Things I Hate About Third Year

[ProfMD]

To answer your question - yes, I went to CT with patients as a resident. Not all the time, we had good transport, but if I did not to wait for the results, I absolutely sat there while the scan was done. Same as a fellow. I have also been known to put on lead and stay in the room with a patient to keep them calm as to avoid sedating them.

Even now, as an attending, I pop over the CT and MRI periodically, particularly if I am waiting for a scan after hours. That way, I can review the images as they are being done. I also go down to the radiology reading room at least 3-4 times a week to discuss my patients' films with the radiologists.

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[sliceofbread136]

GTFO, seriously?

As an attending, I don't do it much (though not zero). As a medical student, every patient on surgery that got a CT had company. My hospital didn't have radiology residents so the radiologists loved the chance to teach. Now I'm not saying I can read CTs all that well, but there are certain tricks I picked up from them that have saved me significant time not having to wait for the full official read.

But hey, what do I know about medical education? I've only done it successfully while you're still pre-clinical so obviously you know what's of value in the clinical realm while I have no clue.

Ah the old appeal to authority fallacy. I'm not preclinical, I'm finishing third year. If you want to spend that many hours working as patient transport to learn a few factoids then fine. I'd rather just spend that time studying or doing something actually useful/practical, but then again I'm not a big bad super successful attending

Thank god you won't be in my residency. It's always the people that know the least that talk the most crap. You need to fix your attitude before everyone hates you

Btw wheeling a patient to ct has led to me learning more about stroke imaging from a stroke neurologist than any time I've spent in lecture. You keep choosing important experiences that you've obviously missed out on and displaying your ignorance through them

The feeling is mutual. I would want my fellow residents to use their time more wisely.

If you're arguing that lecture is useless then sure I agree. But just think of how much more you would learn reading a book on neuroradiology instead of working as a patient transporter.

 

[Psai]

When someone actually is an authority in the subject and has demonstrated depth of knowledge along with actual experience, it's not a logical fallacy. It's pointing out your rather self-inflicted inexperience.

 

[giantswing]

Ah the old appeal to authority fallacy. I'm not preclinical, I'm finishing third year. If you want to spend that many hours working as patient transport to learn a few factoids then fine. I'd rather just spend that time studying or doing something actually useful/practical, but then again I'm not a big bad super successful attending



The feeling is mutual. I would want my fellow residents to use their time more wisely.

If you're arguing that lecture is useless then sure I agree. But just think of how much more you would learn reading a book on neuroradiology instead of working as a patient transporter.

There is a lot of dumb stuff that you'll have to do. Just do it.

 

[sliceofbread136]

When someone actually is an authority in the subject and has demonstrated depth of knowledge along with actual experience, it's not a logical fallacy. It's pointing out your rather self-inflicted inexperience.

I'm sure your residency will be very glad to have your patient wheeling experience. Personally I'll probably wheel them into a wall

 

[Psai]

You do realize that you're fighting against your own strawman and that you look silly doing it

 

[VA Hopeful Dr]

Ah the old appeal to authority fallacy. I'm not preclinical, I'm finishing third year. If you want to spend that many hours working as patient transport to learn a few factoids then fine. I'd rather just spend that time studying or doing something actually useful/practical, but then again I'm not a big bad super successful attending

Its not the appeal to authority that you think it is. Its not my being right merely because I'm an attending. Its my being right because I'm at the end of the path you're still on and I'm telling you flat out that doing things like that will make you a better doctor. Period.

I'll be the first to admit that if you have a kick-ass third year where your residents are actively giving you things to do that are higher yield then by all means do that. But given how most of this thread has been about students who spend all day shadowing or just straight up ignored, I think the advice that I'm defending has definite merit.

 

[VA Hopeful Dr]

I'm sure your residency will be very glad to have your patient wheeling experience. Personally I'll probably wheel them into a wall

Heh, if you can make it through residency without seriously considering doing that so select patients then you're a better person than I am...

 

[DeucesHigh3]

To answer your question - yes, I went to CT with patients as a resident. Not all the time, we had good transport, but if I did not to wait for the results, I absolutely sat there while the scan was done. Same as a fellow. I have also been known to put on lead and stay in the room with a patient to keep them calm as to avoid sedating them.

