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Things you wish your residents would consider.

Discussion in 'Clinical Rotations' started by gabbyj, Jul 22, 2011.

  1. gabbyj

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    One of the things I wish my residents would just understand.

    I pay $45,000 dollars a year to go to school, you earn $45,000 on a resident's salary. While you may think you're being underpaid, and you are, we are making 90,000 less than you (based on very rudimentary math). Students aren't here to simply make your job easier by doing all the scut work, we are here trying to learn as much as we can. You get paid a lot of money compared to me to do it.

    What are some of the things you wish your resident would know?
     
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  3. ShyRem

    ShyRem I need more coffee.
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    We do know that. Remember, we've been there. There are methods to the madness that you perceive. Granted, there are definitely some residents who abuse their students. I think that is abominable. But there are definitely things that are necessary good teaching steps that many students view as "beneath" them or "scut work" that in actuality are valuable steps to get where you should be. And of course, there is the old (and true in some cases) do this scut for me and I'll make sure you get to do something cool "tit for tat" kind of play. This continues even through residency.

    More than once I've had students gripe about doing what they considered "scut work" who later thanked me when they realized *why* I wanted them to do the "scut".
     
  4. Perrotfish

    Perrotfish Has an MD in Horribleness
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    I think that physicians who have gotten through the madness tend to attribute more method to it than might be objectively reasonable.
     
    #3 Perrotfish, Jul 23, 2011
    Last edited: Jul 23, 2011
  5. braluk

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    One thing back when I was a medical student that I wish my resident would consider is that pimping a student in front of a group of people is not a helpful way to teach unless followed up with good teaching points.

    Anyhow, beware TL;DR post coming up!

    There's reasonable scutwork and there's borderline abusive scutwork- granted I'm in a surgical residency so things may be different but I imagine it to be similar across the board. The way I saw clerkships was that nobody liked to stay in the hospital late and that I am now part of that team. This meant everyone needed to be doing something- if you're done, then see who needs help - this goes for medical students and residents alike. As a MS3/MS4 I couldn't write orders, dictate cases, consent for procedures, respond to pages, discharging patients, and well...generally not a whole lot of the important stuff that generally determines if you're going home before the moon rises. I never thought of scutwork as the side effect of a lazy or overworked resident, but because it was stuff that I could do to help us get out early so I can go home to study. I had residents who would finish their work before me, find me and thank me, and send me home earlier than the rest so I could go study. As a MS3, I felt compelled to work so that I could go home and learn.

    So I gladly do it (making phone calls, updating the list, etc..) so that residents can get their stuff done so that the attendings can leave without worrying, which also means that I can leave earlier as well. Granted, even if I went to a school that prohibited me from doing any form of scutwork, I'd feel uneasy being the first to leave with so much left to do on the floors. Of course, I'm not here to only be an extra hand. In return for doing secretarial scut work, I expect to learn, and I expect that my residents, being in a teaching institution, also hold up their end of the bargain and teach me something relevant to either my upcoming exam, or something of relevant to patient care (How to run a code, clinical signs of certain diseases, etc..). . I also expected to be considered part of the team- and not as an errand boy. And at the very least, that they still remember that I am still a student who needs time to study in order to pass. I've definitely had residents hand off meaningless work (like gathering data for his research project) to me so they could go home earlier, and it sucks. I have no problem with scut work being done during the day, but unless the student is on call, or doing something clinically/educationally significant pertinent to patient care, I think its borderline abusive to consistently keep students (particularly students who have to take shelf exams) unreasonably late everyday unless it has education value or it enhances their knowledge of their patient for the AM.

    Things I expect the medical students to do that I had to do that I consider reasonable "scut"- 1) Put notes and orders in the charts of all the floor patients in the AM. Someone's unfortunately gotta do it, sometimes it gets done during rounds, alot of the time it's not- I did it cause residents had AM pre-op, or they had to start seeing consults or start running clinic- and if not started early, it would mean staying late. 2) Update the lists- medications, to do, plan, assessment. Pay attention during rounds, take good notes, anticipate what we will need for each patient and have it on you (i.e. dressings, reflex hammer) 3) Chase down incomplete AM Vitals, I/O's, overnight events (at the very least on your own patients and maybe on a few others that haven't been obtained yet) 4) If any floor duties have not been completed yet because of clinic or something else, you may be asked to do it, it may be patient care related or paperwork for transport, but generally will be an important task so the day can continue. 5) Work the phones to chase down consults, stat labs, and to make sure things are on schedule. 6) Get a good history/physical on new patients, have it ready to go into the chart and come up with a plan and what workup you want ordered and what he will need based on your plan (consent, type and screen, etc...)

