Things I Hate About Third Year

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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.

Nah. You just have a reading comprehension problem, and it apparently is not just with my posts. ;)

Survey says: You missed the boat big time.

So, I think I get it now. Generation Cry Baby:
http://www.newslinq.com/generation-cry-baby-v1/

FTFY snowflake.

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Nah. You just have a reading comprehension problem, and apparently not just with my posts. ;)

Survey says: You missed the boat big time.

Maybe someone will take your advice when you learn how to use a comma.
 
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Maybe someone will take your advice when you learn how to use a comma.


Don't worry about my comma splice on a message board for God's sake. Be concerned with listening to people that have given you good advice. If you have time to proof/edit message board comments, you have time to get off your butt and help out. It won't waste your time or break your back. One of the biggest lessons those going into healthcare need to learn is how to listen to patients and others that have some insight and experience.

You seem like a whiner, millennial cry baby. You are not coming off as a team player, and yes. It matters. But it's your life.
 
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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.
@HooliganSnail
 
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 :rolleyes:
You are talking about god complexes and CNRAs who think they are better than you. What you said bears no relevance at all to the topic of core M3 clerkships that consist only of shadowing. But as usual, you have managed to tug people away from the relevant discussion to play patty-cakes with you.
 
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.

.....? I have so many questions.
Why would you wait by the patients room for multiple hours?
why would you be ignored (i never have been ignored by a radiologist, they are generally super friendly/eager to teach)? the ct takes like 2 minutes max, why would it take hours?
and the walk both ways should take 15 minutes max.

In total, less than one hour. And you're being helpful, which gets you a better eval.
 
Don't worry about my comma splice on a message board for God's sake. Be concerned with listening to people that have given you good advice. If you have time to proof/edit message board comments, you have time to get off your butt and help out. It won't waste your time or break your back. One of the biggest lessons those going into healthcare need to learn is how to listen to patients and others that have some insight and experience.

You seem like a whiner, millennial cry baby. You are not coming off as a team player, and yes. It matters. But it's your life.

So this brings up a couple of things.

1. If you aren't communicating clearly, what is the point of posting?

2. I disagree with his position, but I don't see the relevance of your post either.

3. Making generational comparisons immediately costs you about 20 iq points in my book.

Have a good one
 
.....? I have so many questions.
Why would you wait by the patients room for multiple hours?
why would you be ignored (i never have been ignored by a radiologist, they are generally super friendly/eager to teach)? the ct takes like 2 minutes max, why would it take hours?
and the walk both ways should take 15 minutes max.

In total, less than one hour. And you're being helpful, which gets you a better eval.

Because he's never done it so he doesn't understand anything about it. His ignorance is actually a big argument in favor of actually doing it. Knowing how long scans take, understanding the timing of radioactive dye for different procedures (to understand why the dye didn't light up at the right time), the prerequisites for scans (like checking for internal metal for mris), understanding why a patient wasn't able to get a scan (claustrophobic, orthopneic, etc.). He doesn't even know that the radiologist isn't going to sit there in the scanner room with you rather than their reading room. But who cares about what other physicians do, it's not like I'll have to ever consult them and understand their role in the care of my patient.

Kids these days man. Rather sit around regurgitating "high yield facts" onto a stupid multiple choice test than get a better understanding of practical patient care. Because it's not like you're in medical school to help your patients out. Who cares if my patients want to know about the surgery I'm suggesting, it's not like I'm the surgeon and it's definitely not my responsibility to educate my patients. Knowing about CTs is for chumps and radiologists, my third year medical student life is too important, brb complaining about having nothing to do c u l8r
 
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You are talking about god complexes and CNRAs who think they are better than you. What you said bears no relevance at all to the topic of core M3 clerkships that consist only of shadowing. But as usual, you have managed to tug people away from the relevant discussion to play patty-cakes with you.


No brainiac. Read what I am really saying. People get into some "higher" roles. They start thinking "I'm superior and don't have to do this or that, just like a doctor." SMH It's hierarchal BS. The point is, get into jumping in and helping out regardless of status or status-to-be, b/c it's about the patient and learning AND being part of a team. How in the hell is this not relevant, unless you can only see things one-dimensionally? You show up. You make yourself available. You show you care. You become part of a team. You learn stuff. What you don't want to do is act like you think you are too good to do ****. You interact with patients, which, believe it or not, can be very good learning experiences. What's more, if you are lucky, you may get to ask questions and learn some things during the scan. Yes. You can learn stuff from techs. Hell, if you start talking to people, you'd be surprised what you can learn from others--whether you are shooting for radiology or not. What is so hard about this? Again, what is with this millennial crybaby stuff?
 
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Because he's never done it so he doesn't understand anything about it. His ignorance is actually a big argument in favor of actually doing it. Knowing how long scans take, understanding the timing of radioactive dye for different procedures (to understand why the dye didn't light up at the right time), the prerequisites for scans (like checking for internal metal for mris), understanding why a patient wasn't able to get a scan (claustrophobic, orthopneic, etc.). He doesn't even know that the radiologist isn't going to sit there in the scanner room with you rather than their reading room. But who cares about what other physicians do, it's not like I'll have to ever consult them and understand their role in the care of my patient.

Kids these days man. Rather sit around regurgitating "high yield facts" onto a stupid multiple choice test than get a better understanding of practical patient care. Because it's not like you're in medical school to help your patients out. Who cares if my patients want to know about the surgery I'm suggesting, it's not like I'm the surgeon and it's definitely not my responsibility to educate my patients. Knowing about CTs is for chumps and radiologists, my third year medical student life is too important, brb complaining about having nothing to do c u l8r

:claps:
 
No brainiac. Read what I am really saying. People get into some "higher" roles. They start thinking "I'm superior and don't have to do this or that, just like a doctor." SMH It's hierarchal BS. The point is, get into jumping in and helping out regardless of status or status-to-be, b/c it's about the patient and learning AND being part of a team. How in the hell is this not relevant, unless you can only see things one-dimensionally? You show up. You make yourself available. You show you care. You become part of a team. You learn stuff. What you don't want to do is act like you think you are too good to do ****. You interact with patients, which, believe it or not, can be very good learning experiences. What's more, if you are lucky, you may get to ask questions and learn some things during the scan. Yes. You can learn stuff from techs. Hell, if you start talking to people, you'd be surprised what you can learn from others--whether you are shooting for radiology or not. What is so hard about this? Again, what is with this millennial crybaby stuff?
No one here is talking about "higher roles" or being too good for something dear.