I have no dog in this hunt at all, but really? You've stayed in line-of-sight of the CT while a patient is getting scanned? I guess there's no harm if it's on the order of once every few months, but I'm not sure I'd subject myself even to a limited amount of additional radiation just to avoid some sedation for a patient. (Maybe it's also true that I'm so far from being a soothing presence that it's doubtful that anyone who couldn't tolerate a scan would be able to just because I'm present...)

 

[ProfMD]

I have no dog in this hunt at all, but really? You've stayed in line-of-sight of the CT while a patient is getting scanned? I guess there's no harm if it's on the order of once every few months, but I'm not sure I'd subject myself even to a limited amount of additional radiation just to avoid some sedation for a patient. (Maybe it's also true that I'm so far from being a soothing presence that it's doubtful that anyone who couldn't tolerate a scan would be able to just because I'm present...)

Yes - being in the room was very rare. Being in the control room while the patient was being scanned - not so rare.

The few times I did it was for trauma patients who tend to be a bit hyped up and can have trouble laying still.

 

[sliceofbread136]

You do realize that you're fighting against your own strawman and that you look silly doing it

Ok.

Its not the appeal to authority that you think it is. Its not my being right merely because I'm an attending. Its my being right because I'm at the end of the path you're still on and I'm telling you flat out that doing things like that will make you a better doctor. Period.

I'll be the first to admit that if you have a kick-ass third year where your residents are actively giving you things to do that are higher yield then by all means do that. But given how most of this thread has been about students who spend all day shadowing or just straight up ignored, I think the advice that I'm defending has definite merit.

Sorry but you won't get me to agree. Would rather shadow than wheel someone to the CT. I've never even heard of a med student doing that and neither have the 6 other medical students on my team at a school reputed to be very cut throat.

 

[deleted245139]

Not sure what field pursuing, but friendly advice, it's the little things that give you clout in a department. Getting the IV when the nurse couldn't, helping boost a patient, putting your own hypoxic pt on a NC before walking out of the room rather than telling someone to do it. Most fields rely on a team... it's good to get your hands dirty every once in a while. Your nurses/medics/techs will respect you a hell of a lot more.

Food for thought

 

[ProfMD]

The CT is just one example of something you can do. I don't think anyone is suggesting that you need to push the stretcher. The idea is that you accompany the patient, learn about the imaging and its indications, talk to the radiologist. If you patient is going for an IR procedure, ask if you can go with.

 

[sliceofbread136]

Not sure what field pursuing, but friendly advice, it's the little things that give you clout in a department. Getting the IV when the nurse couldn't, helping boost a patient, putting your own hypoxic pt on a NC before walking out of the room rather than telling someone to do it. Most fields rely on a team... it's good to get your hands dirty every once in a while. Your nurses/medics/techs will respect you a hell of a lot more.

Food for thought

You see all of those serve a purpose and are things that need to get done. Walking a patient to CT does not serve a purpose and would only be for your own personal learning. However that learning is so low yield for the time put in I am baffled by how many people here advocate it.

 

[VA Hopeful Dr]

Ok.



Sorry but you won't get me to agree. Would rather shadow than wheel someone to the CT. I've never even heard of a med student doing that and neither have the 6 other medical students on my team at a school reputed to be very cut throat.

@ProfMD nailed it, its not about physically pushing the stretcher. Its about being involved in the process and learning from the CT tech/radiologist/whoever.

 

[ProfMD]

You see all of those serve a purpose and are things that need to get done. Walking a patient to CT does not serve a purpose and would only be for your own personal learning. However that learning is so low yield for the time put in I am baffled by how many people here advocate it.

I think the point is that you (and others) insist that there are so many useless things about third year - so much wasted time. Yet, when provided with advice from people with more experience (M4s, residents, fellows, attendings) you insist that our advice is stupid. You refuse to find ways to make M3 more useful.

Of course, this could all be a ruse and you just want to get a rise out of people - in which case, mission accomplished, well played.

 

[Psai]

The learning opportunities are obvious and you're the only one that thinks that what was meant was to just literally walk the patient to the ct and that's it. I have no idea why you're so obsessed with this idea of walking patients to the ct scanner. But if you want to be willfully ignorant and ignore helpful advice, that's on you.

 

[deleted245139]

@ProfMD nailed it, its not about physically pushing the stretcher. Its about being involved in the process and learning from the CT tech/radiologist/whoever.