    Those are the things I did as a MS4, and I found it reasonable. While it certainly may not be very helpful for written exams, it does help you become more organized, more efficient, and if you were paying attention on rounds and while updating the list, your clinical acumen will sharpen and you can become a very helpful component of the team. When I have students who catch the hang of it early on, I let them go early. I would never ask students to do things they are uncomfortable with, or to do something that has little relevance to patient care (i.e. food run, or something that I can do myself as long as I got the important stuff taken care of). I also never have medical students stay later than me and service permitting, come way earlier than me.

    I know this was a long post, I finally have a day off and since "scutwork" is something Ive seen everyday, I went a tad bit overboard, but to me, the short and sweet point is that scutwork happens, it is necessary, and it often rolls downhill to the bottom to be done- residency is a hierarchy after all. It has to be done without hesitation or complaints. Being knowledgeable about scutwork has its merits if you can believe it- these can often involve adjunct, extended care, or other disposition work that can be really valuable to making the team run efficiently. But, if no one is stepping in to help when they can, or if its clear that you're being treated like a worker instead of a student, it is a problem.
     
  6. OveractiveBrain

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    This is part of a much bigger talk I give on the first day of a new rotation, but I think it would help make a lot of sense. It echoes the post just above this one. Surprisingly, I find one of my posts being MORE concise than another in a thread (first time for everything I suppose).

    1. The top priority is patient care. Everything we do we do for the patients' sake. I will never ask you to get me coffee or fetch my coat. What SEEMS like scutwork is actually important, required documentation for the continuation of patient care.

    2. We play as a team. You need time to study for your shelf, I've got patients that need tending to. You want to learn, I'll teach you. You want to be involved in patient care and clinical decision making; I'll give you the responsibility.

    3. Given 1 and 2, there is one problem. Medical Students have less knowledge, and worse, in the eyes of the law, FAR less legal responsibility. So, you do the work you CAN do so I can do the work I MUST do.

    The promise I make to my students is this: Everybody has to do the work that no one wants to do. The sooner we get it done, the more time we can spend learning stuff, doing the fun stuff, or even just flat out go home.
     
  7. OveractiveBrain

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    As an aside, don't bring up money. Its trivial, and you won't win any arguements. Every resident went through medical school. And look, you might even be right. You might deserve more education for your money. But the privileged, entitled sentiment is what is flooding our educational system, and weakening it. As soon as you bring it up, people's alarm starts buzzing and it is going to significantly impact your reputation (which is valuable).
     
  8. Sheldor

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    How in the world is it entitled to expect to learn while paying 45k tuition to be in school?
     
  9. tkim

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    Why in the world should you expect to be taught by people who are not paid your tuition dollars to teach?

    I know it's been done this way for as long as people can remember, but shouldn't you be taking this up with the school who collects that tuition money and does ... nothing.
     
  10. Perrotfish

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    Yeah, I would really love to see the budget for medical schools. All the teaching is done by physicians who more than bring in their own salaries just though patient care and residents who have that AND Medicaid funding. So where does the money go?
     
  11. colbgw02

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    Was thinking the same thing...

    Residents earn every penny of their $14-$20 per hour wages even in the absence of a single second of teaching. The attendings are the ones getting paid your tuition. Plus, they're the ones who had the choice to take a job in academia or not. On the other hand, residency is virtually obligatory irrespective of one's interest in teaching.

    I like this idea, actually. How about you take this up with your attending the next time you feel like you're getting scutted out, then come back and report to us on how it went.
     
  12. gabbyj

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    Thanks for all the input, but I wasn't really specific. The kind of scut work im referring to is getting the numbers at 3:45 in the morning on a 20 patient list so the intern can wake up later and come in at 5.

    Another example is a senior resident asking me to come in on my day off to help with the numbers and writing notes or expect a bad evaluation.

    And the last example is writing progress notes on patients you didn't even see in the morning because you were in class all day.

    I'm not sure where those fall into enhancing my education.
     
  13. Sheldor

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    Who cares where there salary dollars come from? Isn't it in their job description/contract to teach? If it isn't then sure, they shouldn't be but I believe that all residents are paid by the institution and expected to teach.
     
  14. dilated

    dilated Fought Law; Law Won
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    No, it's not in our contract to teach (resident salaries are paid by Medicare, not by the institution). When we sit there and let you practice suturing in the OR for a half hour that I could be going home, it's purely optional - and generally done for the students who've earned it by helping the surgical team out. You'll probably find that the fact that you give your school tons of money to pay for PhDs and standardized patients does not really get you a lot of entitlement in the hospital.
     
