Things I Hate About Third Year

[ProfMD]

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!

What you should take away from this discussion is that you need to talk to the M3 and M4 students at your school. Find out which sites are best for different rotations. Find out what they did to have good experiences 3rd year. Also learn from their mistakes.

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[ProfMD]

I edited your post to conform to reality.

Don't take it too hard. Even if your note was in the chart, no one would read it. Reason is that either people do not read any notes (happens all too often) or they are waiting for the plan from the resident or attending. As a student, you do not know enough to give a cohesive plan. The note is for your practice only. The only people who need to read it are your residents/attendings so they can provide feedback. If they are not reading it - that is a problem.

Also, do not be too anxious to have a note in the chart. Having your name in the record is an invitation to be named in a lawsuit should one be filed.

 

[aDOdoctor]

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.

There is no one to bump me to follow me to the CT scanner or pathologists room. Those are easy, simple, and no doubt great learning opportunities. The doctors where I am love to teach and I make sure I know what's going on. I said for the procedures do students at my hospital get bumped. And I told you why and what happens when the procedures are pursued, yet you continue to defend your stance that "No, it HAS to be my way." I'm sorry but it's not. And it's a shame you have turned out to be one of the professionals who will look down on others who have come out of their school as "less experienced" by blaming it squarely on their shoulders because you managed to be in an environment where you could do what you did, yet they could not.


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[cbrons]

Don't take it too hard. Even if your note was in the chart, no one would read it. Reason is that either people do not read any notes (happens all too often) or they are waiting for the plan from the resident or attending. As a student, you do not know enough to give a cohesive plan. The note is for your practice only. The only people who need to read it are your residents/attendings so they can provide feedback. If they are not reading it - that is a problem.

Also, do not be too anxious to have a note in the chart. Having your name in the record is an invitation to be named in a lawsuit should one be filed.

You run around these boards arguing page after page to give nurse practitioners increased autonomy (literally acknowledging in one thread that they should be allowed to write triplicate Rx's for Oxycontin the first day they leave their online degree program and enter full practice). Then you sit here and justify the ridiculously idiotic belief that med students are too stupid to write a note.

Of course they don't know enough to develop a cohesive plan. I guarantee that they would pick it up a lot faster than your brand new DNPs if you stopped and took the time to teach them. Where do you think they're supposed to get that experience from? Their M3 clerkship or a ****ing crackerjack box?

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.

 

[ProfMD]

I think it is actually rare for med student, particularly an M3, to first assist on surgery. This experience is unusual. M3's just do not have the experience to be helpful with much of the operation besides closing, even then it is iffy. I am sure it would make you feel better if it was a resident bumping you. However, whoever is assisting the attending, resident or PA, is someone they have put a lot of time into training. Now, I do think med students should scrub in, second assist, and ideally help close. But that is just me.

 

[ProfMD]

You run around these boards arguing page after page to give nurse practitioners increased autonomy (literally acknowledging in one thread that they should be allowed to write triplicate Rx's for Oxycontin the first day they leave their online degree program and enter full practice). Then you sit here and justify the ridiculously idiotic belief that med students are too stupid to write a note.

Of course they don't know enough to develop a cohesive plan. I guarantee that they would pick it up a lot faster than your brand new DNPs if you stopped and took the time to teach them. Where do you think they're supposed to get that experience from? Their M3 clerkship or a ****ing crackerjack box?

Actually, I never said APNs should have full autonomy on graduation day, but that is a discussion for another board. I do think they should be able to write narcotics on day 1, under the direction of a physician.

And, if you would reread what I wrote, you would see that I did advocate for writing a note, that is reviewed by the residents/attendings you are working with. These people should provide you with feedback. If they are not, that is a problem. I never once suggested that you were "too stupid to write a note." I did say you did not have the experience to formulate a plan. But this is what med school / residency / fellowship are for - to develop that experience.

And, for what it is worth (not much based on the responses from this thread so far) - the med students where I work do write notes and they do go in the chart.

 

[akwho]

There is no one to bump me to follow me to the CT scanner or pathologists room. Those are easy, simple, and no doubt great learning opportunities. The doctors where I am love to teach and I make sure I know what's going on. I said for the procedures do students at my hospital get bumped. And I told you why and what happens when the procedures are pursued, yet you continue to defend your stance that "No, it HAS to be my way." I'm sorry but it's not. And it's a shame you have turned out to be one of the professionals who will look down on others who have come out of their school as "less experienced" by blaming it squarely on their shoulders because you managed to be in an environment where you could do what you did, yet they could not.