Maybe it's just because I am EM.... Me being able to get a line or IO when no one can makes a massive difference, sometimes life and death. To me, those little 'low yield' things are valuable

Edit...Lol hit reply to the wrong individual. My bad

 

[sliceofbread136]

I think the point is that you (and others) insist that there are so many useless things about third year - so much wasted time. Yet, when provided with advice from people with more experience (M4s, residents, fellows, attendings) you insist that our advice is stupid. You refuse to find ways to make M3 more useful.

Of course, this could all be a ruse and you just want to get a rise out of people - in which case, mission accomplished, well played.

I'm not saying 3rd year is useless, I'm saying that doing something like walking all of your patients to the CT scanner is a useless exercise. I also stand by my statement in our previous conversation that OR time is useless for non surgeons.

The learning opportunities are obvious and you're the only one that thinks that what was meant was to just literally walk the patient to the ct and that's it. I have no idea why you're so obsessed with this idea of walking patients to the ct scanner. But if you want to be willfully ignorant and ignore helpful advice, that's on you.

Because that is what the conversation is about... You are the one generalizing this conversation to other areas, not me. And yes I will ignore the advice to waste many hours and energy to learn a few factoids. I could learn the same thing in 1/100th the time by simply reading a book.

 

[sliceofbread136]

Maybe it's just because I am EM.... Me being able to get a line or IO when no one can makes a massive difference, sometimes life and death. To me, those little 'low yield' things are valuable

Edit...Lol hit reply to the wrong individual. My bad

Where have I addressed these things at all? You are just making things up. Practice placing lines would be a valuable experience

 

[NWwildcat2013]

Thank god you won't be in my residency. It's always the people that know the least that talk the most crap. You need to fix your attitude before everyone hates you

Btw wheeling a patient to ct has led to me learning more about stroke imaging from a stroke neurologist than any time I've spent in lecture. You keep choosing important experiences that you've obviously missed out on and displaying your ignorance through them

I did too, but so what? It was just stroke and we spent a disproportionate amount of time on it. Im great at stroke now but I've never seen a tumor or any other neurorad finding except

I'm not saying 3rd year is useless, I'm saying that doing something like walking all of your patients to the CT scanner is a useless exercise. I also stand by my statement in our previous conversation that OR time is useless for non surgeons.



Because that is what the conversation is about... You are the one generalizing this conversation to other areas, not me. And yes I will ignore the advice to waste many hours and energy to learn a few factoids. I could learn the same thing in 1/100th the time by simply reading a book.

This is the point on which I agree with @sliceofbread136 .

I also agree with @mimelim 's previous post about 3rd year being the year where you learn how to fit in at the hospital and how to communicate/work in a medical team. That is all valuable, but I don't think it requires 12 hours every day at the hospital. I think that 8 hours days at the hospital would be sufficient and free up ~4 more hours to study.

I would LOVE third year if we didn't have shelves, but we do. I love being in the hospital and I'd enjoy checking on my patients more in the afternoon, talking with the nurses and residents more about patients, going down to rads to learn about why a scan was read the way it was if I didn't feel the pressure to study. I know that while I am being a "good third year", my classmates, those I am DIRECTLY compared to for honors, slip out to the library for ~2 hours of reading or UWorld. It is a fact that they are learning shelf relevant material more efficiently. Those 2-3 hours over the course of a rotation really add up. I can't bring myself to do that, though. I feel guilty but I know its going to backfire. It seems third year hasn't adapted to accommodate for the modern era of constant examination and the high stakes attached to them. These shelves are increasingly what determines honors and honors is a significant factor in being able to do what you want with your career/life. If the exams were P/F, I would show up to the hospital every day with much less of a mental burden and anxiety level.

 

[Perrotfish]

I think the point is that you (and others) insist that there are so many useless things about third year - so much wasted time. Yet, when provided with advice from people with more experience (M4s, residents, fellows, attendings) you insist that our advice is stupid. You refuse to find ways to make M3 more useful.

Of course, this could all be a ruse and you just want to get a rise out of people - in which case, mission accomplished, well played.

1) There have also been M4s, residents, and attendings who have agreed with him. I think he hit the nail on the head: when it comes to learning in medical school, the question isn't whether or not its educational, its the yield of the education. MS3 is relatively low yield activity, and the yield is dropping dramatically every couple of years as medical students are pushed farther and farther from patient care. The procedural specialties are almost completely useless now, and the previously high yield rounding specialties are beginning to follow as even writing real notes is deemed too dangerous for a medical student. If you can't do enough to make mistakes there's not point to being there in the first place. What was the highest yield part of medical school 20 years ago, and at least on par with Ms2 10 years ago, is rapidly becoming as vestigial to medical education as Organic Chemistry.