  15. Sheldor

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    Then I stand corrected, if it's not part of your job description then you guys shouldn't teach us. However, I doubt it's in the job description to give all the crap work you (not you personally, but residents in general) don't want to do to med students.
     
  16. dantt

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    None of the things I've seen compare to the scut some of the students here have to put up with. Many of them are expected to go pick up food for residents 10 miles away and are actually chewed out for failing to do so. What a ****ty environment to learn in...
     
  17. Jolie South

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    I personally think that anything residents are required to do to take care of patients should be fair game for students to do as well. I feel like the job of a student is to learn to be a resident. Furthermore, the more you help the team, the more time there is for teaching.
     
  18. Sheldor

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    I was under the impression that it was part of the job description for residents to teach medical students. A previous poster said at his program it is not part of their job description. However, if you google "medical resident job description" you get multiple links to universities job descriptions for their residents. Many are similar to this:

    http://www.uph.org/gme/Home/Policies/ResidentJobDescription/tabid/562/Default.aspx

    "Participate fully in the educational and scholarly activities of the program and, as required, assume responsibility for teaching and supervising other residents and students."

    I personally think that residents should teach students, but I agree with the OP that students are students, not employees. They are there to learn. I know that many times you learn by doing things that may seem "pointless" etc. However, getting residents food, doing non-educational busy work, etc aren't conducive to that learning.
     
  19. tkim

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    Then your pointing to the tuition you pay your school with the expectation that residents and attendings teach is a major disconnect.

    Point to the contractual obligations of the institution to teach med students, but don't piss and moan about the tuition dollars you pay for clinical education - it's not going to the residents and attendings.

    It's a fricken scam how med schools charge tuition for the clinical years and do nothing but schedule students for rotations. I paid for it, so does everyone else who's gone through med school, but it doesn't make it right, nor will it help you if mention it in self-righteous and entitled tones.

    If you're in your clinical years now, ghod help you if you let slip your true feelings to the wrong people.
     
  20. Sheldor

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    Still nobody has explained how its "entitled" to expect an education while in school paying tuition? I'm not sure the argument that the tuition money "doesn't go directly to the the residents" makes any sense. The money goes to the institution that employs them, so whats the difference?

    Don't get me wrong, I agree with everything you've said, except that I still don't believe that it rings of entitlement to request an education from school.
     
  21. tkim

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    Your tuition money does not go to the hospital, unless there's some agreement between the two. Your tuition money stays with the school. The government pays resident salaries and training costs. So, complaining about paying tuition and expecting residents who do not get paid from that tuition is major disconnect.
     
  22. ZagDoc

    ZagDoc Ears, Noses, and Throats
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    Don't underestimate this as just scut... it's also a skill. When I was an early MS3, it used to take me over an hour some mornings to collect vitals and labs for a 20 patient census. Now I can do it in 20 minutes. I didn't get that way overnight. Learning what vitals are important for specific patients and their conditions or surgeries isn't something that happens the day you graduate medical school - and the expectation is that you ALREADY possess some form of efficiency when you graduate medical school. If you're taking forever to collect data in the mornings as an intern and you're over hours as a result because you're coming in 90-120 minutes before rounds... well, the PD isn't going to be telling the team to round later. They are going to be telling YOU to become more efficient.

    And I guarantee you the intern is also looking at those numbers his or herself.

    Coming in on the weekend to help round... well, if they aren't giving you any days off on the weekends, thats just abuse of power. But the expectation as a medical student during your clinical years isn't just that you are a fly on the wall to watch us work... you are expected to be a part of the team. Being part of the team also means helping the team. I don't think its unreasonable to ask the student to come in one morning on the weekend to help a short-staffed team round.

    Really agree with braluk's post earlier.
     
  23. Jolie South

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    You get an education by doing. There's only so much people can tell you and then they just need to throw you out there and have you try. Then you get feedback about how to improve. That's what clinical education is.

    Like it or not, doing tasks like getting vitals, checking labs, following up on consults is necessary to taking care of your patients. You don't just write an initial H&P on a patient and walk away. If you actually think about why you're doing something and what you're hoping find, you might actually learn something from a "mindless" task.

    Spoon feeding and lecture type didactics don't really, IMO, teach you how to be a doctor. People can give you guidance, but the clinical years is about learning how to think for yourself and approach problems on your own. I tend to trust that my residents know more about medical education than I do and just go with it.
     