I know you like to think you are a victim of some kind but this thread is not about you.

Sent from my SM-N910P using SDN mobile
 
So this brings up a couple of things.

1. If you aren't communicating clearly, what is the point of posting?

2. I disagree with his position, but I don't see the relevance of your post either.

3. Making generational comparisons immediately costs you about 20 iq points in my book.

Have a good one


Well, seeing the books you seem to favor the most are on the level of Dr Seuss, I grin at your response. But here's some words of wisdom from Dr. Seuss, which may be of benefit, IF you let them be.

"Unless someone like you cares a whole awful lot, nothing is going to get better. It's not."-- Dr. Seuss
 
No one here is talking about "higher roles" or being too good for something dear.

I know you like to think you are a victim of some kind but this thread is not about you.

Sent from my SM-N910P using SDN mobile


You are out in FAR left field, but, you know, you are allowed to be. It's OK.

Some midlevels have incorporated the "I'm too good to..." attitude, which sadly has been attributed to doctors. Oy Vey. This is not hard. When you take the attitude you have taken, it says negative stuff to others around you. Don't think that those not evaluating you won't give feedback on you either, even if their names aren't on the documents. Your attitudes shows lack of initiative. You are still not getting this? Wow.

No. If you read very slowly and carefully, you will see that I am pointing at you two as the special, snowflake victims of M3. You two are crying like babies. Experienced physicians and others have given you good advice, and you blow it off as BS. You just keep missing it; b/c you don't want to get it. You don't want to get that regardless of how far you go in this profession, it's still about serving, working as a team, continually learning, and yes, going the extra mile.

It's been fun. My points are clear. It's your dime of education. It's your career, and it's your life. Do what you want.
 
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.....? I have so many questions.
Why would you wait by the patients room for multiple hours?
why would you be ignored (i never have been ignored by a radiologist, they are generally super friendly/eager to teach)? the ct takes like 2 minutes max, why would it take hours?
and the walk both ways should take 15 minutes max.

In total, less than one hour. And you're being helpful, which gets you a better eval.

You have to wait by the room since you don't know when they will take the patient, variable amount of time. I had to go to the CT 3 times while on trauma, no one ever taught me.

And you aren't being helpful, you are just walking with patient transport. Makes zero difference.
 
Because he's never done it so he doesn't understand anything about it. His ignorance is actually a big argument in favor of actually doing it. Knowing how long scans take, understanding the timing of radioactive dye for different procedures (to understand why the dye didn't light up at the right time), the prerequisites for scans (like checking for internal metal for mris), understanding why a patient wasn't able to get a scan (claustrophobic, orthopneic, etc.). He doesn't even know that the radiologist isn't going to sit there in the scanner room with you rather than their reading room. But who cares about what other physicians do, it's not like I'll have to ever consult them and understand their role in the care of my patient.

Kids these days man. Rather sit around regurgitating "high yield facts" onto a stupid multiple choice test than get a better understanding of practical patient care. Because it's not like you're in medical school to help your patients out. Who cares if my patients want to know about the surgery I'm suggesting, it's not like I'm the surgeon and it's definitely not my responsibility to educate my patients. Knowing about CTs is for chumps and radiologists, my third year medical student life is too important, brb complaining about having nothing to do c u l8r

Like I said, I have done it (forced to on surgery)

I do like the vast list of things you have learned: how long it takes, you can't have metal in MRIs, a patient can't get a scan with claustrophobia and that a radiologist doesn't stand in the room with active radiation. I could have told you these things in middle school. Literally the only possible useful thing you mentioned was dye timing.

I also never complained about having too little to do in third year, I have had a generally good third year experience.

And since you know soooo much about CT, why don't you explain to me how it works at a basic level. Be sure to tell me what transfer function they are using and how an inverse radon transform works. I'll be waiting.
 
Hey mods... I think this thread has outlived its usefulness.
 
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Like I said, I have done it (forced to on surgery)

I do like the vast list of things you have learned: how long it takes, you can't have metal in MRIs, a patient can't get a scan with claustrophobia and that a radiologist doesn't stand in the room with active radiation. I could have told you these things in middle school. Literally the only possible useful thing you mentioned was dye timing.

I also never complained about having too little to do in third year, I have had a generally good third year experience.

And since you know soooo much about CT, why don't you explain to me how it works at a basic level. Be sure to tell me what transfer function they are using and how an inverse radon transform works. I'll be waiting.

It's one thing to know something intellectually. Anyone can look anything up on wikipedia and think they're an expert in something (as above). It's another to see an mri machine go down for a few days because some transporter left a iv pole in the room. Or when asking a patient if they ever had an mri, it's nice to know how it sounds so you can jog their memory because it can make a difference in management. Which you would know except you're apparently much too busy to be with your patients

There's also a control room. You don't stand there next to the ct machine getting irradiated. You're paying big money for your education, it's embarrassing for me to have a colleague look so simple and uninformed. If you only want to learn the most important basic things, you're in the wrong field. Feel free to be a midlevel. I also have a bit of a background in quantum mechanics if you want me to explain basic functions since you seem to think that's necessary for you to take a few minutes of your busy MS3 life to bring your patient to ct and learn something new
 
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You're missing the forest for the trees kiddo. Don't forget, it was you that brought up this whole ct thing. And I've been through quantum mechanics this radon transform stuff looks like kiddie stuff which makes sense, based on your general level

Uh huh.... Seems to me you are full of crap

And no one is impressed by you taking Pchem. I took that as a freshmen
 
Uh huh.... Seems to me you are full of crap

And no one is impressed by you taking Pchem. I took that as a freshmen

Like I said, you're the one bringing up nonsense out of nowhere. You go out of your way to miss the point. But you're the only one responsible for your own education. No one can force you to learn, yet your attitude needs adjusting

I thought I could help you but now I see that you've been a whiner your whole time here on sdn and likely longer
 
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Like I said, you're the one bringing up nonsense out of nowhere. You go out of your way to miss the point. But you're the only one responsible for your own education. No one can force you to learn, yet your attitude needs adjusting

And it seems we've gone full circle. I think we are done here, enjoy your vast knowledge of CT.
 