2) Its not trolling not to take advice when you're not asking for it in the first place. If you're married, you know well enough that when your wife rants about her boss she is not obliquely asking for a lecture on how to win friends and influence people. Similarly, when a medical student on a medical student forum complains about being a medical student, they aren't necessarily looking for a counterpoint.

 

[tymont12]

2) Its not trolling not to take advice when you're not asking for it in the first place. If you're married, you know well enough that when your wife rants about her boss she is not obliquely asking for a lecture on how to win friends and influence people. Similarly, when a medical student on a medical student forum complains about being a medical student, they aren't necessarily looking for a counterpoint.

Then why make a thread on a forum? The whole point of this damn website is to have a discussion, not a stupid Mexican standoff.

 

[VA Hopeful Dr]

I'm not saying 3rd year is useless, I'm saying that doing something like walking all of your patients to the CT scanner is a useless exercise. I also stand by my statement in our previous conversation that OR time is useless for non surgeons.

As a non-surgeon, I'm going to have to disagree with this somewhat. Sure that 10th lap chole you're watching from the corner isn't all that useful, but that's why I think overnight call also has value. The after-hours OR time is where students actually tend to be allowed to do stuff. I learned one handed ties and subcuticular suturing on a 2am c-section and drained a deep breast abscess myself (with attending hovering 1cm away) at midnight.

 

[VA Hopeful Dr]

1) There have also been M4s, residents, and attendings who have agreed with him. I think he hit the nail on the head: when it comes to learning in medical school, the question isn't whether or not its educational, its the yield of the education. MS3 is relatively low yield activity, and the yield is dropping dramatically every couple of years as medical students are pushed farther and farther from patient care. The procedural specialties are almost completely useless now, and the previously high yield rounding specialties are beginning to follow as even writing real notes is deemed too dangerous for a medical student. If you can't do enough to make mistakes there's not point to being there in the first place. What was the highest yield part of medical school 20 years ago, and at least on par with Ms2 10 years ago, is rapidly becoming as vestigial to medical education as Organic Chemistry.

Hence why many of us are suggesting finding education where you can

 

[cbrons]

Hey man you're free to go to the CT or sweep the hospital floors all you want, but the chances of learning anything from that are exceedingly low and it won't benefit anyone else. That fits my definition of a waste of time, don't care if that is a "preclinical" outlook

Lmao

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[cbrons]

I think the point is that you (and others) insist that there are so many useless things about third year - so much wasted time. Yet, when provided with advice from people with more experience (M4s, residents, fellows, attendings) you insist that our advice is stupid. You refuse to find ways to make M3 more useful.

Of course, this could all be a ruse and you just want to get a rise out of people - in which case, mission accomplished, well played.

Come on be ez on him. No decent human being isnt extremely jaded and angry by the end of the waste of time called M3 year.

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[cbrons]

1) There have also been M4s, residents, and attendings who have agreed with him. I think he hit the nail on the head: when it comes to learning in medical school, the question isn't whether or not its educational, its the yield of the education. MS3 is relatively low yield activity, and the yield is dropping dramatically every couple of years as medical students are pushed farther and farther from patient care. The procedural specialties are almost completely useless now, and the previously high yield rounding specialties are beginning to follow as even writing real notes is deemed too dangerous for a medical student. If you can't do enough to make mistakes there's not point to being there in the first place. What was the highest yield part of medical school 20 years ago, and at least on par with Ms2 10 years ago, is rapidly becoming as vestigial to medical education as Organic Chemistry.

I re-read this multiple times with a tear in my eye. Finally someone important understands...

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[mimelim]

Come on be ez on him. No decent human being isnt extremely jaded and angry by the end of the waste of time called M3 year.

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It has to be said, there is a lot of variability between schools, some are just plain worse than others. I'm not sure how many schools you have been exposed to clinical curriculums for, but I wouldn't generalize so much based on a relatively limited sample.

 

[Señor S]

It has to be said, there is a lot of variability between schools, some are just plain worse than others. I'm not sure how many schools you have been exposed to clinical curriculums for, but I wouldn't generalize so much based on a relatively limited sample.

True enough, but I still think the general trend with 3rd year is all negative: it's a race to the bottom, and everybody will ultimately end up in the same place.