    #22 Jolie South, Jul 24, 2011
    Last edited: Jul 24, 2011
  24. SouthernSurgeon

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    Agree with all of this. It drives me crazy when students label things like prerounding and note writing as "scut" - because all of a sudden when you are an intern that "scut" becomes your "job" - and most of us residents have seen the interns who are inefficient at prerounding and can't write a quick/coherent progress note. Believe it or not it does take some practice and experience to get efficient.

    And just a word of caution to the OP - whining about getting in earlier than the intern is not going to win you any sympathy. I promise you that they are working harder and more hours than you, double-checking everything you do or say, and taking a larger burden of responsibility. I can afford to get in at 5 instead of 3:45 because I can do everything you do (and more) in 1/4 the time, and because I spent every 3rd or 4th night in the hospital...so by the time you were showing up I had already been there for 20+ hours and had a pretty good handle on the AM vitals.
     
  25. OveractiveBrain

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    Let me try it this why for you. Can you feel the entitlement in this paragraph?

    I pay 45,000 dollars for education. I want my education. I expect the residents to stop doing their job to teach me. i expect the nurses to drop their spot at the computer so I can look up my labs. I expect the attendings (who, amongst ensuring adequate patient care, is also there to manage billing) to not just educate everyone, i expect them to specifically sit me down and say "now im going to teach you, are you ready?" Frankly, I really dont care how much you get paid. I don't care about teamwork or patient care. I want time off when I want time off. I want to be educated. I PAID for it after all. Im not getting what I paid for. I dont think that the things Im doing or learning are worthwhile. I want more for my money. Give it to me.

    Let's try it another way, one less entitled. One that might get you farther.

    I pay 45,000 dollars for education. I want my education. What I've been getting on the wards is very different from what I'm used to. In the classroom, I was doused with information, this fountain of knowledge. When I'm on the wards, everything is different. I get hardly any time to myself, I get no lectures, no dedicated time. All I do is run around getting vitals, filling out forms, and sticking them in charts. Its not only inefficient, it just seems down right mean. I want to be learning something, not being some one's servant!

    One is worthwhile, a complaint we've addressed here.

    The other is irritating, grating, and self-centered. The former is about a lack of perspective on the student. The student sees only the world from their own vantage point. I pay money, gimme gimme gimme. Since I've paid for it, I deserve it. No. I deserve MORE. I paid money, and so I'm going to get it. The student ignores the possibility that what they've gotten IS an education, an education in the system of medicine. With it, comes some knowledge. The student sees their immediate superior (the resident) as the one inflicting the damage (rather than a system influencing the decisions) and so lashes out at the resident, citing finances as the driving motivator. Since the student sees only from their own perspective, they assume that everything is about money.

    What medical school offers is exposure to various fields of medicine and an education in the process of medicine in the united states (see Neil Patricks post). It is not centered around the medical content of a single individual student. When someone says "i deserve because" it is, by its very definition, entitlement. vs someone who says "Im part of a team, what can I do to make patient care better?"
     
  26. gabbyj

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    Thats not really what I was saying at all. I was saying that residents are the ones that are being paid $90,000 more than me to actually DO some work. I'm fairly certain I'm as efficient as any of the residents here at getting vitals because I've seen all of them do it and I've actually taught them how to organize them/view them easier on our computerized system. I've written plenty of notes and forwarded them to our residents only to have them sign them off without really double checking it.

    By learning, I never implied that it was the resident's job to teach me. I can learn on my own, or by asking questions when the timing is appropriate. It takes away from my educational experience, however, when you make me wake up earlier than you, and we ARE leaving the hospital at the same time when you make me sit down at the end of the day to help write orders.

    We take 30 hour calls q6d, while it might not be the same as some of your q4d calls, we actually have a NIGHT FLOAT system here so the residents don't take overnight calls. Residents complain all the time about the dangers of working 80+ hours and I get it, the program could lose accreditation, and students don't actually have any liability so I view it as an opportunity to learn. However, if you're telling me to come in on my 1 day off a week because you need help writing notes on a 12 patient list I AM wondering why you don't realize that you're actually getting paid $90,000 more than me to actually do your work.

    p.s. put in an average of 95 hours a week over the past 7 weeks of surgery and I was fine with it. The tipping point was asking me to come in on my day off or expect a bad eval.
     
  27. ZagDoc

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    I can tell this is a sore spot for you. Ok, asking you to come in on your one day off a week to round, and threatening you with a bad eval. Keeping you to do menial tasks at the end of the day that can easily be handled solo. Those are ******* move by an ******* resident. Don't really see how that is pertinent to this thread since I would argue that is the exception not the norm. It also seems like you are upset that your medical school has you taking overnight call when the interns are on night float. Why you want to take this out on the residents, who have no input into your rotation schedule whatsoever, I have no idea.