You have to wait by the room since you don't know when they will take the patient, variable amount of time. I had to go to the CT 3 times while on trauma, no one ever taught me.

And you aren't being helpful, you are just walking with patient transport. Makes zero difference.

Doing it on a trauma service is a little different. My experiences were always rigging them up, moving them myself, taking them into the room, helping with the bed transfer, going to the reading room, talking with the radiologist, and then repeating in reverse. Never took that long, and I only did it because it was relatively urgent/no one else was available. I guess another important detail is that I volunteered to do it because I knew how, I wasn't told.

The situation you're describing sounds much less educational or helpful. If you tried to speak with the radiologist after, and weren't able to, then that sounds pretty worthless. Context helps a lot.

I'll stop derailing though

Hey mods... I think this thread has outlived its usefulness.

I tend to disagree.
It's a good thread for bitching and venting about this year, which is something we all probably need. Being derailed for a few pages isn't so bad. Sorry that I helped divert atttention from the main point, which is that at times it sucks to be a third year medical student. Mostly it ain't so bad though
 

I "liked" this b/c there is a huge, member notation page covering it, but I think it's probably some BS someone wrote before. Who knows ? I don't cry over it, b/c I don't want to be associated w/ the cry babies. You can bet the bank I won't lose sleep over it. In fact I am over this thread. :)
 
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I thought I could help you but now I see that you've been a whiner your whole time here on sdn and likely longer

Where have I complained about anything in this thread? I just think going with patients to the CT is a not a good use of time and remain unconvinced otherwise
 
I'm not unclined to shut down a good venting thread, but if the other nonsense and personal attacks continue, it will be dealt with.

Users are reminded to stay on topic and make use of the ignore function.
 
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I honestly can't believe there are medical students who think that doing the work of transporters and clerks is a vital part of their education. You guys are paying a FORTUNE to learn how to be a doctor by, basically, pretending to be one under a real physician's close supervision. If you're doing something else, a job that a working physician does not do, then your school is failing you. When you're doing a job that even an RN won't do, like faxing papers or walking beds to CT, then your school if failing you profoundly.

Think about what medical school was designed to be. When Osler and his compatriots made this whole thing up in the late 1800s medical school was designed to work exactly like residency does work now. The students did physician work like rounding, procedures, managing deliveries, and everything else a physician could do, all under the watchful eye of senior physicians. They didn't mime it, they didn't watch it, they did the work. The wrote the orders, they did the surgeries, and when they screwed up they did the autopsies. That's how you actually learn medicine in medical school.

After WWII, of course, residencies became a more and more of a requirement to work and medical school degenerated a bit. Now there was a second, higher priority class of trainees in the hospital and the medical students, despite paying slightly more to study medicine, were now supervised primarily not by senior physician educators but instead by brand new physicians who were themselves struggling to learn. Procedures began to go almost exclusively to residents and rounding became the only real place where students still acted like doctors. Still, the expectation was very much that students would at least pretend to be doctors. and as little as 10 years ago no one would describe MS3 as a waste of time.

Then in our generation things really began to collapse. Despite seeing tuition rise to the stratosphere, medical schools rapidly realized that there was a legal risk associated with allowing students to actually do anything. Furthermore, since the students were required to go through medical school to be allowed into a residency, there was no incentive whatsoever to provide any kind of education at all. In fact, they realized that they could save an extra few thousand by understaffing the wards of academic hospitals when it came to basic support staff, like clerks and transporters, because they know trainees will be forced to figure it out. Its like you went into a Michelin three star restaurant, paid $500 for your dinner, and the chef then came out and told you that not only will he not be cooking for you, but he expects you to help wash the dishes. If you protested I bet he'd even call you 'entitled'.

Medical school is turning into a scam. They are taking a fortune from you, for two years, to provide lectures of such low quality that everyone skips them and instead learns from the high quality lectures available online. They charge another fortune in MS3 to have you shadow disgruntled trainees who are not paid even a penny of that tuition and, again, to study materials that you buy yourself, online. In MS4 they charge you a fortune in exchange for nothing at all. Medical schools are changing from valuable educators into a form of regulatory capture: an industry that exists entirely because the law insists that it has to. It is the height of Stockholm syndrome to let someone tell you that this is exactly how medical education is supposed to work.
 
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I honestly can't believe there are medical students who think that doing the work of transporters and clerks is a vital part of their education. You guys are paying a FORTUNE to learn how to be a doctor by, basically, pretending to be one under a real physician's close supervision. If you're doing something else, a job that a working physician does not do, then your school is failing you. When you're doing a job that even an RN won't do, like faxing papers or walking beds to CT, then your school if failing you profoundly.

Think about what medical school was designed to be. When Osler and his compatriots made this whole thing up in the late 1800s medical school was designed to work exactly like residency does work now. The students did physician work like rounding, procedures, managing deliveries, and everything else a physician could do, all under the watchful eye of senior physicians. They didn't mime it, they didn't watch it, they did the work. The wrote the orders, they did the surgeries, and when they screwed up they did the autopsies. That's how you actually learn medicine in medical school.

After WWII, of course, residencies became a more and more of a requirement to work and medical school degenerated a bit. Now there was a second, higher priority class of trainees in the hospital and the medical students, despite paying slightly more to study medicine, were now supervised primarily not by senior physician educators but instead by brand new physicians who were themselves struggling to learn. Procedures began to go almost exclusively to residents and rounding became the only real place where students still acted like doctors. Still, the expectation was very much that students would at least pretend to be doctors. and as little as 10 years ago no one would describe MS3 as a waste of time.