 

[akwho]

As a counterpoint to the above commentators. I believe it's still possible to have a phenomenal experience in third year, I certainly did, but third year is no longer spoonfed to you. Medical students just aren't needed as much anymore with large healthcare teams and physician extenders everywhere. This means you will have to work hard and fight for your education. It starts with planning your third year rotations at sites known to let students do a lot. Most importantly you must demonstrate professionalism, competence and build trust with your team. Many times I heard the comment, "I usually never let medical students do this so I am trusting you." You build that trust from T=0 with the team, everyday, every minute, with your actions and words.

Here is a list of procedures/workups I got to do that most medical students don't: LP, para, steinman pin placement, pedicle screw placement in a spine surgery, large dorsal midline closures, drain placements, screw/plate fixation in ENT and ortho, reaming, ACL graft placement, reduction and splinting, patellar and hip relocations, lac repairs in sensitive facial areas, ED arterial bleeding vessel ligation, art stick attempts (3x failures so far), nasopharyngeal endoscopy, no to minimal teammate prerrounding on my patients, and they would put in orders I requested, use my notes, because they trusted me to ask for help when I needed it, 2x NSVD's, 15x C-section first assists.

But guess what? I never got to do any of these things until at least two to three weeks into the rotation, where I had proven my interest, usefulness, competence, and reliability to the residents and attendings. So work hard, prove your worth, and it's possible to get the third year experience of old. Don't expect anyone to hand you a great third year experience, in fact don't expect anyone to hand you anything -- it's a good lesson for life.

 

[dadaddadaBATMAN]

Ok.



Sorry but you won't get me to agree. Would rather shadow than wheel someone to the CT. I've never even heard of a med student doing that and neither have the 6 other medical students on my team at a school reputed to be very cut throat.

I've done this multiple times. Sometimes transport gets locked up or they take too long. One of the patients I was following on medicine had an incarcerated hernia and ended up losing about a foot of small bowel. I don't think it would have been a good idea to wait the hour and a half that transport wanted to take her down to CT.

Moving a patient is actually a relatively useful skill to have in a few different specialties: anesthesia, emergency medicine and surgery come to mind. It's not like it's super high order thinking, but neither is placing a NG tube or an IV. Disconnecting monitoring equipment, IVs, O2, etc... it's something you should be capable of, same as gowning and gloving.

 

[cbrons]

As a counterpoint to the above commentators. I believe it's still possible to have a phenomenal experience in third year, I certainly did, but third year is no longer spoonfed to you. Medical students just aren't needed as much anymore with large healthcare teams and physician extenders everywhere. This means you will have to work hard and fight for your education.

Yep pay 40+ grand a year to fight nurse practitioners (who bypassed all that med school stuff and now make 6 figures a year) just to have meaningful patient interaction.

It's actually mind-boggling how you can think this is an OK situation.

Its actually criminal that many modern medical schools rob you of that much money and then throw you at a hospital with a bunch of volunteers saying, "Just be an aggressive learner and it might not be a total waste of your time."

By the way guy, the younger attendings these days by and large do NOT like or appreciate "pushy" (assertive) med students. Asking to be too involved can be a very quick way to a bad evaluation which can screw up your whole career.

There needs to be a renaissance in medical education and a massive pushback against this shadow-centric clinical curriculum of fake student notes, minimal patient interaction, and passive learning. Students today pay way too much money and get precious little in return.

What is absolutely disgraceful is the older generation of physicians who, if not directly responsible as part of the rulemakers and clerkship directors, then indirectly responsible through indifference, have allowed the modern med students to be placed in the role of strict observers. This when many in the said older generation enjoyed much greater hands on training for much cheaper and with much greater financial reward on the other end.

The fact that the AAMC continues to allow schools to throw students to the side of the curb is disgusting. But what do you expect from them? They're too busy coming up with the next diversity seminar or application service racket. Maybe they can create a service for med students who want to complain about shadowing on their $40,000 M3 clerkships. They can charge for each grievance filed and call it something like GAS-ASS (GArbage School ASsessment Service). $11 dollars for each complaint about a rotation for the first 2 and then $26 for each one after. Now there's something those corrupt flat-footed *****s can really dip their beaks into.

