exit interviews after a 1 month clerkship

"I was very iffy about you at first. The previous 3 students from your school were very entitled and lazy."

Explains why it felt like I was being shunned that 1st week.

It only takes 1 as*hole, or in my case 3 in a row, to ruin your chance.

I want to believe what you say. I just can't based on what I've seen in real life.

He said SHOULD NOT. He didn’t say it doesn’t happen.

 

[Weirdy]

He said SHOULD NOT. He didn’t say it doesn’t happen.

Ooh gotcha. My bad.

 

[MedicineZ0Z]

Hey man,

I get where you're coming from but I think the point they're trying to get across, and albeit not stating or realizing it explicitly, is that not everyone has the same standard you've stated. And sometimes we as students have to give them (whoever) a chance to trust us before they actually trust/respect us.

On clerkships for podiatry. Equivalent to your sub-I. This is my 6th one in a different city/state/hospital. Every time I come into an OR and try to be helpful (and not in the gunner kind of way) I get looks from scrub techs or circulating nurses that say "Wtf is this kid doing here?".

Even if I know how to set up an OR and scrub in, I still have to bite my tongue and put the ball in their court- so they would even give me a chance to show them - "Hey, you can trust me. I'm not trying to make more work for you. I have some experience and if I don't know something, I'll straight up ask you before I do any damage."

80% of the time it only takes 1 case for them to trust me and let me get away with more responsibilities. Helping transport the patient, helping set up the OR, even small **** like grabbing gloves or loading local or injecting. I never grab off their table, and even if they know me and are the type to let me do it, I always say "Hey, is it alright if I grab XYZ off your table?" when they're busy doing something else.

The other 20% are people who do not treat anyone like an adult.
Example: Go into the OR, I've been here 3 days and some of the staff already know me. My name tag is pinned to my chest like a f*ckin golden retreiver.

"Hello, my name is Weirdy. I will be scrubbing in today with Dr. XYZ. Can I grab my gloves and the resident's for you?"

"Do you know where they are?"
"Yes."
"I doubt that. Just stay where you are."
Proceeds to go back to her story with the other scrub tech opening sets.

Alrighty, maybe she's just having a rough day. I'm just the dumba*s med student on a new rotation to them. I get it.

Scrub tech who's opening asks for another gown, he's seen the entire interaction, recognizes me from previous case.
"Yes, I can get that for you."
"NO. I don't want you rummaging through my closet."

Alrighty. She's just one of those types of people. I get it. I go position lights.

"You realize xyz resident just came in to adjust those and now you're moving them right?"
"Oh I'm sorry. I didn't realize they were already in here." I put them back to where it was.
"Just saying. They already set them up and now you're moving it."

Entire case went like this. Not only were they treating me like this the entire time, they were even sh*tting on the attending and resident during the case, rushing them, asking them if that's the proper tool they wanted. Everyone picked up on it. They lit her up soon as they realized and everyone laughed at her expense intraop. Here's the sad part- she didn't even realize why they were lighting her up. No self-awareness whatsoever of why they were making jokes at her expense.

Common sense and respect isn't common to everyone.

If playing the game right now gets the job done faster and makes me some friends, even if it makes me look like a self-deprecating bottom of the totem pole **** eating student, then I'll keep playing that game until respect and trust are earned.

You think law students or MBA folks or those in PT school deal with any of that?

Literally it's ONLY in medicine where we have this culture that everyone who is a trainee is a complete *****. Forget usefulness. Everyone thinks a medical trainee is literally stupid (as in unintelligent). They don't think you're in the process of learning. Trust me, most nurses, RTs, other hospital staff among others *actually* think that those in training (aside from maybe senior residents) are dumb. This applies heavily even in the most pro physician settings (which is where I am, ironically).