Then in our generation things really began to collapse. Despite seeing tuition rise to the stratosphere, medical schools rapidly realized that there was a legal risk associated with allowing students to do anything. Furthermore, since the students were required to go through medical school to be allowed into a residency, there was no incentive whatsoever to provide any kind of education at all. In fact, they realized that they could understaff the wards of academic hospitals when it came to basic support staff, like clerks and transporters, because they know trainees will be forced to figure it out. Its like you went into a Michelin three star restaurant, paid $500 for your dinner, and the chef then came out and told you that not only will he not be cooking for you, but he expects you to help wash the dishes. If you protest I bet he'd even call you 'entitled'.

Medical school is turning into a scam. They are taking a fortune from you, for two years, to provide lectures of such low quality that everyone skips them and instead learns from the high quality lectures available online They charge another fortune in MS3 to have you shadow disgruntled trainees who are not paid even a penny of that tuition and, again, to study materials that you buy yourself, online. In MS4 they charge you a fortune in exchange for nothing at all. Medical schools are changing from valuable educators into a form of regulatory capture: an industry that exists entirely because the law insists that it has to. It is the height of Stockholm syndrome to let someone tell you that this is exactly how medical education is supposed to work.
:bow::bow::bow:
 
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I honestly can't believe there are medical students who think that doing the work of transporters and clerks is a vital part of their education. You guys are paying a FORTUNE to learn how to be a doctor by, basically, pretending to be one under a real physician's close supervision. If you're doing something else, a job that a working physician does not do, then your school is failing you. When you're doing a job that even an RN won't do, like faxing papers or walking beds to CT, then your school if failing you profoundly.

Think about what medical school was designed to be. When Osler and his compatriots made this whole thing up in the late 1800s medical school was designed to work exactly like residency does work now. The students did physician work like rounding, procedures, managing deliveries, and everything else a physician could do, all under the watchful eye of senior physicians. They didn't mime it, they didn't watch it, they did the work. The wrote the orders, they did the surgeries, and when they screwed up they did the autopsies. That's how you actually learn medicine in medical school.

After WWII, of course, residencies became a more and more of a requirement to work and medical school degenerated a bit. Now there was a second, higher priority class of trainees in the hospital and the medical students, despite paying slightly more to study medicine, were now supervised primarily not by senior physician educators but instead by brand new physicians who were themselves struggling to learn. Procedures began to go almost exclusively to residents and rounding became the only real place where students still acted like doctors. Still, the expectation was very much that students would at least pretend to be doctors. and as little as 10 years ago no one would describe MS3 as a waste of time.

Then in our generation things really began to collapse. Despite seeing tuition rise to the stratosphere, medical schools rapidly realized that there was a legal risk associated with allowing students to do anything. Furthermore, since the students were required to go through medical school to be allowed into a residency, there was no incentive whatsoever to provide any kind of education at all. In fact, they realized that they could save an extra few thousand by understaffing the wards of academic hospitals when it came to basic support staff, like clerks and transporters, because they know trainees will be forced to figure it out. Its like you went into a Michelin three star restaurant, paid $500 for your dinner, and the chef then came out and told you that not only will he not be cooking for you, but he expects you to help wash the dishes. If you protest I bet he'd even call you 'entitled'.

Medical school is turning into a scam. They are taking a fortune from you, for two years, to provide lectures of such low quality that everyone skips them and instead learns from the high quality lectures available online They charge another fortune in MS3 to have you shadow disgruntled trainees who are not paid even a penny of that tuition and, again, to study materials that you buy yourself, online. In MS4 they charge you a fortune in exchange for nothing at all. Medical schools are changing from valuable educators into a form of regulatory capture: an industry that exists entirely because the law insists that it has to. It is the height of Stockholm syndrome to let someone tell you that this is exactly how medical education is supposed to work.
I'm sorry, but your history lesson isn't quite right. Up until a couple decades ago, hospitals had minimal phlebotomy and transporters. It was the residents and students that were doing all of that work if they couldn't beg a nurse to do it. Outside of a double handful of places (almost entirely in NYC), the amount of "scutwork" required for both the residents and the students has gone significantly *down* over time, not up. Hospitals have more ancillary staff to do the things you're complaining about than ever, though it is true many of them are lighter on the nursing side of things (which affects the nurses, but not so much affects you).

It's true that the amount of "real work" in M3/M4 year has gone down as well, both for reasons of billing (medical student notes can no longer just be cosigned and billed as a full physician note) and liability. That said, the exposure is still there and M3 is a valuable experience that is essential in the development of a physician... Its current state is not ideal, but better than a lot of people in this thread are saying.

Tuition inflation being a complete ripoff is a different problem entirely.
 
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I honestly can't believe there are medical students who think that doing the work of transporters and clerks is a vital part of their education. You guys are paying a FORTUNE to learn how to be a doctor by, basically, pretending to be one under a real physician's close supervision. If you're doing something else, a job that a working physician does not do, then your school is failing you. When you're doing a job that even an RN won't do, like faxing papers or walking beds to CT, then your school if failing you profoundly.

Think about what medical school was designed to be. When Osler and his compatriots made this whole thing up in the late 1800s medical school was designed to work exactly like residency does work now. The students did physician work like rounding, procedures, managing deliveries, and everything else a physician could do, all under the watchful eye of senior physicians. They didn't mime it, they didn't watch it, they did the work. The wrote the orders, they did the surgeries, and when they screwed up they did the autopsies. That's how you actually learn medicine in medical school.

After WWII, of course, residencies became a more and more of a requirement to work and medical school degenerated a bit. Now there was a second, higher priority class of trainees in the hospital and the medical students, despite paying slightly more to study medicine, were now supervised primarily not by senior physician educators but instead by brand new physicians who were themselves struggling to learn. Procedures began to go almost exclusively to residents and rounding became the only real place where students still acted like doctors. Still, the expectation was very much that students would at least pretend to be doctors. and as little as 10 years ago no one would describe MS3 as a waste of time.