    That being said, I would caution you on this "I wish the residents would just DO their JOBS" attitude. Part of the purpose of medical school isn't just to hand-hold you through shelf exams and USMLEs... it's to teach you how to be a resident, because you do not get to pass go, you do not collect $200, you are going to BE a resident very, very soon. If you can tell me a way to teach you how to be a resident without practicing being one, I'm all ears. Until then, you have to practice doing the things residents do. Yes, this takes alot of time away from studying. Yes, that sometimes involves doing "our" work. No, it will not help your shelf exam score. But it will help you be a better resident, and more importantly, help you take better care of your patients.

    Sidenote: It's not "our" work, it's the team's work. It's not just work either... its taking care of patients for gods sake. Ok, we're getting paid to do it. By why don't you want to do it? Isn't that why you wanted to go to medical school in the first place? Some of my most profound experiences during medical school came while I was doing "scut work". The patient with metastatic ovarian cancer that I had to go to pull her drain... and we ended up talking for 30 minutes about mortality while watching the sun set out the window. The CHF patient who I was getting up-to-date I/O's from the nurse on... and I end up being the one to run into the family and am the only one to explain to them what's going on. The hospice patient I went to check up on in the early PM, and I'm the person who discovers she's passed away. The testicular cancer patient who I shoot the *** with about the Packers which I change out the wound vac in his perineum, and am blown away by the cheerfulness of a man who has a wound vac in his perineum.

    Could I have been studying during all those times? Sure as **** I could have. But why the hell would I want to spend time with books when I can spend time taking care of patients?

    Oh man, I wish I could print this out and put it on your car's windshield in three years.
     
    #26 ZagDoc, Jul 24, 2011
    Last edited: Jul 24, 2011
  28. smq123

    smq123 John William Waterhouse
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    What I wish students would know:

    1) Residents aren't here simply to teach students, we are here to....take care of patients.

    Teaching is not a priority on some days, unfortunately. The truth of clinical medicine is that there are a lot of patients who require a lot of care, and there aren't always enough people to provide that care.

    Wishing that residents would DO their jobs would mean wishing that residents would take care of patients. Teaching students may be in the job description, but it's hardly the #1 priority of the day to day work of a resident. Sorry, but that's the fact of the matter.

    2) Most students are not as good as they think they are. Some ARE truly stellar students, but they are rarer than you would think. Furthermore, the ones who are convinced that they are good and deserve honors rarely DO deserve honors.
     
  29. gabbyj

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    1) I think there is some misunderstanding going on here. I said that I'm trying to learn as much as I can in the hospital. I never expected one of the residents to be the one doing the teaching. I can learn a lot of things about the hospital through observation, asking questions at the appropriate time, reading, lectures, etc. I'm lucky because I have a lot of interaction with attendings who ARE willing to teach, so I don't expect anything from the residents. I merely brought up the money because I don't think a resident should be making me come in on my day off to help with the threat of a bad eval, when normally it WOULD be in their job description to take care of the work on that day on their own, and they earn $90,000 more than me to fulfill that job description.

    2) Never said I was a great student, just have an eye for efficiency. I wrote a small script that saved at least 1 min per patient. Before me, all vitals for a 24hr period were laid out horizontally on a screen and required a lot of scrolling to see all of them. I wrote a script that made them all appear vertically and you could get any 24hr range with a quick glance instead. I didn't want to write a script, however, that would simply report ranges because I still think its important to evaluate trends in vitals. (I was a computer engineer in my previous life)
     
  30. Perrotfish

    Perrotfish Has an MD in Horribleness
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    Nvm
     
    #29 Perrotfish, Jul 24, 2011
    Last edited: Jul 24, 2011
  31. turkeyjerky

    Physician 10+ Year Member

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    Those s hit moves by s hit residents are exactly what students are bltching about in this thread--it may be an exception to the norm, but if you're stuck with that guy for 8 weeks you can get pretty miserable and you'll get dejected over this whole thing.

    That other stuff you mention is not included in what I, and most other students, consider scut. I wouldn't mind doing any of that, hell i'd be happy as a clam if that was all I did all day on my surgery clerkship. Any type of activity which involves evaluating a patient is not scut, hands down. Scut is stuff like running forms across the hospital, scheduling follow up appts (not typing in the computer that they need follow-up, I mean spending 20 min on hold with a receptionist to actually schedule the appt), gathering supplies for a procedure that the resident does (w/o a speck of teaching on how to do it). Worse than scut is being kept around for 2 hours after you're done w/ everything only to watch your resident finish his progress notes.