 

[hallowmann]

Rule 1: It’s never the med student fault
Rule 2: it’s never the intern fault
Rule 3: it’s always the fault of the senior and attending

All of the teams that I have been on even as an intern are smooth for those reasons. All med students even as a third year will have an opportunity by their second week to chart review new admits, collaborate with me on important key history and physical exam findings, independently interview the patient/do physical exam under my supervision, discuss A/P back in the team room, present independently to the attending, and write their notes, which will most of the time be copied and pasted without much changes. Not planning to change my approach.

As for the other field people walking around like hot stuff, lol who cares. There have been plenty of occasions when I pretended to be the dumb resident and blamed myself for the problem to dissipate tension. Have to play the game and keep calm.

This is the dynamic that works, its how I work, and for the most part its the dynamic I've experienced for much of my training. Its how it should work.

I couldn't care less if an attending or even a patient thinks I'm stupid or I did something wrong or didn't know something. Who cares? If my student or junior does something wrong, its my fault for not catching it or explaining it clearly enough. Its my job to make sure the patient is being taken care of and the plans are being implemented and its my attending's job to make sure I don't screw that up.

 

[Neopolymath]

I feel like part of the problem is expectations that don’t align with the level of training. An MS3 should function as an MS3. They are made to feel dumb/treated like a freshman in college (even though they’re a 25 year old graduate student) because they can’t function as a pgy-3.
This attitude allows them to be brushed aside and disrespected by other healthcare personnel which only serves to reduce the quality of their education.

This is the big issue. I spent 3 years getting spoken to like a kindergartner by people that I have objectively accomplished 10x what they have in life and this is by fellow physicians/trainees not even the grumpy scrub techs or nurses. It's honestly ridiculous to look back on. At this point it's humorous but I can see why people end up so mean after training. Luckily, I don't derive my self-worth from these people.

 

[Neopolymath]

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

There is a gigantic area between infantilizing med students and med students acting like they have the knowledge of attendings and need to be thanked for handing the team bandages on rounds because they are crucial lol. I have confidence with even the tiniest effort we could hit that football field sized middle ground. Personally, I would have liked to have been treated like a future colleague that was in the process of earning my way into a dignified profession. I don't even ask that anyone be a halfway decent person at work, nice, acknowledge existence etc as I know that's too hard for all the weirdos in medicine. Just don't treat grown men like they are 7.

 

[shouldigomd]

You think law students or MBA folks or those in PT school deal with any of that?

Literally it's ONLY in medicine where we have this culture that everyone who is a trainee is a complete *****. Forget usefulness. Everyone thinks a medical trainee is literally stupid (as in unintelligent). They don't think you're in the process of learning. Trust me, most nurses, RTs, other hospital staff among others *actually* think that those in training (aside from maybe senior residents) are dumb. This applies heavily even in the most pro physician settings (which is where I am, ironically).

I agree it is malignant and needs to change but it is certainly not "only" in medicine. There are plenty of careers out there where people face a similar struggle of abuse. Medicine still is all about politics / power and $$.

I am a cardiology fellow and I will tell you now that don't expect to be treated like "an adult" until you are an attending. Be humble, have thick skin, let things go and work hard is really the best recipe. Don't focus on the abuse. Focus on the learning.

Nurses will piss you off.... but they are stuck and you are passing through. They are cleaning up poop.... and you will be making >4x their salary.

NPs/PAs .... same thing. Some are fantastic and others are jerks. I deal with so many that are so rude but just have to let them have their moment. They will be answering to you one day.

 

[NicMouse64]

I agree it is malignant and needs to change but it is certainly not "only" in medicine. There are plenty of careers out there where people face a similar struggle of abuse. Medicine still is all about politics / power and $$.

I am a cardiology fellow and I will tell you now that don't expect to be treated like "an adult" until you are an attending. Be humble, have thick skin, let things go and work hard is really the best recipe. Don't focus on the abuse. Focus on the learning.

Nurses will piss you off.... but they are stuck and you are passing through. They are cleaning up poop.... and you will be making >4x their salary.

NPs/PAs .... same thing. Some are fantastic and others are jerks. I deal with so many that are so rude but just have to let them have their moment. They will be answering to you one day.