Then in our generation things really began to collapse. Despite seeing tuition rise to the stratosphere, medical schools rapidly realized that there was a legal risk associated with allowing students to do anything. Furthermore, since the students were required to go through medical school to be allowed into a residency, there was no incentive whatsoever to provide any kind of education at all. In fact, they realized that they could save an extra few thousand by understaffing the wards of academic hospitals when it came to basic support staff, like clerks and transporters, because they know trainees will be forced to figure it out. Its like you went into a Michelin three star restaurant, paid $500 for your dinner, and the chef then came out and told you that not only will he not be cooking for you, but he expects you to help wash the dishes. If you protest I bet he'd even call you 'entitled'.

Medical school is turning into a scam. They are taking a fortune from you, for two years, to provide lectures of such low quality that everyone skips them and instead learns from the high quality lectures available online They charge another fortune in MS3 to have you shadow disgruntled trainees who are not paid even a penny of that tuition and, again, to study materials that you buy yourself, online. In MS4 they charge you a fortune in exchange for nothing at all. Medical schools are changing from valuable educators into a form of regulatory capture: an industry that exists entirely because the law insists that it has to. It is the height of Stockholm syndrome to let someone tell you that this is exactly how medical education is supposed to work.

Hell yeah bro.

Really, all you Uncle Toms who defend the inanities of 3rd year need to STFU. Med students could spend their whole day shadowing the janitor and you'd still have some idiot saying that it was totally useful because you get "real-life experience in the nuances of aseptic technique and prevention of nosocomial infections."

And no, I don't have a problem with making phone calls or moving patients, but I'm only doing it to be helpful, not for the sake of "education."
 
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Its current state is not ideal, but better than a lot of people in this thread are saying.

No, it very often is every bit as bad as people in this thread are saying.
 
It is true that Osler pioneered bring M3 and M4 students out of the classroom and onto the wards. However, he is also the one who pioneered residency programs.

I have yet to see a hospital that has cut back on ancillary staff (unit clerks, transport people, etc) and expect med students and residents to do it instead. This is outside of NYC, of course, where I hear patient transport at night is a routine responsibility of residents. I don't ever remember faxing paperwork, tubing supplies, pushing carts, etc as a med student or a resident and I do not see them doing that now (except in emergencies when time is of the essence).

I do think there are things that med students should do more of such as drawing blood, starting IVs, placing Foleys, etc that are traditionally nursing roles. This does not need to be a daily activity, of course. However, I do remember as an intern, being called to start IVs when the ICU nurses with 15+ years of experience could not get access.

You alluded to liability being part of the problem and I certainly agree with this. However, I also think there are other things contributing:

1) Electonic medical records - With paper charts, I think it was much easier for students to write note and put them in the chart. With EMR is depends whether they hospital's system has a mechanism for the student writing a note that the resident or attending can then review.

2) Electronic orders - It was much easier for students to do orders when they could write them and the resident consign them. CPOE has made this much more difficult.

3) Billing - Part of this is efficiency. Med students do reduce efficiency, and attendings are under increasing pressure to produce revenue. Now, I feel quite strongly that if an attending is not willing to sacrifice efficiency for the sake of the student, then s/he should not be in academics.

4) Billing, part 2 - When a student writes a note, only some of it can count toward the billing. The attending needs to repeat a lot of the evaluation and documentation in order to charge for it. If a resident does the note, the attending can just confirm the main points and then bill for the resident's note. Hence, there tends to be more importance planned on the resident note than the student note.

5) Scut work - This is a touchy subject and please don't think I am pointing fingers at anyone on this forum. This is just an observation I have made regarding students I have seen over the years. There is an attitude among some students that scut is a waste of time. However, when asked what they mean by scut, some students will report stuff that I consider to be part of being a doctor - chasing down lab results, following up on consults, calling consults, following up on radiology reports, changing surgical dressings, etc.
 
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I honestly can't believe there are medical students who think that doing the work of transporters and clerks is a vital part of their education. You guys are paying a FORTUNE to learn how to be a doctor by, basically, pretending to be one under a real physician's close supervision. If you're doing something else, a job that a working physician does not do, then your school is failing you. When you're doing a job that even an RN won't do, like faxing papers or walking beds to CT, then your school if failing you profoundly.

Think about what medical school was designed to be. When Osler and his compatriots made this whole thing up in the late 1800s medical school was designed to work exactly like residency does work now. The students did physician work like rounding, procedures, managing deliveries, and everything else a physician could do, all under the watchful eye of senior physicians. They didn't mime it, they didn't watch it, they did the work. The wrote the orders, they did the surgeries, and when they screwed up they did the autopsies. That's how you actually learn medicine in medical school.

After WWII, of course, residencies became a more and more of a requirement to work and medical school degenerated a bit. Now there was a second, higher priority class of trainees in the hospital and the medical students, despite paying slightly more to study medicine, were now supervised primarily not by senior physician educators but instead by brand new physicians who were themselves struggling to learn. Procedures began to go almost exclusively to residents and rounding became the only real place where students still acted like doctors. Still, the expectation was very much that students would at least pretend to be doctors. and as little as 10 years ago no one would describe MS3 as a waste of time.

Then in our generation things really began to collapse. Despite seeing tuition rise to the stratosphere, medical schools rapidly realized that there was a legal risk associated with allowing students to actually do anything. Furthermore, since the students were required to go through medical school to be allowed into a residency, there was no incentive whatsoever to provide any kind of education at all. In fact, they realized that they could save an extra few thousand by understaffing the wards of academic hospitals when it came to basic support staff, like clerks and transporters, because they know trainees will be forced to figure it out. Its like you went into a Michelin three star restaurant, paid $500 for your dinner, and the chef then came out and told you that not only will he not be cooking for you, but he expects you to help wash the dishes. If you protested I bet he'd even call you 'entitled'.