    Most of my rotations have been different--I've worked hard, but I've learned a lot and haven't been given a bunch of bltchwork to do. I get it though, your life sucks and you wish you didn't choose your specialty/program/medicine, but don't take it out on me.
     
  32. DrBowtie

    DrBowtie Final Countdown
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    Looking back on third year, the take away point for me was learning to work as efficiently as possible within the hierarchy, and learning each person's role within the hierarchy. Its not my fifth patient that I followed with pancreatitis.

    I kinda enjoyed the scut (gathering vitals etc.) as it was something that I could actually be responsible for. If I didn't do that, rounds wouldn't go as smooth and everyone knew that was the med students job. It was more useful for everyone on the team than me writing the student note to be put in the chart for no one to ever read, or doing an H&P on a patient that a resident will have to go back and repeat.

    My favorite residents haven't been the ones who were the traditional teachers, being able to stump speech on any topic.

    Its the ones to taught me tips and tricks to be more efficient.
    The ones who taught me practical skills for functioning on my own.
    The ones who went over top 10 cross cover calls. Who can't get XYZ drug that nursing will always call and ask for.

    That's the type of stuff that will serve us better further along the line IMO when you've surpassed all of the book learning you did on IM in 1 month as an intern.
     
  33. Mr hawkings

    Mr hawkings Senior Member
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    I wish i knew more residents that would take the time to do what you're describing.

    I consider what most people describe as scutwork to be a learning experience and i like doing it but if there is a better/faster way of doing a task you assign me than the way i'm doing it, i would appreciate some input hefore i spend 2 hours doing a task that could have been done in 3 mins if i had some guidance.

    Also, i find it odd that i'm a student in a teaching hospital yet i have yet to meet one single person at any level of the totem pole who will accept that teaching med students is part (albeit a small part) of their job.
    I know everyone is focused on patient care
     
  34. ShyRem

    ShyRem I need more coffee.
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    Sorry you feel sitting on hold for 20 minutes getting a follow up appointment is scut. The residents do that every day. Getting supplies? We do that too. Running paperwork across the hospital? we do that too. Sounds like you're doing things residents would otherwise be doing that involve patient care, patient charts, or patient treatment in some fashion.

    I draw the line at running outside errands or personal errands that have nothing to do with patients. THAT is scut.
     
  35. 45408

    45408 aw buddy
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    That's not scut, sorry. Reviewing vital signs is a useful thing to do, and it takes quite a bit of time to get a good feel for what's normal given the patient's diagnosis. Same goes for looking up labs.

    That's lame.

    So...go see the patients and then write a note. We're all on a team together. Seeing patients and writing notes isn't scut.

    I send the students to go do the work they can do, because I have to go do a number of things that they can't do. For me, some of it would be crap work (because it's easy and mindless for me at this stage), but it's still useful for them to do at least a dozen or two times. You should know how to pull out a drain, remove staples, and such. Otherwise, you're going to be the dead weight intern come July. Trust me, you don't want to be that guy.
     
  36. 45408

    45408 aw buddy
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    Yeah, but I don't think the students should. It's a completely useless activity that does nothing to add to anyone's life.

    Now, if they do it, and I then have free time to teach them, they'll get that benefit.

    :thumbup: Agreed.
     
  37. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    We were expected to teach and instruct. Which doesn't mean formal lectures of spoon feeding, but I think if you're a resident with medical students and you're not helping their education, at least a little every day, then you suck.
     
  38. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    Please say this again. :thumbup:

    I didn't realize this as a medical student, and probably, embarrassingly enough now, often thought I was better than I was as a student. As you move up the food chain, you begin to see who the real outstanding students are, and it doesn't really boil down to simply kissing ass - these students are few and far between. Every student seems to think they are a pretty and unique flower, and they really are simply "adequate for level of training" like almost everyone else.
     
  39. ArcGurren

    ArcGurren only one will survive
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    The only kind of 'scutwork' i really take issue with is when it's completely unrelated to patient care... like "go buy coffee for me" or "go take this bedpan out and dump it". I'll even go get the coffee for you if I like you, but things for which it's the nurses job should be done BY the nurses (such as the bedpans)... that is not my purview unless I'm collecting stool cultures or something relevant to the patient's health. Thankfully this hasn't happened to me.

    I feel like most people who whine about making phone calls, running films down to radiology, making followup appointments, etc are people who are trying to literally do the least amount of work possible at all times. As much as I love my free time, I think I'd actually free up more time by finishing up the busy work, getting the clinical work done on time, etc instead of b***ing about perceived scut.
     