Probablh not with the way things are going. We will be answering to them.....

 

[Neopolymath]

I agree it is malignant and needs to change but it is certainly not "only" in medicine. There are plenty of careers out there where people face a similar struggle of abuse. Medicine still is all about politics / power and $$.

I am a cardiology fellow and I will tell you now that don't expect to be treated like "an adult" until you are an attending. Be humble, have thick skin, let things go and work hard is really the best recipe. Don't focus on the abuse. Focus on the learning.

Nurses will piss you off.... but they are stuck and you are passing through. They are cleaning up poop.... and you will be making >4x their salary.

NPs/PAs .... same thing. Some are fantastic and others are jerks. I deal with so many that are so rude but just have to let them have their moment. They will be answering to you one day.

I really like this. This is the way to lead a happy life in med school (and I imagine residency). I recommend it as it worked for me quite well. if you ignore the admin yelling in the background at my school, I have had an excellent 3.5 years. Uncouple being irritated by such a simple and stupid situation and your self worth.

Preclinical students should take note. Show up on time. Follow the three As of work. Don't let life pass you by and ignore the knuckleheads you meet along the way. You are probably going to get **** talked for not knowing where the foam tape is kept in a building you have never been in. You will probably be told like a 3 year old how to put gloves on by a weak AF FM resident who can't even procedurally manage a hangnail after you did a ton of technical stuff on surgery and EM (or past life). They can't stop the clock. Blow off some steam on SDN and then commit to treating people well around you at work.

 

[slowthai]

I really like this. This is the way to lead a happy life in med school (and I imagine residency). I recommend it as it worked for me quite well. if you ignore the admin yelling in the background at my school, I have had an excellent 3.5 years. Uncouple being irritated by such a simple and stupid situation and your self worth.

Preclinical students should take note. Show up on time. Follow the three As of work. Don't let life pass you by and ignore the knuckleheads you meet along the way. You are probably going to get **** talked for not knowing where the foam tape is kept in a building you have never been in. You will probably be told like a 3 year old how to put gloves on by a weak AF FM resident who can't even procedurally manage a hangnail after you did a ton of technical stuff on surgery and EM (or past life). They can't stop the clock. Blow off some steam on SDN and then commit to treating people well around you at work.

Lol, I feel like I'm going to be pissed off all of third year. Definitely going to have to work on mentally stiff arming these people and their BS out of my way

 

[MLNS]

Should be obvious but I see so many bizarre interactions from co-residents that I think this might help a lot moving forward: be nice to nurses.

Something that has worked for me in residency is actually caring enough to build relationships with the nurses I work with. Shooting the **** during down time, asking about their kids, etc.

I do it because I genuinely want a cordial work environment but an added effect it’s had is that I don’t get called for dumb **** and let me tell you that has been a life-saver on call nights

 

[Neopolymath]

Lol, I feel like I'm going to be pissed off all of third year. Definitely going to have to work on mentally stiff arming these people and their BS out of my way

Nah. There aren't hordes of people like this. The reason they are unsavory is due to how much they stick out and how pointless the behavior is. The best thing is to go in knowing it is a privilege to be learning medicine and work hard to be positive and learn everyone's name and at least one fact about them. Acknowledge them. You will have far less trouble than some of your peers if you do those simple, polite things. 3rd year is bad in the abstract sense not the day to day sense IMO. Don't go in feeling like it's a hoop because the whole year including your personal life will pass you by. That is the number one mistake of medical trainees, apparently... Just letting life pass them by with "just one more thing and then I'll be happy" attitudes.

 

[deleted1079620]

Preclinical students should take note. Show up on time. Follow the three As of work. Don't let life pass you by and ignore the knuckleheads you meet along the way. You are probably going to get **** talked for not knowing where the foam tape is kept in a building you have never been in. You will probably be told like a 3 year old how to put gloves on by a weak AF FM resident who can't even procedurally manage a hangnail after you did a ton of technical stuff on surgery and EM (or past life). They can't stop the clock. Blow off some steam on SDN and then commit to treating people well around you at work.

