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Eh, it is what it is and the end result (step 1) turned out well. I enjoyed M2 year for the most part, was just much busier than M1.
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who has 4 legs?
I know this is an allopathic thread, but third year of podiatry sucks. Clinic Monday-Wednesday-Friday, class Tuesday-Thursday. Why am I still in lectures?!?!?!?!
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We get lectures not sure why you're complaining
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Right? Go back to your forum! lol
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deleted564496
Four weeks in... biggest thing I hate.. Sitting around in the afternoons literally not doing a ******* thing, just wasting space, listening to nurses blab and kids cry while trying to study. JUST SEND ME HOME INTERNS!!!!!
Guess I better get used to it.
Guess I better get used to it.
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Bumping this thread for a big shoutout to attendings and residents who give verbal feedback like "you're one of the strongest students I've worked with" and then proceed to not submit actual evals, while ****ty attendings who don't give a **** about students are always sure to get in evals ASAP.
I have one senior resident who just told me for the second time today that I'm the smartest med student he's met. Both times were sort of public/in front of people (not patients—interns and other med students) though so I've had trouble discerning whether he's being genuine or busting my chops. Either way I do believe he likes me.
I have no idea whether he's turned in any of my evaluations, but I can say that when I had to do a mid-rotation performance review with my preceptor I had to pressure residents to submit them because at the time only one person had submitted anything.
I think residents are just understandably terrible at prioritizing med student paperwork crap and it sucks because I already feel ****ty loading them up with more paperwork but on top of that I have to gently nudge them to actually go through with filling it out and handing it in.
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Better than 8.5 hours of rounds on 14 patients.
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Yeah, man, the sitting around kinda sucks but it could be worse. Most of it, for me, is just spent joking and bitching with the residents about unnecessary admissions and patients who legitimately appear to have just made **** up overnight.
Not super productive, but not a bad time at work all things considered.
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No literally, sitting around doing anything is better than rounds for that long on that few patients. I wish I was exaggerating. My mind was so fatigued afterwards that I couldn't decide which door to take out of the hospital to my car. I'm sure this is the first of many similar days for the next 40-50 years, but the first was rough lol
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If your patient is getting studies done them go follow them. If you got a ct go talk to the radiologist. Etc
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Yeah, I don't understand how that took so long. My day is not like that.
Yesterday I got in at 7, and we had run the census and rounded on patients by like 10. Then I saw a few patients, got some woman a blanket, and proceeded to spend hours looking up pedantic stuff on AAFP and trying to read some case files while the intern and resident charted. Boring as hell and of course just after I'm dismissed and I'm in the elevator a code blue gets called to an area of the hospital I (a) don't know how to get to (b) don't know if I have access to and (c) don't know if my team responds to. I just try to stay out of the way and figure out what I'm supposed to do when I see my resident go flying past so quick that I lost track of him. Oh well. There's always next time.
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People say this, and it sounds good in theory, but really how would this work? Do you give all the nurses for all your patients your cell number, and expect them to remember to give you a buzz? Do you just camp outside the patient's room for the 4 hour block when they might be going down to radiology or the endo suite? I only ask because it's nearly impossible now, as an intern, to know exactly when a patient is having something done, and we're the first-line call/page from the nurses. As a med student, we were always the last one to find anything out.
Also, the time to talk to the radiologist is with your team after a final read which shows something discussion-worthy, or if you're sending a patient for a truly emergent study. Not that they mind the visitors, rather because you have no idea when a study will actually get read (even if you've staked out the pt's room, followed them to CT, talked to the techs, etc).
Again, I'm not saying a med student *shouldn't* do these things (and yes, I spent countless afternoons praying for the residents to pull their heads up from the EMR and remember to send me home), but easier said than done.
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I get it. I'm still a student. But there's nothing stopping you from going to the radiologist after the final read is done. I don't know how to follow your patient. Get buddy buddy with their nurse? Camp out? I don't know but if you're sitting there in the team room then you should try to find something to do. Learning how the hospital works is just as important as learning about how to read an abg imo
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1. When the senior wants to pre-round and you end up pre-rounding on everyone's patients then immediately round on all the same patients with the attending. As opposed to pre-rounding alone on your own patients then rounding with the attending. Literally spent 8 hours seeing the same 10 patients (twice) the other day.