Let's problem solve. Which procedures are you getting bumped from, by whom are you getting bumped, what is your performance like compared to your peers, what is your personality like, what type of hospital are you rotating in, is there enough procedures that residents above you are comfortable doing them, why do you think you are getting bumped?

 

[cbrons]

Actually, I never said APNs should have full autonomy on graduation day, but that is a discussion for another board. I do think they should be able to write narcotics on day 1, under the direction of a physician.

And, if you would reread what I wrote, you would see that I did advocate for writing a note, that is reviewed by the residents/attendings you are working with. These people should provide you with feedback. If they are not, that is a problem. I never once suggested that you were "too stupid to write a note." I did say you did not have the experience to formulate a plan. But this is what med school / residency / fellowship are for - to develop that experience.

And, for what it is worth (not much based on the responses from this thread so far) - the med students where I work do write notes and they do go in the chart.

Correct, you think brand new NPs know enough to independently determine when, what, and who should be prescribed a schedule II narcotic in a country that is in the midst of the worst opioid epidemic in world history, but third and fourth year M.D. students do not know enough to write a note that goes into the EMR.

I wonder what it is you think about N.P. school makes it so vastly superior to medical school.

But then again, you have already admitted that you don't care if there is any profession left over for the younger generation so long as you make as much money as possible and retire just before they let someone with an online diploma do the exact same surgical procedures you spend decades learning.

 

[ProfMD]

Correct, you think brand new NPs know enough to independently determine when, what, and who should be prescribed a schedule II narcotic in a country that is in the midst of the worst opioid epidemic in world history, but med students do not know enough to write a note that goes into the EMR.

Yes, I see where you are coming from.

Did you miss the part where I said they should be able to prescribe narcotics "under the direction of a physician." That is, I say "Hey Mr X need such and such a dose of this narcotic - would you please write it since I am scrubbed in and they will not take a verbal order."

You may have also missed the part where I said med student at my place do write notes that go in charts, which is fine with me.

Point is, whether it is in the chart or not is unimportant. The important part is writing the note and getting feedback.

Now do you see?

 

[cbrons]

Did you miss the part where I said they should be able to prescribe narcotics "under the direction of a physician." That is, I say "Hey Mr X need such and such a dose of this narcotic - would you please write it since I am scrubbed in and they will not take a verbal order."

You may have also missed the part where I said med student at my place do write notes that go in charts, which is fine with me.

Point is, whether it is in the chart or not is unimportant. The important part is writing the note and getting feedback.

Now do you see?

Correct, so you think brand new NPs should prescribe Oxys "under your supervision" but med students "don't know enough" (your words) to write a friggen note under your supervision.

I'm just throwing back the implication of what you said.

BTW if the notes do not go in the chart, they will never ever give you feedback. I haven't heard of it happening once at the hospital that no longer allows MS notes to go in the chart and the students have written this in their evals for a very long time.

 

[Señor S]

Let's problem solve. Which procedures are you getting bumped from, by whom are you getting bumped, what is your performance like compared to your peers, what is your personality like, what type of hospital are you rotating in, is there enough procedures that residents above you are comfortable doing them, why do you think you are getting bumped?

See

I think it is actually rare for med student, particularly an M3, to first assist on surgery. This experience is unusual. M3's just do not have the experience to be helpful with much of the operation besides closing, even then it is iffy. I am sure it would make you feel better if it was a resident bumping you. However, whoever is assisting the attending, resident or PA, is someone they have put a lot of time into training. Now, I do think med students should scrub in, second assist, and ideally help close. But that is just me.

There's your answer. Now shut up.

 

[Señor S]

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.

 

[ProfMD]

Correct, so you think brand new NPs should prescribe Oxys "under your supervision" but med students "don't know enough" (your words) to write a friggen note under your supervision.

I'm just throwing back the implication of what you said.

BTW if the notes do not go in the chart, they will never ever give you feedback. I haven't heard of it happening once at the hospital that no longer allows MS notes to go in the chart and the students have written this in their evals for a very long time.

As I said - I agree with you - not getting feedback on notes is a problem. I happen to think this feedback can come regardless. If it is not, that is unfortunate. I will say again so we are clear - whatever form your notes take, in chart or not, if you are not getting feedback, that is a problem and harmful to your education.

And, I will again restate my point since clearly you misunderstood, my fault I am sure. I do think an APN can write prescription that I tell her to. I also said that you, as a medical student, were not experienced enough to formulate a plan. I never said you could not write a note.

Here is a quote from my post above:
"As a student, you do not know enough to give a cohesive plan."