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[cbrons]

..accidental repost

 

[Señor S]

The fact that the AAMC continues to allow schools to throw students to the side of the curb is disgusting. But what do you expect from them? They're too busy coming up with the next diversity seminar or application service racket. Maybe they can create a service for med students who want to complain about shadowing on their $40,000 M3 clerkships. They can charge for each grievance filed and call it something like GAS-ASS (GArbage School ASsessment Service). $11 dollars for each complaint about a rotation for the first 2 and then $26 for each one after. Now there's something those corrupt flat-footed *****s can really dip their beaks into.

I'm Señor S, and I approve this post.

 

[Señor S]

But seriously, when you have

-Increasingly hands-off education
-Lengthier post-graduate training
-Skyrocketing tuition
-Midlevels expanding scope of practice
​

Something's gotta give. It's only a testament to the utter powerlessness of medical students--and corruption/incompetence of administrators--that things have gotten this bad.

 

[WingedOx]

It has to be said, there is a lot of variability between schools, some are just plain worse than others. I'm not sure how many schools you have been exposed to clinical curriculums for, but I wouldn't generalize so much based on a relatively limited sample.

Oh it's very possible to get a good education and still be very bitter about the experience you had. Believe me.

 

[akwho]

Yep pay 40+ grand a year to fight nurse practitioners (who bypassed all that med school stuff and now make 6 figures a year) just to have meaningful patient interaction.

There needs to be a renaissance in medical education and a massive pushback against this shadow-centric clinical curriculum of fake student notes, minimal patient interaction, and passive learning. Students today pay way too much money and get precious little in return.

What is absolutely disgraceful is the older generation of physicians who, if not directly responsible as part of the rulemakers and clerkship directors, then indirectly responsible through indifference, have allowed the modern med students to be placed in the role of strict observers. This when many in the said older generation enjoyed much greater hands on training for much cheaper and with much greater financial reward on the other end.

But seriously, when you have

-Increasingly hands-off education
-Lengthier post-graduate training
-Skyrocketing tuition
-Midlevels expanding scope of practice
​

Something's gotta give. It's only a testament to the utter powerlessness of medical students--and corruption/incompetence of administrators--that things have gotten this bad (with no end in sight).

I actually can't disagree with any of the above. I had to work my ass off for a great experience -- I'm just trying to give other students who may be reading this thread a way to make use of a 70k (dunno how you got away with paying 40k) MS-III: 1) schedule at sites with relative high med student autonomy, 2) demonstrate competence early & repeatedly. I got stellar evals all of medical school, and was never described as pushy which may be a risk if asking for procedures well outside of your demonstrated competence level.

I honestly think the "shadow MS3" phenomena is coming about due to the expanded role of mid-levels. They are taking the role med students use to fill, teach less and teach worse for the most part. Frankly large portions of the current generation of attendings is to blame. It is easier and more efficient for them to hire a midlevel to do a job than teach an MS-III every 4-6 weeks to do the same job. While they benefited from the teaching of older doctors who diligently took on that sacred teaching duty, they are now taking the easy way out, which is harming the next generation of doctors.

 

[aDOdoctor]

As a counterpoint to the above commentators. I believe it's still possible to have a phenomenal experience in third year, I certainly did, but third year is no longer spoonfed to you. Medical students just aren't needed as much anymore with large healthcare teams and physician extenders everywhere. This means you will have to work hard and fight for your education. It starts with planning your third year rotations at sites known to let students do a lot. Most importantly you must demonstrate professionalism, competence and build trust with your team. Many times I heard the comment, "I usually never let medical students do this so I am trusting you." You build that trust from T=0 with the team, everyday, every minute, with your actions and words.

Here is a list of procedures/workups I got to do that most medical students don't: LP, para, steinman pin placement, pedicle screw placement in a spine surgery, large dorsal midline closures, drain placements, screw/plate fixation in ENT and ortho, reaming, ACL graft placement, reduction and splinting, patellar and hip relocations, lac repairs in sensitive facial areas, ED arterial bleeding vessel ligation, art stick attempts (3x failures so far), nasopharyngeal endoscopy, no to minimal teammate prerrounding on my patients, and they would put in orders I requested, use my notes, because they trusted me to ask for help when I needed it, 2x NSVD's, 15x C-section first assists.

But guess what? I never got to do any of these things until at least two to three weeks into the rotation, where I had proven my interest, usefulness, competence, and reliability to the residents and attendings. So work hard, prove your worth, and it's possible to get the third year experience of old. Don't expect anyone to hand you a great third year experience, in fact don't expect anyone to hand you anything -- it's a good lesson for life.