2. Not being able to put in orders.
3. Running a plan by the senior, being told "no, let's do this instead", presenting the "do this instead" plan to the attending, being told "no" by the attending, then listening to the senior suggest and take credit for my original plan.
4. Finishing notes on your patients only to find out your senior won't let you leave until her notes are done too.
One time a senior (not my senior) gave me a hard time about not leaving even after they told me "you can go home". Idk what the protocol usually is, but if it's not my senior or intern telling me to go home, then I'm not going home.
2. Not being able to put in orders.
3. Running a plan by the senior, being told "no, let's do this instead", presenting the "do this instead" plan to the attending, being told "no" by the attending, then listening to the senior suggest and take credit for my original plan.
4. Finishing notes on your patients only to find out your senior won't let you leave until her notes are done too.
One time a senior (not my senior) gave me a hard time about not leaving even after they told me "you can go home". Idk what the protocol usually is, but if it's not my senior or intern telling me to go home, then I'm not going home.
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It will never end...............
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lmao i thought the gunners come out of the woodworks in the winter months
yeah you gotta do what your team tells you to do, not a random unless they're cross covering for your team
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If it makes you feel better the patient was probably a) dead or b) fine and it would have just been a lot of c) noisy people not doing anything productive.
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Depends on how much time you're going to spend in the hospital. As a resident, I need to know how my hospital works. I didn't need this information as a student.
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So you're supposed to figure it out as a busy intern carrying 10 patients that you're writing notes on while getting 100 inane pages from nurses about stupid things instead of when you're a student with all the time in the world crying about how your intern isn't sending you home?
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I've taken some extra time to learn how the hospital I'm currently at works and it has come in handy when the intern/senior needed something done. Pt care aside aside, if I can help my team get stuff done faster that hopefully means I get to go home earlier and I maybe get a better eval.
We have 3 major rotation sites and some of the PGY-3 medicine residents haven't done x-service at x-site so even they don't know how things work everywhere.
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Asked about it the next day. Patient was dead. The resident totally understood my confusion because he just laughed and was like "yeah, even I didn't know where that was. I don't really think anybody did. This happens every time a code gets called to somewhere that's not an actual room—everbody just starts running around trying to figure out where the **** it is."
I felt a little ****ty about it at first, but it's definitely true that they had plenty of people to run the code long before I could have even gotten there.
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maybe, but few people will ever be in a position where knowing how their hospital for M3 works will carry over to intern year. And I really don't think I'd ever go get a prelim read unless it was extremely time sensitive and if that were the case, people more important than me will be handling the case. Most of the time, these scans are CYA medicine or fishing expeditions.
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I thought I'd be able to do things in third year if I took initiative, but whenever I try the residents say "Dont do that" or "Cant do that." I'd love to do something. Anything. The most exciting day I had was when I faxed something for a resident. Im not mad at residents or attendings. The insane charting and busywork they have to do is mind boggling and they just don't have time to make sure I have a good "educational experience". They also don't know what I can do safely or competently. I get it. I wouldn't want to balance a resident's workload and worry about making sure the mystery med student of the month gets a slice of the action.
It seems like the trend over time has been for less hands on MS3 education. 10 years from now it'll probably look completely like shadowing (already does honestly).
It seems like the trend over time has been for less hands on MS3 education. 10 years from now it'll probably look completely like shadowing (already does honestly).
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The gradual dumbing down of the M3 and M4 year, not letting students do anything is a problem that is just brushed aside with, "dont worry, youll learn as a resident." AKA 3rd year is a waste of time and money and if it was eliminated, and you moved right onto to internship after M2, I bet you patient outcomes would be the same in most cases. Thats essentially PA school anyway btw.
Med schools do not care if you pay thousands just to shadow. The LCME does not care if you just shadow all day. The AAMC doesnt care if you never do an H and P the entire time you are in med school. Shadowing is a very valuable experience (for them, not for you). Why? Because the school doesnt have to pay your preceptors for anything since having you shadow involves no work whatsoever.
But hey you can always write a fake note on any patient you watch the attending see and then compare it to his note later on. That is a very valuable experience, self grading yourself. I mean it must be valuable since the school admins and hospital admins told me it is. Of course it also has the added benefit of not giving anyone but yourself (the consumer) more work.