I don't know how this turned into another APN hate fest, so I will get back to the original intention regarding notes and sum up as follows:

If you were a med student at my place, you would write a note in the chart, I would read it and give feedback.

 

[akwho]

See There's your answer. Now shut up.

 

[aDOdoctor]

I think it is actually rare for med student, particularly an M3, to first assist on surgery. This experience is unusual. M3's just do not have the experience to be helpful with much of the operation besides closing, even then it is iffy. I am sure it would make you feel better if it was a resident bumping you. However, whoever is assisting the attending, resident or PA, is someone they have put a lot of time into training. Now, I do think med students should scrub in, second assist, and ideally help close. But that is just me.

Yeah, don't let them do anything at all and call them "iffy," as you obviously came straight out of the womb knowing how to do everything. That's why you are allowed, and we are not. Forgive us.


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[Señor S]

Yeah, don't let them do anything at all and call them "iffy," as you obviously came straight out of the womb knowing how to do everything. That's why you are allowed, and we are not. Forgive us.

Dude, didn't you hear akwho? The next time some PA tries to bump you from a case, STAND UP FOR YOURSELF! You need the experience after all, and everybody has to respect that.

 

[akwho]

Dude, didn't you hear akwho? The next time some PA tries to bump you from a case, STAND UP FOR YOURSELF! You need the experience after all, and everybody has to respect that.

Will be sad to see you continue your trajectory as a terrible med student to terrible resident because you think you have no power to improve things in your education. I have another word for it, lazy.

 

[aDOdoctor]

Dude, didn't you hear akwho? The next time some PA tries to bump you from a case, STAND UP FOR YOURSELF! You need the experience after all, and everybody has to respect that.

That will go over well with the attending and the rest of the surgical team.

I was just telling a friend tonight how an OB doc kicked me off of a vaginal delivery I had been leading to let the midwife STUDENT lead instead.

ak, to answer your previous question, I have excellent grades and evals and have zero issues getting along with others. I am more proactive than many of my classmates. I honestly cannot explain why things happen the way they do. But I've resolved that many things will have to be learned at the resident level, as they allow you a higher level of responsibility.


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[ProfMD]

Yeah, don't let them do anything at all and call them "iffy," as you obviously came straight out of the womb knowing how to do everything. That's why you are allowed, and we are not. Forgive us.


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Actually, the knowledge and skill I have mostly came from residency and fellowship, but the foundation was laid in medical school, including M3 year. My skills were absolutely iffy at that time. They got better because I made myself available and residents and attendings started letting me do stuff. Closing skin is usually what people start with. Hence my comment that M3's should at least participate in the closure with either the resident or attending. That is what I do when I have a med student scrubbed in.

I get that you all are bitter about your M3 experiences and it sucks that it was not a better learning experience for you. There are certainly things that you could have done to make it better, and there are certainly things the school/hospital could do better. Point is, do what you can, look for opportunities, and make the best of it. If all that fails, know that med school is temporary and eventually someone will teach you how to be a doctor.

 

[cbrons]

Will be sad to see you continue your trajectory as a terrible med student to terrible resident because you think you have no power to improve things in your education. I have another word for it, lazy.

So explain what he is supposed to do in that situation.

PA: Excuse me med student, please stand in that corner so I can first assist on this procedure.

 

[Señor S]

Will be sad to see you continue your trajectory as a terrible med student to terrible resident because you think you have no power to improve things in your education. I have another word for it, lazy.

That hurts man. Hey, can we get back to you babbling more bull**** platitudes and calling it advice? Like, if we all just "believe in ourselves" we can "achieve anything" because "failure is not an option"?

 

[dadaddadaBATMAN]

I edited your post to conform to reality.

I mean, the reading notes part/directed feedback will vary from person to person and resident to resident. Sometimes you have to be kindof an a*shole to get good feedback, and ask specific questions. A lot of times when I ask someone twice if my presentations sucked they'll give a response of "no but your physical exam blows, you should x, y and z." Which is good to know. Sometimes it pays to give less of a **** about your grade and more about whether you're actually learning.

I personally am enjoying my training wheels and biking as fast as I can with them on. Pretend like you're the resident, and it's easier to give a damn. You'll also get more of the feedback and the opportunities you're asking for. Or at least that was my experience. The stuff will be real very, very soon. Intern year is coming like a train at the end of the tunnel.

 

[akwho]

I was just telling a friend tonight how an OB doc kicked me off of a vaginal delivery I had been leading to let the midwife STUDENT lead instead.

ak, to answer your previous question, I have excellent grades and evals and have zero issues getting along with others. I am more proactive than many of my classmates. I honestly cannot explain why things happen the way they do. But I've resolved that many things will have to be learned at the resident level, as they allow you a higher level of responsibility.