Medical school is turning into a scam. They are taking a fortune from you, for two years, to provide lectures of such low quality that everyone skips them and instead learns from the high quality lectures available online. They charge another fortune in MS3 to have you shadow disgruntled trainees who are not paid even a penny of that tuition and, again, to study materials that you buy yourself, online. In MS4 they charge you a fortune in exchange for nothing at all. Medical schools are changing from valuable educators into a form of regulatory capture: an industry that exists entirely because the law insists that it has to. It is the height of Stockholm syndrome to let someone tell you that this is exactly how medical education is supposed to work.

No one is saying that med students should run around pushing patients from place to place. The original comment was "should I go to ct with my patient?" And the answer is yes, you should. Not every time obviously but at least once to see what it entails, how long it takes, what you need to be prepared. It can something can be a valuable experience and not to be dismissed offhand by a strawman argument. Obviously learning how to be a doctor is what you're there for but the idea is that it's valuable to learn how the hospital runs.

I agree with all of your points. Lazy older physicians are being enabled by midlevels who are doing an increasing amount of the work and are now angling to replace them. Management companies and hospital systems are buying up physician practices and leaving employment as the sole employment opportunity for the new grads. The proliferation of exploitative fellowships, partially driven by the perceived need to separate physician training from midlevel, is pushing medical education back even further so that skills that residents should be practicing are being snatched up by the fellow and the poor medical students don't even get to sniff at these things.

But what can we do? Medicine has been taken over by the administrators and the bureaucrats. You can't wipe your rear within 1000 feet of a patient without having to document it somewhere and a chaperone. Physicians have allowed insurance companies dictate to us how to record medical terminology to receive reimbursement, subsequent encounter. The government is watching expenditures and putting downward pressure on payments with nonsense quality measures. I heard that one of the area hospitals lost tens of millions of dollars this year due to low satisfaction scores (wtf? it's a hospital, not a hotel). All of this pressure and stress rolls down to the medical student with less and less autonomy and clinical duties.

I just read How We Die by Sherwin Nuland and he said that when he was a med student, he cut open someone's chest and started doing cardiac massage. That's unimaginable today. The triumph of the insurance company, hospital administration and government bureaucracy over american medicine is a real shame.
 
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It is true that Osler pioneered bring M3 and M4 students out of the classroom and onto the wards. However, he is also the one who pioneered residency programs.

I have yet to see a hospital that has cut back on ancillary staff (unit clerks, transport people, etc) and expect med students and residents to do it instead. This is outside of NYC, of course, where I hear patient transport at night is a routine responsibility of residents. I don't ever remember faxing paperwork, tubing supplies, pushing carts, etc as a med student or a resident and I do not see them doing that now (except in emergencies when time is of the essence).

I do think there are things that med students should do more of such as drawing blood, starting IVs, placing Foleys, etc that are traditionally nursing roles. This does not need to be a daily activity, of course. However, I do remember as an intern, being called to start IVs when the ICU nurses with 15+ years of experience could not get access.

You alluded to liability being part of the problem and I certainly agree with this. However, I also think there are other things contributing:

1) Electonic medical records - With paper charts, I think it was much easier for students to write note and put them in the chart. With EMR is depends whether they hospital's system has a mechanism for the student writing a note that the resident or attending can then review.

2) Electronic orders - It was much easier for students to do orders when they could write them and the resident consign them. CPOE has made this much more difficult.

3) Billing - Part of this is efficiency. Med students do reduce efficiency, and attendings are under increasing pressure to produce revenue. Now, I feel quite strongly that if an attending is not willing to sacrifice efficiency for the sake of the student, then s/he should not be in academics.

4) Billing, part 2 - When a student writes a note, only some of it can count toward the billing. The attending needs to repeat a lot of the evaluation and documentation in order to charge for it. If a resident does the note, the attending can just confirm the main points and then bill for the resident's note. Hence, there tends to be more importance planned on the resident note than the student note.

5) Scut work - This is a touchy subject and please don't think I am pointing fingers at anyone on this forum. This is just an observation I have made regarding students I have seen over the years. There is an attitude among some students that scut is a waste of time. However, when asked what they mean by scut, some students will report stuff that I consider to be part of being a doctor - chasing down lab results, following up on consults, calling consults, following up on radiology reports, changing surgical dressings, etc.
These are just excuses for why it sucks, not reasons why it doesn't suck.

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I honestly can't believe there are medical students who think that doing the work of transporters and clerks is a vital part of their education. You guys are paying a FORTUNE to learn how to be a doctor by, basically, pretending to be one under a real physician's close supervision. If you're doing something else, a job that a working physician does not do, then your school is failing you. When you're doing a job that even an RN won't do, like faxing papers or walking beds to CT, then your school if failing you profoundly.

Think about what medical school was designed to be. When Osler and his compatriots made this whole thing up in the late 1800s medical school was designed to work exactly like residency does work now. The students did physician work like rounding, procedures, managing deliveries, and everything else a physician could do, all under the watchful eye of senior physicians. They didn't mime it, they didn't watch it, they did the work. The wrote the orders, they did the surgeries, and when they screwed up they did the autopsies. That's how you actually learn medicine in medical school.

After WWII, of course, residencies became a more and more of a requirement to work and medical school degenerated a bit. Now there was a second, higher priority class of trainees in the hospital and the medical students, despite paying slightly more to study medicine, were now supervised primarily not by senior physician educators but instead by brand new physicians who were themselves struggling to learn. Procedures began to go almost exclusively to residents and rounding became the only real place where students still acted like doctors. Still, the expectation was very much that students would at least pretend to be doctors. and as little as 10 years ago no one would describe MS3 as a waste of time.

Then in our generation things really began to collapse. Despite seeing tuition rise to the stratosphere, medical schools rapidly realized that there was a legal risk associated with allowing students to actually do anything. Furthermore, since the students were required to go through medical school to be allowed into a residency, there was no incentive whatsoever to provide any kind of education at all. In fact, they realized that they could save an extra few thousand by understaffing the wards of academic hospitals when it came to basic support staff, like clerks and transporters, because they know trainees will be forced to figure it out. Its like you went into a Michelin three star restaurant, paid $500 for your dinner, and the chef then came out and told you that not only will he not be cooking for you, but he expects you to help wash the dishes. If you protested I bet he'd even call you 'entitled'.