What are the “three As of work”? I’ve never heard this phrase before.

 

[throwaway1224]

"I was very iffy about you at first. The previous 3 students from your school were very entitled and lazy."

Might just be my personal opinion, but if 1-2 people who work with, teach, etc. are the problem, they are probably the problem If everyone you work with is the problem, you're probably the problem.

I mean maybe this is just my school , but the vast, vast majority of fellow medical students I've worked with have been excellent or at least average. I'm sure there are arrogant douche medical students (just like there are arrogant douche NPs, RNs, PAs, administrators, etc.), but in my experience they are the exception rather than the rule.

 

[Neopolymath]

What are the “three As of work”? I’ve never heard this phrase before.

Affable, Available, Able. Words to live by as a trainee.

 

[Weirdy]

Might just be my personal opinion, but if 1-2 people who work with, teach, etc. are the problem, they are probably the problem If everyone you work with is the problem, you're probably the problem.

I mean maybe this is just my school , but the vast, vast majority of fellow medical students I've worked with have been excellent or at least average. I'm sure there are arrogant douche medical students (just like there are arrogant douche NPs, RNs, PAs, administrators, etc.), but in my experience they are the exception rather than the rule.

Completely understand.

I didn't believe the attending at first until they gave me names and I realized these were the same type of students that faked COVID symptoms so they could visit more appealing programs or just go home- even if they were off-service.

 

[MerYangBey]

Should be obvious but I see so many bizarre interactions from co-residents that I think this might help a lot moving forward: be nice to nurses.

Something that has worked for me in residency is actually caring enough to build relationships with the nurses I work with. Shooting the **** during down time, asking about their kids, etc.

I do it because I genuinely want a cordial work environment but an added effect it’s had is that I don’t get called for dumb **** and let me tell you that has been a life-saver on call nights

I get this. But I would rather have a work environment that is at baseline business like with genuine interactions between people that actually wanna talk to each other. But if you’re business like then you’re mean/unapproachable which shouldn’t be the case. Let me say especially as a a woman...

 

[mehc012]

And they do only a very small amount of what that person with 8 years post med school training does. They’re not performing the entire scope of what that person does by any stretch of the imagination.


If you think the first two years are fluff, I hope I’m misinterpreting your post.
See below for my opinions regarding clinical Ed. Feel free to search my post history for comments about my ideal medical school curriculum if your curious about specifics.

not at all crazy. And I’d be all for it. Perhaps we’ve got our wires crossed here. I’m not in favor of the current system where we pay tons of money and don’t get EMR access half the time. I’d love to be in a more meaningful role earlier. However, that’s not the system we’re in. The original post was asking why med students are treated like we’re useless. It wasn’t asking if we should advocate for a revamp of our current educational model in which medical students are able to contribute more to patient care. I actually think the way we do clinical education could use a major overhaul. That doesn’t change what reality is today or why medical students currently don’t contribute much in the majority of clinical settings.

Also, we still do get some on the job training. You still learn suturing, note writing, treatment for common disease processes, etc. You just can’t take responsibility for it, hence the aforementioned uselessness.

'On the job' implies that you are actually doing the job.
If someone has to repeat your work, you are not doing the job.

 

[Osteosaur]

I've never encountered any of my fellow students "making fun" of a nurse. Does this really happen?

I think its one thing to be humble, and be comfortable admitting you don't know. Everyone should be like that.

I don't think its healthy for administration, attendings, etc. to beat down students to the point you feel like a burden in a healthcare setting, or dissuade you from making meaningful contributions within your developing skillset. If staff feels that way they should not have students.

 

[Ho0v-man]

'On the job' implies that you are actually doing the job.
If someone has to repeat your work, you are not doing the job.

Good point. We’re also not getting paid so I guess it’s not a good term. I guess I should just call it “training” then. Please see the rest of my post.