  40. tkim

    tkim 10 cc's cordrazine
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    Actually all through med school and residency I thought myself subpar in comparison to my peers. Still do, even in private practice in comparison to my partners.
     
  41. turkeyjerky

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    I don't have any problem with any of that stuff if it's my patient. I do have a problem if it's for some random guy I've never even met, and yeah, that's the $hitwork of residency, not what I'm paying (and you paid 3 years ago) 40,000 dollars a year for. Yeah, it's scut and F you for thinking I'm learning something from it. I don't have any problem getting supplies for a procedure that I'm going to to do, get taught how to do or assist on; I do have a problem with it if you're gonna have me fetch your stuff and then send me on another errand while you do it.
     
  42. KnuxNole

    KnuxNole Sweets Addict
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    I think different people have different definitions of "scut". The scut that I had to do for two rotations, I felt I learned nothing from them at all. The residents that taught me stuff I liked. The ones that told me to "make copies of these", "take the blood pressure for XXX" or "make xxx phone call" didn't help. That was basically all the scut I was given. Of course I did them because it made the resident's lives easier, but I don't think I was ever given the "scut" tasks people described, which was "take down all the vitals of the floor", "write notes on certain patients". My tasks were simply to follow 1-2 patients, take the H+P and present to the attending or in rounds. But then again, that would take a good amount of the day, so there probably wasn't a lot of time for scut.
     
  43. Perrotfish

    Perrotfish Has an MD in Horribleness
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    I feel like in modern medicine the only thing I'm given the opportunity to be outstanding at IS kissing ass. Kissing ass meaning making bestest of best friends with my bosses, or volunteering to do lots and lots of scut, or showing up earlier and staying later than everyone else despite the fact I have nothing to do, or compulsively checking computers so that I can tell the resident that I noticed a lab value one minute before he would have actually seen it. In other words tasks which, while they might show that I'm a 'team player', could be done by any HS sophmore and in no way reflect the progress I'm making towards being a physician.

    I mean, how else do I seperate myself from the pack? Excellence in the 0-1 procedures I'm allowed to do per rotation? Brilliant assessment and plan for the patient that the resident writes a note and order on before I'm even allowed to present? Correctly answering the pimp questions everyone is too busy to ask me? Outstanding performance standing in the corner while the resident mutely moves from chart to chart? (or, in Surgery, mutely retracting)' They've taken all the parts of medicine that we can actually be graded on and they've said that they just can't let medical students do those things any more for legal reasons. Or, like note writing, they say that we can do it but it needs to be completely duplicated by the Intern, which means that no one ever really evaluates or notices the work. The result is a medical education by shadowing, and you can't grade shadowing unless you're just grading brown nosing. Opportunites to show efficieny, clinical judgement, and a knack for procedural work just do not arise.

    At the end of my clinicals I am now pretty much convinced that the three major factors differentiating a excellent student from a merely good student are, in ascending order, masochism, flattery, and hotness.
     
    #42 Perrotfish, Jul 26, 2011
    Last edited: Jul 26, 2011
  44. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    I hear your frustration, but the masochism, flattery, and hotness just simply don't play into what I'm talking about. The qualities the outstanding students have, you either have or you don't unfortunately. There is only so much here you can "make" happen. Show up and do your best, but what you describe isn't going to make anyone stand out. So what can you do? I don't know, because I'm not sure there is anything you can do to make a difference. Also, I'd be the last guy to know. I'm a competent, ethical, conscientious, hardworking guy who tries to do his best, and I wasn't counted as one of those "amazing students" back when I was a student. Though, like you, I didn't get it - how could I be better? I'm pretty much convinced now you just are or are not and there really isn't much you can do about it to "make it happen".
     
  45. HiddenGentleman

    HiddenGentleman ASA Member
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    Thread summary: student got on here to vent about bad clinical experience---> a few residents and attendings (browsing med student forums??) felt personally attacked ---> residents and attendings attack back ----> transforms into a discussion about why most students suck
     
  46. OveractiveBrain

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    "Its not in the what, nor the how. Its in the Why"

    I think this happens to a lot of people. And perrot, I'm not picking on you, you have just so eloquently described what I think many people feel. I'm just quoting you to illustrate the concept, to give people a frame of reference. It's because I think ALOT of people think just like this. The student's perspective is "holy crap, I really gotta impress these guys otherwise I'm not going to Honors. I need honors. Now, what can I do to get honors? Hmm..." If that's your soul, that's your WHY, then that will bleed into everything you do. And people notice. You may not SAY it out loud, but you will show your intentions "I'm doing this for the grade, to separate myself from the rest of the pack." Then there is a clash. They can tell you're not interested in what they're doing or in their field, that you're doing things for a grade, and you fall into the middle of the pack.