I'm glad that you got to do a lot. But where I'm at, students are just simply not allowed to do those things. The doctors are too afraid of liability and would rather do it themselves because the chances of them messing up are much less than a student. This is very prevalent in my school. I can't tell you how many times the midwife or PA or surgical resident bumped me from being first assist in literally anything surgical related. Some OB docs won't let you put in a speculum. I quote from above, it is absolutely criminal. Some may get lucky and do a procedure here or there like a chest tube. When I am disregarded that much that consistently, I don't want to try anymore, and I'd rather study for the shelf and Step 2. Please do not make it seem that just because a student didn't get much procedural experience, must mean they are not a hard worker or untrustworthy.


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[akwho]

I'm glad that you got to do a lot. But where I'm at, students are just simply not allowed to do those things. The doctors are too afraid of liability and would rather do it themselves because the chances of them messing up are much less than a student. This is very prevalent in my school. I can't tell you how many times the midwife or PA or surgical resident bumped me from being first assist in literally anything surgical related. Some OB docs won't let you put in a speculum. I quote from above, it is absolutely criminal. Some may get lucky and do a procedure here or there like a chest tube. When I am disregarded that much that consistently, I don't want to try anymore, and I'd rather study for the shelf and Step 2. Please do not make it seem that just because a student didn't get much procedural experience, must mean they are not a hard worker or untrustworthy.

Stand up for yourself, no one else is going to do it for you. There is no way a midwife or PA should be bumping you. That literally never happened to me.

 

[Señor S]

Stand up for yourself, no one else is going to do it for you. There is no way a midwife or PA should be bumping you. That literally never happened to me.

Come on dude. As a med student you have 0 leverage vis-a-vis a PA or midwife (or NP or anybody really); they have credentials, experience, relationships with staff, but more than anything else insurance will actually reimburse for what they do. There's something to be said for being proactive, but there's also a time to shut up and gracefully step aside; if you learn nothing else 3rd year, it should be to distinguish the latter from the former.

 

[akwho]

Come on dude. As a med student you have 0 leverage vis-a-vis a PA or midwife (or NP or anybody really); they have credentials, experience, relationships with staff, but more than anything else insurance will actually reimburse for what they do. There's something to be said for being proactive, but there's also a time to shut up and gracefully step aside; if you learn nothing else 3rd year, it should be to distinguish the latter from the former.

If you ever want to be a RD (real doctor) you are going to have to learn how to conflict manage to get the learning experiences you need to be a good doc.

You don't need, and shouldn't want, leverage over the PA/NP to get a good experience, I'm not fighting them to see their continuity patient in clinic. If they like you they will teach, offer to finish floor notes so you can get to the OR, and watch you close & give advice on which kind of suture the attending likes. If you suck they will assert their limited authority all over you. If they are a horrible, jealous person, work around them just like you would a bad resident.

Throwing up your hands, leaving early every day to "study" and letting yourself be bumped everyday from meaningful learning experiences is a guaranteed path to having an awful third year.

 

[Señor S]

If you ever want to be a RD (real doctor) you are going to have to learn how to conflict manage to get the learning experiences you need to be a good doc.

You don't need, and shouldn't want, leverage over the PA/NP to get a good experience, I'm not fighting them to see their continuity patient in clinic. If they like you they will teach, offer to finish floor notes so you can get to the OR, and watch you close & give advice on which kind of suture the attending likes. If you suck they will assert their limited authority all over you. If they are a horrible, jealous person, work around them just like you would a bad resident.

Throwing up your hands, leaving early every day to "study" and letting yourself be bumped everyday from meaningful learning experiences is a guaranteed path to having an awful third year and setting yourself up behind the learning curve.

What's your point? There aren't enough hours in the day to be best friends with everybody in the hospital, and it won't matter anyways: they want the case, they're bumping the student. Given that these pricks are invariably master politicians who are buddy-buddy with every important person--and given that they always have the option to quit and massively inconvenience everybody--whose side will the attending take?

An attending has a ton of clout. A resident has some clout. A med student has 0 clout. "Conflict management" only works when you have something to offer the other party, which no med student does. We're total non-entities, practically no different than a volunteer or some high school kid shadowing.

 

[Psai]

So many midlevels take joy in being petty to the med student. Man there are some who refuse to listen to a consult from the student. I get it, they think their time is valuable but it's a teaching hospital. The student should get the opportunity to talk to the attending anyway.