Who is leading the delivery is usually discussed with the attending prior to the second stage of labor, it should be well known who is going to catch the baby if you're at the point where you're "leading" the delivery. That sounds like a communication issue. I'm sorry that you've been having a bad 3rd year experience. However, I think the approach of being passive for the next year and hoping to learn everything in residency is the wrong one and will put you very far behind your peers. Maximize your time now. Figure out ways to get the experience you want, empower yourself by finding the right mentor who will let you do a lot. If you encounter a roadblock figure out a way around or over it. Don't just wait a year for it to be removed.

 

[akwho]

So explain what he is supposed to do in that situation.

PA: Excuse me med student, please stand in that corner so I can first assist on this procedure.

You stand your ass in the corner. How many times has this happened to me? Zero. Because the PA's I'm working with get to know me, respect me and make sure I get to do stuff even when they are scrubbed.

How many times have I been bumped by a resident, plenty but that is their right as my senior. Just a hint, the more surgeries you go to the more uncovered ones you will find and be able to assist on. Nobodies med school batting average for first assists is going to be 1.0

Edit: Also got to cut on Fournier's Gangrene case 2nd year because I was doing nights at the ED instead of going to class. Just me and the R5 doing an emergent flesh eating bacteria case. That was a great experience I got by doing nights, certainly wouldn't have been able to do that during the day.

 

[aDOdoctor]

Who is leading the delivery is usually discussed with the attending prior to the second stage of labor, it should be well known who is going to catch the baby if you're at the point where you're "leading" the delivery. That sounds like a communication issue. I'm sorry that you've been having a bad 3rd year experience. However, I think the approach of being passive for the next year and hoping to learn everything in residency is the wrong one and will put you very far behind your peers. Maximize your time now. Figure out ways to get the experience you want, empower yourself by finding the right mentor who will let you do a lot. If you encounter a roadblock figure out a way around or over it. Don't just wait a year for it to be removed.

It was clear who was leading it. The nurse came up to me later and apologized for the doctor's behavior and thought it was incredibly rude for that to happen, and that I was doing perfectly. There wasn't much of a way around it. I lost because of my status as a med student.

The only thing I can do is keep trying. I'm going to be the best doctor I can be for my patients, but there will be roadblocks, and people who are ahead of me or other students need to understand that these roadblocks are many times unable to be worked around. And it's because of my experiences that will allow me to be patient with those who will also face unfortunate 3rd year experiences. Instead of putting people down, it's better to just walk them through it so that they can be brought up to the same speed as you. If they don't care they'll show it, and you can stop being so proactive with them. A person who does not care will not care no matter what is done for them.


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[akwho]

It was clear who was leading it. The nurse came up to me later and apologized for the doctor's behavior and thought it was incredibly rude for that to happen, and that I was doing perfectly. There wasn't much of a way around it. I lost because of my status as a med student.

The only thing I can do is keep trying. I'm going to be the best doctor I can be for my patients, but there will be roadblocks, and people who are ahead of me or other students need to understand that these roadblocks are many times unable to be worked around. And it's because of my experiences that will allow me to be patient with those who will also face unfortunate 3rd year experiences. Instead of putting people down, it's better to just walk them through it so that they can be brought up to the same speed as you. If they don't care they'll show it, and you can stop being so proactive with them. A person who does not care will not care no matter what is done for them.

Well that's a bummer. You should definitely report back to the administration about your poor experiences on this rotation so they can make necessary adjustments to it. I would classify it as unacceptable to be bumped from leading a delivery for a midwife student.

 

[Señor S]

Well that's a bummer. You should definitely report back to the administration about your poor experiences on this rotation so they can make necessary adjustments to it. I would classify it as unacceptable to be bumped from leading a delivery for a midwife student.

You are truly talking **** now. Who gives a **** what you personally would classify as unacceptable? There's not a medical school administrator in the world who would so much as lift a finger in response to such an utterly mundane "problem."

 

[GUH]

You stand your ass in the corner. How many times has this happened to me? Zero. Because the PA's I'm working with get to know me, respect me and make sure I get to do stuff even when they are scrubbed.

Believe it or not, you can't always control what other people do to you. To think you can is arrogant and incorrect.

 

[akwho]

Believe it or not, you can't always control what other people do to you. To think you can is arrogant and incorrect.