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da8s0859q
Outcomes wouldn't be the same. There is an appreciable difference between most M3s I've met anywhere and most PGY1s I've met anywhere. I didn't like M3 either, but it served its purpose.
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If it has a purpose i would love to know what it is... please dont hold back on me
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When I finished third year, I went right into my M4 IM subi. That month, I worked with a couple third year medical students, a couple of brand new interns, a senior resident, and an attending.
As an M4, I was stunned, absolutely stunned at how much more functional in a hospital environment I was than the M3s. These were smart people, probably with better preclinical grades than I, but at the beginning of third year they knew practically nothing about the day to day tasks expected of a physician. For you to say that M3 year makes no difference just baffles me, and tells me you've had minimal exposure to a student at the beginning of the year compared to one at the end. It's an easy pattern to pick up on as a resident as well, and I've seen it four times over now (that M4 year and my 3 years of residency). M3 year, as ****ty of an experience as it is to go through, is part of what makes the huge gap between the experiences of an actual physician and a PA. Residency is more important of course, but you wouldn't be near as prepared for residency without having that variety of exposures first.
On the other hand, my skills that July were fairly equal to the beginning interns. And they only got worse in the 11 months after that subi when I was doing BS rotations/vacation/interviews before I was a beginning intern myself. M4 is the useless year, though it definitely does a heck of a lot for mental health (and you need time to interview anyway).
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I certainly can't speak for every medical school or rotation, but from my perspective...
The purpose of MS3 is get your feet wet in the clinical environment. For most students, they have zero appreciation (even after their "clinical" ECs as a pre-med) for what a hospital rounding service looks like, how a surgeon's practice works, or how an outpatient FM doc does their job. Most only have the vaguest of notions of what a RN, NP, PA, MA, OT, PT, unit secretary, or PharmD do, never mind the individual physician services. I think that a lot of people (Physicians and other groups) under appreciate how long it takes to actually be comfortable in a completely new environment. It is one thing to enter a new environment and learn how to do one specific workflow and learn it well. It is another to need to be able to work in that environment and solve problems as they arise.
MS3 is also the time to start laying the framework for the development of more advanced skills. Every single MS3 should be learning medical communication and documentation. Being able to take a good H&P is a skill and it takes time to develop. Being able to round efficiently and effectively on a large and busy service is a skill and it takes time to develop. That starts as an MS3. Now, if you lack mentors in the form of MS4s, residents and attendings to coach you on how to do those things as an MS3, THAT is a huge problem. If you don't have someone critiquing your communication skills as an MS3, your school is shafting you. It doesn't have to be something formal, but you have to figure out what you are doing right and wrong and MS3 is the best time to get started on it. If you are an MS3 and you are a errand boy, there is something wrong. My expectation of all MS3s on our service is to have a full assessment of the patient. For all MS4s, they have to have a plan. Now, I don't care if it is completely wrong. But, by forcing them to develop those things, it gives me an opportunity to teach them specifically where they went wrong, rather than giving general feedback.
MS3s should also be learning basic procedural skills, suturing, knot tying, lines, etc. I have a big long post elsewhere specifically about this. I had an MS3 with me this weekend who did an entire femoral central line by herself. I was scrubbed in and assisting every step and it was a patient setup for success (intubated, sedated, large vessels, etc), but my comfort with her doing as much as she did was predicated on 2 months worth of basic skill derivation as an MS3 in the ICU and then on the vascular service. I was working with ~30 MS4s at a workshop not too long ago and asked how many had placed a central line as a student, all but 2 said they had. Granted, these are all MS4s going into surgery, so they likely sought those opportunities out, but they also came from 25+ different schools, so clearly those opportunities do exist.
MS4 is a problem because the expectations are so low and there are very few formal rewards after you have already started interviewing. Personally, I did a full ultrasound month where I did the vascular lab studies with the techs and then read the exams with the physicians. I did Cardiology, Nephrology and Neurology in the spring of my MS4, knowing that I was going into vascular surgery. I worked pretty damn hard on those rotations, but they probably helped me take care of patients as much or more than many of my surgical rotations.