 

[aDOdoctor]

If you ever want to be a RD (real doctor) you are going to have to learn how to conflict manage to get the learning experiences you need to be a good doc.

You don't need, and shouldn't want, leverage over the PA/NP to get a good experience, I'm not fighting them to see their continuity patient in clinic. If they like you they will teach, offer to finish floor notes so you can get to the OR, and watch you close & give advice on which kind of suture the attending likes. If you suck they will assert their limited authority all over you. If they are a horrible, jealous person, work around them just like you would a bad resident.

Throwing up your hands, leaving early every day to "study" and letting yourself be bumped everyday from meaningful learning experiences is a guaranteed path to having an awful third year.

Ok. You obviously know how the dynamics work more in the OR/floors better than I do despite not being there. And when the surgeon says "Hand the scope/tool to X" I'm not going to get into an argument

Telling people in Alaska they shouldn't be cold because it's hot in Florida makes little sense. Experiences wildly vary. The other day I begged the surgical resident let me put in a friggin NG tube and he wouldn't let me do that. Am I supposed to start doing "favors" for them? No. I'm keeping my dignity. And forget you for saying otherwise.

Thanks for playing tho. Please see yourself out.

Sent from my iPhone using SDN mobile app

 

[Azete]

Only pre-clinical, but the reviews from most MS3s here is that 3rd year has become at best a glorified shadowing experience, and at worst paying to do obscene amounts of non-educational labor (i.e. lots of clerical bull**** for an understaffed hospital).

Can't wait!

 

[dadaddadaBATMAN]

Only pre-clinical, but the reviews from most MS3s here is that 3rd year has become at best a glorified shadowing experience, and at worst paying to do obscene amounts of non-educational labor (i.e. lots of clerical bull**** for an understaffed hospital).

Can't wait!

It varies a lot from school to school and from site to site within a school. Even ****ty schools tend to offer a lot of valuable learning. VA sites tend to offer a lot of clinical learning opportunities even though they have all sorts of interesting dysfunctions.

And honestly, even that "clerical bull****" is actually pretty important and valuable, because it's part of the job in a lot of places.

I get that people wish they could have a pure clinical experience with lots of procedures, directed feedback, etc. But honestly, a lot of the work we'll do even as physicians will be some of this same bull****. Scheduling follow up, moving patients, writing notes, etc. are all tasks we all need to do in varying capacities.

 

[cbrons]

I get that people wish they could have a experience that is at least 0.1% clinical and get some directed feedback, etc. Scheduling follow up, moving patients, writing fake notes that not a single person will ever read since it doesnt go in the chart, etc. are all tasks we don't need to do but do anyway because the school can then avoid using our tuition dollars to pay teachers.

I edited your post to conform to reality.

 

[akwho]

Guess I don't know what I'm talking about, and you all should continue to bitch instead of take meaningful steps to improve your experience. Don't blame me when your attending doesn't let you do jack because you leave at 4pm everyday and show bare minimum interest in anything except studying for your shelf.

Or maybe I do know something and have figured out some useful ways to get a great third year experience. I honored almost every rotation, was AOA, learned a ton, did a ton, and matched a top-15 surgical sub speciality program. I did that by showing up on time, staying late, taking overnight call, being a team player, seeking out procedures, asking if I could do things ahead of time, not letting myself be bumped by midlevels, and teaching younger medical students procedures I had already developed a competency in. Most of all I consistently built up my competence level each rotation to the point I was allowed to do what the residents above me were doing. I never once left the hospital early because "I had to study." The hospital is your playground as an MS-3, no real responsibilities, follow your IM patient with a GI bleeder to the scope room, read your breast cancer biopsy's slide with the pathologist, follow your trauma patient to the CT scanner and watch the radiology traumatologist point out minor injuries you didn't even know existed (Biffl I'm looking at you).

If you aren't doing these things, then you have no right to bitch about your third year experience sucking -- it's you that sucks.

 

[cbrons]

Only pre-clinical, but the reviews from most MS3s here is that 3rd year has become at best a glorified shadowing experience, and at worst paying to do obscene amounts of non-educational labor (i.e. lots of clerical bull**** for an understaffed hospital).

Can't wait!

Maybe your school will be one of the few where it is different.

BTW the problem isn't the so-called "non-educational" labor. It's that the entire ****ing rotation is shadowing interspersed with some non-educational labor.