But you can control 1) interactions before the "bad interaction" and 2) your response to the "bad interaction"

Senor S has adopted the helpless infant mentality. Cbrons is more a rage against the world type, that at least I can somewhat respect. However, my argument is that both are less effective adaptive tactics than simply figuring out how to maximize the third year experience that is within your grasp.

 

[Perrotfish]

Point is, do what you can, look for opportunities, and make the best of it. If all that fails, know that med school is temporary and eventually someone will teach you how to be a doctor.

I think part of the discussion here is what 'making the best of it' means. As others have pointed out, all medical students are triaging between learning by reading at home and learning by doing in the hospital. All the ways that students can make more out of their time on the wards comes at the price of less reading time.

The question is, at what point does MS3 become so low yield that the best strategy is just to get kicked out of the hospital early so that you can go home and read? When I was an MS3 we were still writing real notes and largely managing floor patients, so on inpatient medicine/Peds/ICU services the answer was the classic 'good' MS3 approach: affable, available, and able. There was something to learn so (almost) everyone worked cheerfully,. OB/GYN and Surgery on the other hand had degenerated into an abusive parody of premedical shadowing, and the clear option was to make it clear that you were more trouble than you were worth: exasperating, elusive, and egregious. It was undignified, and I'll admit it was more of an emotional decision at the time than a cognitive one, but I would eventually be discarded like week old milk and still have enough hours to actually get to a coffee shop and learn a little something about Surgery and Ob/Gyn. Now it sounds like the rotations that I had a chance to get something out of are going down the same road.

This is the thing that I think a lot of medical school administrators don't get. Students aren't fleeing the wards to have fun, they're fleeing them to... learn medicine. Medical school faculty are collecting the most avid learners in the world, they are fleecing them for an unprecedented amount of money, and are returning an educational experience so poor that those students actually run from it so that they have some hope of actually learning something before Internship starts. Its turning into Trump University with stethoscopes.

 

[akwho]

Perrotfish's triage metaphor is useful because it's actually what medical students do when deciding where to spend time.

My rotations
Rotations worth staying: Peds, Ob/gyn, psych, internal med, general surgery, ortho, neurosurgery, PM&R, ENT, EM
Rotations not worth staying: Family med (1/2 the days), rads (all the days)

 

[NWwildcat2013]

I think part of the discussion here is what 'making the best of it' means. As others have pointed out, all medical students are triaging between learning by reading at home and learning by doing in the hospital. All the ways that students can make more out of their time on the wards comes at the price of less reading time.

The question is, at what point does MS3 become so low yield that the best strategy is just to get kicked out of the hospital early so that you can go home and read? When I was an MS3 we were still writing real notes and largely managing floor patients, so on inpatient medicine/Peds/ICU services the answer was the classic 'good' MS3 approach: affable, available, and able. There was something to learn so (almost) everyone worked cheerfully,. OB/GYN and Surgery on the other hand had degenerated into an abusive parody of premedical shadowing, and the clear option was to make it clear that you were more trouble than you were worth: exasperating, elusive, and egregious. It was undignified, and I'll admit it was more of an emotional decision at the time than a cognitive one, but I would eventually be discarded like week old milk and still have enough hours to actually get to a coffee shop and learn a little something about Surgery and Ob/Gyn. Now it sounds like the rotations that I had a chance to get something out of are going down the same road.

This is the thing that I think a lot of medical school administrators don't get. Students aren't fleeing the wards to have fun, they're fleeing them to... learn medicine. Medical school faculty are collecting the most avid learners in the world, they are fleecing them for an unprecedented amount of money, and are returning an educational experience so poor that those students literally flee from it so that they have some hope of actually learning something before Internship starts. Its like Trump University with stethoscopes.

You totally get it.

This is what I was trying to get at in my post a few pages back. I learned seizure work up and management in 1 night from a textbook. I took away more from that one night of careful reading and practice questions than I did from an 80 hour week on neurology where the cases are complicated, exceptions to the normal management are made, and attendings and residents are bothered by my numerous questions and attempts at clarification.

Here's an issue I'm curious about. What do you all think about lack of feedback in the form of generic and complimentary feedback when you definitely know there are things you could work on? I find that residents and attendings rarely give me constructive criticism that I need to hear. I feel like I could do nothing or be a complete superstar and still get the same "Great. Keep up the good work" feedback.


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[ProfMD]

I think part of the discussion here is what 'making the best of it' means. As others have pointed out, all medical students are triaging between learning by reading at home and learning by doing in the hospital. All the ways that students can make more out of their time on the wards comes at the price of less reading time.