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deleted307836
My impression is that the clinical education experience really varies a lot by school/hospital. Can anyone affirm the generalization that the more a hospital is in competition with other hospitals in an area, the more that the M3/M4 experience is likely to be more like shadowing? E.g., a hospital in Omaha vs NYP.
I don't know why that would be the case, just prima facie.
I would think it would depend more on how resident ran your hospital is. Some community sites without a lot of residency programs seemed like they had no idea what to do with students and some were the best one-on-one with a resident/attending learning I've ever had. Some academic medical centers resident-ran will have better didactics and the whole team knows how to integrate medical students very well, and at others the students seem to be pushed to the side to shadow.
I'm not sure what are the factors that control this, I do this
and call it "culture"seems the only way to find out is to talk to people (who have little basis for comparing the culture of their medical school to others) or just get a feel for it on interview day
couple this with the fact that how "shadowy" to involved the experience can be can be due to the student themself, or just attending or service dependent in that hospital.
come up with other ways to make a good list of schools that's broad, then try to talk to alumni or SDN about their experiences
Residents are the best to ask to see if they felt like their med school prepared them via MS3/4.
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Lol what a waste of time. Should I follow them to the bathroom too?
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how else are you going to catch that hematuria. the more proactive a 3rd year is, the more things they will learn. kinda like that karate kid movie. you won't know that you are learning stuff, but there will be a big difference in clinical skills between MS 3, and 4.
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Yeah it's such a waste of time to know how the hospital works so that you have an idea what the problem is when something is held up instead of being all hurr durr where is da troponin or when your patient can't get an mri because they can't lay back and stay still for long enough.
And yes I have gone to the bathroom with a patient to get a urine sample. Even hand delivered it to the lab. EM docs can tell you that getting the urine sample holds things up all the time which you would know if you weren't sitting there playing on your phone all day wondering why no one will teach you.
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I'm sure there are plenty of random factoids I could learn from the thousands of possible low yield actions I could make at any point in my life. Doesn't mean that they aren't wastes of time.
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As it will directly impact future employment, I'd say by definition it isn't a waste of time.
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You have such a pre clinical outlook. Low yield? Lmao dude. You're done with step 1. The more things you know about how the hospital works outside of your little review books and question banks, the better you will be as a doctor. You'll never know when knowing a fact will save your patients life. Sorry that life won't throw turners syndrome at you as much as uworld will.
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deleted245139
Waste of time?
I don't consider learning the ins and outs of patient care a waste of time. Its handy to know what size IV and location You need for different studies. Contrast timing differences between CT PE and CT aortogram for R/O dissection. Seeing someone get a Cath. Seeing an LP under floro. Don't let your nievity hamper your education. Experience as much of this as you can, while you can. Ask questions. Come prepared. Volunteer for stuff. Put yourself,out there. You'll be a better doctor for it
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Hey man you're free to go to the CT or sweep the hospital floors all you want, but the chances of learning anything from that are exceedingly low and it won't benefit anyone else. That fits my definition of a waste of time, don't care if that is a "preclinical" outlook
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Yes I learn that random list of things by wheeling patients to the CT scanner, thank you for enlightening me despite all my naivety
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deleted245139
Just do yourself a favor and drop this attitude by residency. It will save you, your coresidents, and your PD a lot of headaches.
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How many patients do you wheel to CT each day? Gtfo
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Weird, I don't think I've ever seen a resident wheeling someone to CT. Gtfo
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deleted245139
Lol no worries my man, I won't be seeing you in residency so no skin off my back. You seem to have it all locked up.
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GTFO, seriously?
As an attending, I don't do it much (though not zero). As a medical student, every patient on surgery that got a CT had company. My hospital didn't have radiology residents so the radiologists loved the chance to teach. Now I'm not saying I can read CTs all that well, but there are certain tricks I picked up from them that have saved me significant time not having to wait for the full official read.
But hey, what do I know about medical education? I've only done it successfully while you're still pre-clinical so obviously you know what's of value in the clinical realm while I have no clue.
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Thank god you won't be in my residency. It's always the people that know the least that talk the most crap. You need to fix your attitude before everyone hates you
Btw wheeling a patient to ct has led to me learning more about stroke imaging from a stroke neurologist than any time I've spent in lecture. You keep choosing important experiences that you've obviously missed out on and displaying your ignorance through them