Medical school is turning into a scam. They are taking a fortune from you, for two years, to provide lectures of such low quality that everyone skips them and instead learns from the high quality lectures available online. They charge another fortune in MS3 to have you shadow disgruntled trainees who are not paid even a penny of that tuition and, again, to study materials that you buy yourself, online. In MS4 they charge you a fortune in exchange for nothing at all. Medical schools are changing from valuable educators into a form of regulatory capture: an industry that exists entirely because the law insists that it has to. It is the height of Stockholm syndrome to let someone tell you that this is exactly how medical education is supposed to work.
Yes yes yes

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MS3 here who recently faxed paperwork and it was the highlight of my day. All I got to "do". That was the result of me asking "what can I do to help"? Being proactive and taking initiative has never resulted in learning something like a procedure. It's always something like faxing.

I recently had clinic and the attending was so busy he told me that he wouldn't be able to talk to me and recommended just observing. Eventually he told me to go to lunch and when I asked when he'd like me back he said "It doesn't matter". I returned and saw another patient with him but he seemed irritated and told me to "take a break". I read for an hour then went back to see the last patient with him but he told me to just leave because he "forgot I was there". This is not uncommon and my classmates have reported similar experiences. One friend told me that he is rotating on something fairly specific and the residents said they don't know why the school allows it because there is nothing a med student can do to meaningfully contribute and they will be relegated to shadowing.

Honestly third year has been demoralizing so far. I'm trying as best I can to make the best of it and learn but it's a losing battle.


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It's true that the amount of "real work" in M3/M4 year has gone down as well, both for reasons of billing (medical student notes can no longer just be cosigned and billed as a full physician note) and liability. That said, the exposure is still there and M3 is a valuable experience that is essential in the development of a physician... Its current state is not ideal, but better than a lot of people in this thread are saying.

Tuition inflation being a complete ripoff is a different problem entirely.

I can only speak of my M3 experience at my school (state MD program).

1. Those 2 things you listed (billing changes and liability) have signficantly limited the exposure. At my institution there are entire clerkships where you simply shadow. Do you think that is useful exposure?

2. Because of #1 it makes me very seriously doubt the veracity of your claim that "M3 is a valuable experience that is essential in the development of a physician"

3. Tuition inflation is not a separate problem. It is costing us more and more money to do things any premedical student or even a child could do (shadow) for free.

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MS3 here who recently faxed paperwork and it was the highlight of my day. All I got to "do". That was the result of me asking "what can I do to help"? Being proactive and taking initiative has never resulted in learning something like a procedure. It's always something like faxing.

I recently had clinic and the attending was so busy he told me that he wouldn't be able to talk to me and recommended just observing. Eventually he told me to go to lunch and when I asked when he'd like me back he said "It doesn't matter". I returned and saw another patient with him but he seemed irritated and told me to "take a break". I read for an hour then went back to see the last patient with him but he told me to just leave because he "forgot I was there". This is not uncommon and my classmates have reported similar experiences. One friend told me that he is rotating on something fairly specific and the residents said they don't know why the school allows it because there is nothing a med student can do to meaningfully contribute and they will be relegated to shadowing.

Honestly third year has been demoralizing so far. I'm trying as best I can to make the best of it and learn but it's a losing battle.


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You arent alone, many many rotations at my school are exactly like this

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Changing directions a bit... Im new to third year so I need to vent about this.

I have trouble taking this year seriously when I will be evaluated by attendings who barely interact with me. Its not their fault and I can tell some wish they had more time to teach. I will have had 4 attendings in 4 weeks. If you subtract the occasional clinic day that means each attending will have seen me for a grand total of 4 days. They only round with us so that means each has seen me for about 3h/day and 2 presentations/day for a total of 12 hours and 8 presentations (many of which are truncated or not actually done for the sake of speeding up rounds). They will never have read a note by me since I am supposed to just practice on my own time.

Yet I will be evaluated by these attendings. How can anybody take third year grades seriously? I'd like to think the modern era of attendings are acutely aware of the situation and put less stake in 3rd year grades when selective for residency, but it doesn't seem like that is the case from what I read.
 
These are just excuses for why it sucks, not reasons why it doesn't suck.

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Yes, they are reasons why the value of third year has gone down. I never intended them as "reasons why it doesn't suck."

MS3 here who recently faxed paperwork and it was the highlight of my day. All I got to "do". That was the result of me asking "what can I do to help"? Being proactive and taking initiative has never resulted in learning something like a procedure. It's always something like faxing.

I recently had clinic and the attending was so busy he told me that he wouldn't be able to talk to me and recommended just observing. Eventually he told me to go to lunch and when I asked when he'd like me back he said "It doesn't matter". I returned and saw another patient with him but he seemed irritated and told me to "take a break". I read for an hour then went back to see the last patient with him but he told me to just leave because he "forgot I was there". This is not uncommon and my classmates have reported similar experiences. One friend told me that he is rotating on something fairly specific and the residents said they don't know why the school allows it because there is nothing a med student can do to meaningfully contribute and they will be relegated to shadowing.

Honestly third year has been demoralizing so far. I'm trying as best I can to make the best of it and learn but it's a losing battle.


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These are exactly the types of attendings who should not be in academic practice. Unfortunately, if the school is not going to take evaluations from students seriously, I see no way of getting them out of academic practice. Part of the problem is the attitude of the individual physician - if they cannot or are not willing to teach you, they should not be med school faculty.

The other problem is reimbursement structure - the money comes of clinical care, and this is how the clinical faculty are paid. If the medical school wants the clinical faculty to pay more attention to teaching, one way is to financially incentivize it.

Changing directions a bit... Im new to third year so I need to vent about this.