The question is, at what point does MS3 become so low yield that the best strategy is just to get kicked out of the hospital early so that you can go home and read? When I was an MS3 we were still writing real notes and largely managing floor patients, so on inpatient medicine/Peds/ICU services the answer was the classic 'good' MS3 approach: affable, available, and able. There was something to learn so (almost) everyone worked cheerfully,. OB/GYN and Surgery on the other hand had degenerated into an abusive parody of premedical shadowing, and the clear option was to make it clear that you were more trouble than you were worth: exasperating, elusive, and egregious. It was undignified, and I'll admit it was more of an emotional decision at the time than a cognitive one, but I would eventually be discarded like week old milk and still have enough hours to actually get to a coffee shop and learn a little something about Surgery and Ob/Gyn. Now it sounds like the rotations that I had a chance to get something out of are going down the same road.

This is the thing that I think a lot of medical school administrators don't get. Students aren't fleeing the wards to have fun, they're fleeing them to... learn medicine. Medical school faculty are collecting the most avid learners in the world, they are fleecing them for an unprecedented amount of money, and are returning an educational experience so poor that those students actually run from it so that they have some hope of actually learning something before Internship starts. Its turning into Trump University with stethoscopes.

I understand what you are saying. I do wonder how much of it is interest though. I realized I wanted to be a surgeon during my M3 surgery rotation - despite standing there retracting or even just watching, I still wanted to be in the OR.

On the other hand, there is nothing more painful to me than the endless rounding of medicine.

 

[Perrotfish]

Here's an issue I'm curious about. What do you all think about lack of feedback in the form of generic and complimentary feedback when you definitely know there are things you could work on? I find that residents and attendings rarely give me constructive criticism that I need to hear. I feel like I could do nothing or be a complete superstar and still get the same "Great. Keep up the good work" feedback.

My first day of surgery (second rotation) I fumbled my first presentation pretty badly and started to stall for a few seconds to regroup.

Me: "I'm sorry... I just... um... I need to... um"
Surgery R4: "You just need to shut the f--k up"

That was the end of my first presentation

Be careful what you wish for.

 

[ProfMD]

My first day of surgery (second rotation) I fumbled my first presentation pretty badly and started to stall for a few seconds to regroup.

Me: "I'm sorry... I just... um... I need to... um"
Surgery R4: "You just need to shut the f--k up"

That was the end of my first presentation

Be careful what you wish for.

Unfortunately, you had a horrible senior resident.

The other thing these folks can do is remember their bad experiences and try and make sure the experience is better for their own students.

 

[Perrotfish]

I understand what you are saying. I do wonder how much of it is interest though. I realized I wanted to be a surgeon during my M3 surgery rotation - despite standing there retracting or even just watching, I still wanted to be in the OR.

On the other hand, there is nothing more painful to me than the endless rounding of medicine.

In my school, on our 8 week blocks, we always switched between sites 4 weeks in. On my Ob/Gyn rotation I switched from a run down public hospital where we were allowed to do anything to a high end private hospital where all the patients had blue cross and I had to stand against the back wall and watch. It took about 2 days for my motivation to drop from at least middling to just about nothing

On the other side of eduction, I'm did my residency through the military, which still has the students on wards writing all of the notes on their patients. That included students from the local civilian (very high quality) medical school. I would also see students from the same school on my resident rotations at the local children's hospital, where they were never allowed to write orders and their notes didn't go in the chart. The ones on our ward pretty much stayed all day, at the children's hospital they found a thousand excuses to disappear. Same students, same school, only difference was what they were allowed to do.

I know anecdotes are not data, and I do think motivation is part of it, but I think the quality of the education is a bigger part.

 

[Perrotfish]

Unfortunately, you had a horrible senior resident.

The other thing these folks can do is remember their bad experiences and try and make sure the experience is better for their own students.

He was undoubtedly a dick. On the other hand he was funny, which helped.

The more serious answer to @NWwildcat2013 is that the problem with feedback is tied to the problem of medical students not being given real responsibilities The reason that Interns get excellent feedback is that the Seniors and Attendings have a very keen sense of what messes they had to clean up when the Intern Interned badly. On the other hand, when no one has to read your notes, and you can't place and orders, and you didn't do any procedures complicated enough to do wrong, how well do you think a stressed resident with no education in teaching is going to understand what your strengths and weaknesses even are?