    But what if we change the perspective, what if the perspective was "I don't know anything about this field. I want to learn as much as possible. I'm going to read, do what's best for my team, do everything for my patients, and take every opportunity to be involved, even if being involved is just listening." If that's your soul, thats your WHY, it will bleed into everything you do. And people notice. You may not say it out loud, but you will show your intentions "I'm doing this to better myself, for the sake of my patients, and to be a team player." And because you become legitmately interested in what the person is doing, you care about their field, AND you're doing the right things for the right reason, then you DO separate yourself from the rest of the pack.

    Of course, you are always going to have the totally Richard residents, Donkey rotations where they are out to get you. They want you to suffer as they had suffered, and they judge based on some preconceived, erroneous checklist that you have neither seen nor expected. That's horse****.

    Is it ideal? No. Is it always fair? No. Can our system improve? Oh yeah. But what we've got is what we've got. Here's the cool thing about following the path in the second paragraph. If you believe you want to be a good student and do the right thing, then you will act like a good student and do the right thing,. If you believe you're interested in what the rotation has to offer, you will enjoy it more. You let yourself be influenced by the rotation and you form a deeper connection with it. Then, being intertwined, you convince the evluators that you care, you form connections with them, and suddenly, you "score" better.

    Think its all horse hockey? It isn't. Residents are people. People like people who are like them. People judge based on their own paradigms, their own perspective, ASSUMING that the world is the way the see it through their own lenses, their own biases. If you let yourself be biased, transformed by those biases (to better understand), you might just manipulate the system of human emotion enough to make the difference.

    Then, all you have to do IS answer a few pimp questions or do well on a test. The subjective stuff is covered. Then tackle the objective. And honors.

    My own experience. I got mostly honors in my third year clerkships. I used the principles in the second paragraph (for more information, read 7 Habits of Highly Effective People and Start With Why) in most of my clerkships. It worked. There were two times I didn't get honors. One was OB. Scored crap on teh shelf, got a crap grade. Policy of the clerkship. Fine. The other was surgery. I DIDN'T practice the principles of the second paragraph. I was offended by the residents. Their incompetence, their attitude, their arrogance. So, I said "**** em." Even though I got something like an 84 on the shelf, a 100% on my oral (these are the only two things the clerkship uses to give us a grade, and why I focused only on those two things), I ended up having to APPEAL for a high pass from a pass. Yeah. MURDERED The objective stuff. Let my principles of fall apart with the people and I suffered.

    I really believe the power is in the people, not necessarily in the things you do.
     
    #45 OveractiveBrain, Jul 27, 2011
    Last edited: Jul 27, 2011
  47. OveractiveBrain

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    Im pretty sure no one was personally offended. (offended?)

    And Im pretty sure you have missed the point of the thread. (attacks back?)

    Take it as a few suggestions to get better? (Do med students suck?)
     
  48. HiddenGentleman

    HiddenGentleman ASA Member
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    I'm pretty sure the point of the thread was things you wish your residents would consider, not suggestions from residents on how medical students can get better.
     
  49. OveractiveBrain

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    That was the title, not the direction the thread went. Threads often shift gears as people post. Its sort of the point of a forum... you know, differing opinions from different perspectives, discussions charged by a simple question or some statement.

    You don't have to listen if you don't want to.
     
  50. Bartelby

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    That is truly messed up. I don't think I have worked with any resident or intern who sucked that much. Virtually all of them have ranged from enthusiastic and fun to work with to pretty much indifferent to my existence. I guess I have just been lucky to be in a place that treats students okay.

    By the way, I agree with other posters here. I would never mention money and how you are owed teaching time in real life unless things get so bad that you don't care about your eval anymore. You have a very valid point, but it will be seen as the entitled whining of a man-child by most.
     
  51. Perrotfish

    Perrotfish Has an MD in Horribleness
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    I respect y'all's opinions, but I just don't agree. Jdh I just don't believe there is an indelibe 'elite' quality that residents can see shining through students without us having the opportunity to work. How can you tell? How do you know what your seeing in any way correlates to the qualities that make a good working physcian? Overactive, I also don't believe that the difference between sincere and self motivate actions shines through. People just aren't that insiteful under any circumstance, and medicine is full of people who are significantly less insightful than average (sleep deprived, overworked, and to some extent the field selects for bad social skills). People are people, and when they have nothing else to base their judgement on they reward employees with the best personality.
     

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