I have trouble taking this year seriously when I will be evaluated by attendings who barely interact with me. Its not their fault and I can tell some wish they had more time to teach. I will have had 4 attendings in 4 weeks. If you subtract the occasional clinic day that means each attending will have seen me for a grand total of 4 days. They only round with us so that means each has seen me for about 3h/day and 2 presentations/day for a total of 12 hours and 8 presentations (many of which are truncated or not actually done for the sake of speeding up rounds). They will never have read a note by me since I am supposed to just practice on my own time.

Yet I will be evaluated by these attendings. How can anybody take third year grades seriously? I'd like to think the modern era of attendings are acutely aware of the situation and put less stake in 3rd year grades when selective for residency, but it doesn't seem like that is the case from what I read.

Do you spend more time with the residents? Is it one resident team for four weeks? Often times the faculty will solicit opinions from the residents when writing the evaluations. Also, you are right that third year grades mean less and less. Fourth year sub-I grades are more important, but letters of recommendation are more important than either of them.
 
Yes, they are reasons why the value of third year has gone down. I never intended them as "reasons why it doesn't suck."



These are exactly the types of attendings who should not be in academic practice. Unfortunately, if the school is not going to take evaluations from students seriously, I see no way of getting them out of academic practice. Part of the problem is the attitude of the individual physician - if they cannot or are not willing to teach you, they should not be med school faculty.

The other problem is reimbursement structure - the money comes of clinical care, and this is how the clinical faculty are paid. If the medical school wants the clinical faculty to pay more attention to teaching, one way is to financially incentivize it.



Do you spend more time with the residents? Is it one resident team for four weeks? Often times the faculty will solicit opinions from the residents when writing the evaluations. Also, you are right that third year grades mean less and less. Fourth year sub-I grades are more important, but letters of recommendation are more important than either of them.

The residents are around longer so I do spend more time with them. I've developed a great working/teaching relationship with one I work directly under so its great to hear that they may communicate that to the attendings. I wasn't sure to what extent that might occur if at all.




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Oh, lovely. I just found out that shelves are pass/fail in third year and our letter grades are entirely subjective based on our evals. This can't possibly go bad in any way whatsoever. On the upside, I can chill for the shelves I guess...
 
MS3 here who recently faxed paperwork and it was the highlight of my day. All I got to "do". That was the result of me asking "what can I do to help"? Being proactive and taking initiative has never resulted in learning something like a procedure. It's always something like faxing.

I recently had clinic and the attending was so busy he told me that he wouldn't be able to talk to me and recommended just observing. Eventually he told me to go to lunch and when I asked when he'd like me back he said "It doesn't matter". I returned and saw another patient with him but he seemed irritated and told me to "take a break". I read for an hour then went back to see the last patient with him but he told me to just leave because he "forgot I was there". This is not uncommon and my classmates have reported similar experiences. One friend told me that he is rotating on something fairly specific and the residents said they don't know why the school allows it because there is nothing a med student can do to meaningfully contribute and they will be relegated to shadowing.

Honestly third year has been demoralizing so far. I'm trying as best I can to make the best of it and learn but it's a losing battle.


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See things like this infuriate me. If you don't want a student, don't take one. If you do, you're expected to actually teach.
 
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I wonder how much the school can pressure clinical faculty to participate.


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They can pressure them, but it takes the will to do it. Several ways are:
1) Fire them (an extreme response).
2) Assign them to a non-teaching service. Some hospitals have teaching and non-teaching services.
3) Financially incentivize them to teach by rewarding teaching and scholarship not just clinical productivity.
4) Deny them academic promotion (not all faculty will care about this).
 
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Oh, lovely. I just found out that shelves are pass/fail in third year and our letter grades are entirely subjective based on our evals. This can't possibly go bad in any way whatsoever. On the upside, I can chill for the shelves I guess...

That really sucks, better hope you get lucky with your attendings
 
See things like this infuriate me. If you don't want a student, don't take one. If you do, you're expected to actually teach.
So the problem at some schools is the local physicians volunteer one year to teach for a brief period of time. Then the corrupt school which is basically going broke increasingly abuses their good nature by never giving them a break. The school pressures them to continue taking students by crying that they "dont have anyone else." So the physicians begrudingly accept students, thinking that there would be no one else if not for them. And that a worthless rotation is better than none at all.
Its corrupt government schools taking increasing tuition dollars and abusing the good nature of burnt out volunteers.

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So the problem at some schools is the local physicians volunteer one year to teach for a brief period of time. Then the corrupt school which is basically going broke increasingly abuses their good nature by never giving them a break. The school pressures them to continue taking students by crying that they "dont have anyone else." So the physicians begrudingly accept students, thinking that there would be no one else if not for them. And that a worthless rotation is better than none at all.
Its corrupt government schools taking increasing tuition dollars and abusing the good nature of burnt out volunteers.

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I'll keep this in mind if the local DO school that I applied to take students from pressures me to take too many or anything else like that.
 
You arent alone, many many rotations at my school are exactly like this

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That sucks. I have had isolated days of shadowing that were a waste, but never entire rotations. That would be ****ing obscene
 
1) Electonic medical records - With paper charts, I think it was much easier for students to write note and put them in the chart. With EMR is depends whether they hospital's system has a mechanism for the student writing a note that the resident or attending can then review.

2) Electronic orders - It was much easier for students to do orders when they could write them and the resident consign them. CPOE has made this much more difficult.

3) Billing - Part of this is efficiency. Med students do reduce efficiency, and attendings are under increasing pressure to produce revenue. Now, I feel quite strongly that if an attending is not willing to sacrifice efficiency for the sake of the student, then s/he should not be in academics.

4) Billing, part 2 - When a student writes a note, only some of it can count toward the billing. The attending needs to repeat a lot of the evaluation and documentation in order to charge for it. If a resident does the note, the attending can just confirm the main points and then bill for the resident's note. Hence, there tends to be more importance planned on the resident note than the student note.
.

I don't disagree with any of this, and I understand its not entirely medical schools' fault that things are how they are. It doesn't change the question, though: is there really a role for medical school clinicals in a world where its becoming legally impossible for medical students to really have clinicals? Is it ethical for schools to charge so much when they offer so little?
 
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