 

[ProfMD]

In my school, on our 8 week blocks, we always switched between sites 4 weeks in. On my Ob/Gyn rotation I switched from a run down public hospital where we were allowed to do anything to a high end private hospital where all the patients had blue cross and I had to stand against the back wall and watch. It took about 2 days for my motivation to drop from at least middling to just about nothing

On the other side of eduction, I'm did my residency through the military, which still has the students on wards writing all of the notes on their patients. That included students from the local civilian (very high quality) medical school. I would also see students from the same school on my resident rotations at the local children's hospital, where they were never allowed to write orders and their notes didn't go in the chart. The ones on our ward pretty much stayed all day, at the children's hospital they found a thousand excuses to disappear. Same students, same school, only difference was what they were allowed to do.

I know anecdotes are not data, and I do think motivation is part of it, but I think the quality of the education is a bigger part.

My anecdotes have to do with my classmates in med school. We did not switch sites midway through rotations, so I cannot compare experiences like you can. However, I can say that on any given rotation, there were those of us who tries to do our best, be available, remain positive, etc. We got to do more, got better feedback, and so forth. Then there were those, on the same rotation at the same hospital, who complained, left early, etc - they learned less and got poorer evaluations.

So, I see it as a bit of a chicken and egg phenomenon rather than a one way street.

 

[Señor S]

The "leaving early" thing I confess I don't get at all. Are there really a lot of students who just duck out without being dismissed first?

Pretty much all the feedback I've gotten has ranged from good to great. I've never missed a day or showed up late. Certainly I've never moaned or complained to anybody that I wasn't getting to do enough. I still think 3rd year sucks and is largely a waste of time, for exactly the reasons Perrotfish mentioned.

 

[Psai]

My first day of surgery (second rotation) I fumbled my first presentation pretty badly and started to stall for a few seconds to regroup.

Me: "I'm sorry... I just... um... I need to... um"
Surgery R4: "You just need to shut the f--k up"

That was the end of my first presentation

Be careful what you wish for.

Damn dude that's rough. I can't even imagine how bad you felt.

 

[jl lin]

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.

Just wondering what the big deal is about wheeling a patient down to CT scan? Why is this a big deal? You talk to patient if possible on the way down. You may find out interesting things. Like VA Hopeful said, there's opportunity to learn something. I think in HC, there is a lot of learning while doing stuff. Seriously. I am SMH, cuz I really don't see what the big deal is.

You are humble and eager to learn and help out or you aren't. The god-thing in medicine was always usually BS by most great docs--even >20 years ago, although some got pulled into that kind of thinking.

I now even see this attitude from CRNAs, who still have RN in their titles BTW. You are struggling with GI bleed and you can't keep the suction working for some stupid reason, while trying to see why the damn blood is not transfusing quickly enough, and the pt's about to aspirate all this blood that coming out of her gut--Meanwhile, the CRNA is asking for someone to wipe off the pt's mouth and find her her Ambu bag? Seriously. This "far-removed" crap from helping the patient is totally asinine. Many of us aren't going to waste your time when you have other things to learn, but really, when there is an obvious need, use your hands and help the hell out; b/c, after all, it's for the patient. Also, people have to learn to work as a team, period. You can't work as a team or team leader and be devoid of the humility to jump in when in fact your set of hands are useful in whatever capacity for the patient. Zero respect for those that won't get their hands dirty or won't off their butts b/c they think doing such is beneath them or it's a waste of their time. And no one else worth anything will respect you either. No one is telling anyone to be a damn gofer. It's just about looking at the situation, seeing the need and the opportunity to help, as well as learning something and developing team respect.

 

[Psai]

Just wondering what the big deal is about wheeling a patient down to CT scan? Why is this a big deal? You talk to patient if possible on the way down. You may find out interesting things. Like VA Hopeful said, there's opportunity to learn something. I think it HC, there is a lot of learning while doing stuff. Seriously. I am SMH, cuz I really don't see what the big deal is.

He is an exalted medical student who can only perform the highest yield of tasks whilst among the patient peasants

 

[jl lin]

This is the thing that I think a lot of medical school administrators don't get. Students aren't fleeing the wards to have fun, they're fleeing them to... learn medicine. Medical school faculty are collecting the most avid learners in the world, they are fleecing them for an unprecedented amount of money, and are returning an educational experience so poor that those students actually run from it so that they have some hope of actually learning something before Internship starts. Its turning into Trump University with stethoscopes.

God, I hope not. If there is truth in that, that is pretty scary--even though I get that most of the clinical learning comes through residency and onward.
OTOH and back to supporting the others, there is something to be said by making yourself open and available and humble--and about working to help the whole team, etc. When people don't do this, it doesn't bode well for them from what I have seen. There are always some, shall we say, "political" exceptions. But what are you gonna do? That's everywhere.

 

[jl lin]

He is an exalted medical student who can only perform the highest yield of tasks whilst among the patient peasants

Yea that will be seen as a ****ty attitude, and it won't help moving forward.

 

[cbrons]

You are humble and eager to learn and help out or you aren't. The god-thing in medicine was always usually BS by most great docs--even >20 years ago, although some got pulled into that kind of thinking.

I now even see this attitude from CRNAs, who still have RN in their titles BTW. You are struggling with GI bleed and you can't keep the suction working for some stupid reason, while trying to see why the damn blood is not transfusing quickly enough, and the pt's about to aspirate all this blood that coming out of her gut--Meanwhile, the CRNA is asking for someone to wipe off the pt's mouth and find her her Ambu bag? Seriously. This "far-removed" crap from helping

Yeah, you completely missed the entire point of the discussion.

Just wondering what the big deal is about wheeling a patient down to CT scan? Why is this a big deal? You talk to patient if possible on the way down. You may find out interesting things.

please stop

Sent from my SM-N910P using SDN mobile

 

[sliceofbread136]

Just wondering what the big deal is about wheeling a patient down to CT scan? Why is this a big deal? You talk to patient if possible on the way down. You may find out interesting things. Like VA Hopeful said, there's opportunity to learn something. I think in HC, there is a lot of learning while doing stuff. Seriously. I am SMH, cuz I really don't see what the big deal is.

You are humble and eager to learn and help out or you aren't. The god-thing in medicine was always usually BS by most great docs--even >20 years ago, although some got pulled into that kind of thinking.

I now even see this attitude from CRNAs, who still have RN in their titles BTW. You are struggling with GI bleed and you can't keep the suction working for some stupid reason, while trying to see why the damn blood is not transfusing quickly enough, and the pt's about to aspirate all this blood that coming out of her gut--Meanwhile, the CRNA is asking for someone to wipe off the pt's mouth and find her her Ambu bag? Seriously. This "far-removed" crap from helping the patient is totally asinine. Many of us aren't going to waste your time when you have other things to learn, but really, when there is an obvious need, use your hands and help the hell out; b/c, after all, it's for the patient. Also, people have to learn to work as a team, period. You can't work as a team or team leader and be devoid of the humility to jump in when in fact your set of hands are useful in whatever capacity for the patient. Zero respect for those that won't get their hands dirty or won't off their butts b/c they think doing such is beneath them or it's a waste of their time. And no one else worth anything will respect you either. No one is telling anyone to be a damn gofer. It's just about looking at the situation, seeing the need and the opportunity to help, as well as learning something and developing team respect.

This rambling only made half sense, and the answer should be obvious but I'll bite. There is transport to move patients, you walking with them does not help anyone out. The only reason to do it is what ever learning you would get from being at the CT, which is usually zero since you will be ignored. Even if the radiologist does acknowledge you long enough to tell you what he'll eventually put in his read (huzzah!), you spent multiple hours standing by the patient's room, walking them to the CT, waiting for the CT and then walking back with them. You are devoting probably 10 hours of busy work per a factoid learned.

 

[sliceofbread136]

Yea that will be seen as a ****ty attitude, and it won't help moving forward.

You entirely missed the point... try picking up the ability to read, that skill will help highly with residency as well.

 

[jl lin]

This rambling only made half sense, and the answer should be obvious but I'll bite. There is transport to move patients, you walking with them does not help anyone out. The only reason to do it is what ever learning you would get from being at the CT, which is usually zero since you will be ignored. Even if the radiologist does acknowledge you long enough to tell you what he'll eventually put in his read (huzzah!), you spent multiple hours standing by the patient's room, walking them to the CT, waiting for the CT and then walking back with them. You are devoting probably 10 hours of busy work per a factoid learned.

Sigh. You have, repeatedly, and entirely missed the point. So,whatever. Love your attitude. I am sure many other people in healthcare as well as I would love working with or around or near you.

 

[jl lin]

Yeah, you completely missed the entire point of the discussion.


please stop

Sent from my SM-N910P using SDN mobile

See as I have said above, slice has totally missed the point, and apparently so have you. Don't learn from people here giving you sage advice.

Sure, medicine and healthcare should be all about "every 'man' for himself." Here's another

 

[sliceofbread136]

Sigh. You have, repeatedly, and entirely missed the point. So,whatever. Love your attitude. I am sure I and many other people in healthcare would love working with or around or near you.

No I understood your "point", it is just entirely not pertinent. I don't know if it is because English is not your first language, but I don't feel like there is any communication potential on your part so I'm just gonna drop this conversation entirely.