Unwritten rules\advise for third year

[Bluesaurus]

---

Members don't see this ad.

Even though I'm nearly done with it, I'm curious what people think are unwritten rules of 3rd year. Anyone care to share what they think? Some random thoughts although most of this is common sense.

1) On Residents
Never ask a resident questions unless thinking about it beforehand and also timing it appropriately. Basically just don't ask since you can just ask another medical student later or look it up rather than bother them. Instead just agree with whatever they're saying and laugh at their jokes, move along. If the resident is teaching you a procedure or talking to you directly, it may situationally OK to ask random questions, but use discretion. Also try to not hover over them if they are working (give them space.) Also never complain about things to them since that means you have a bad attitude.

2) On Attendings
Since you sometimes you rarely get to interact with your attending, being able to present a patient or two when given the opportunity can potentially be your entire grade so the first couple you do with a new attending are more important than the later ones since that's when they make their first impression.

Figure out how your attending wants to present since the intro line can cause them annoyance since each one wants it a different way. If you don't know, then just pick a way and talk confidently and try to get through it without allowing all the residents\attending to nit pick until afterwards or on someone else. Watch the way the residents and team presents as well to mirror the intros. By the time you get past the HPI, people are beginning to lose interest anyways.

3) On other Medical Students
If you're paired with another student, watch what they do. If you're getting there at 6AM, and the other student is there at 5:30AM, then that means you're late for work. If you both get there at 7:30 AM, then there is no problem at all. Sometimes people arrive early for no reason, and it doesn't matter, but sometimes it does so use discretion. I'm not saying to try to outcompete people, but just make sure that the other person doesn't make you look bad. Same thing if the other medical students are presenting patients, find yourself a patient!

4) On criticism from residents
If a resident gives you some crazy procedure or task, and then makes fun of you or pressures you, they are probably just testing your confidence to see if you crack. Attendings also occasionally do this with your answers asking you if you're sure of that answer. Just stick with it most of time since they like to see if people will become unsure of themselves. I like to just say I don't know if I actually am unsure.

5) On Attending Pimping
Attendings like to state random facts during rounds, and then they pimp you or the group on what they said 2-3 days later. It's worth writing down the musings of attendings on a notepad whenever possible because even the stuff that you think is trivial tends to come back up.

6) On walking rounds
Keep track of the room numbers of the patients so you can get the chart as soon as the group arrives (kind of obvious but sometimes people don't.)

7) Lunch breaks\studying
ALWAYS let one of the residents know where you're going if you're going to study or go eat even if the resident thinks they don't need to know. I've seen people get in trouble for taking things too loosely, and then getting in minor trouble over it. Also again if it's a group of medical students it probably doesn't matter because groups rarely get in too much trouble, but if one student is present while one is not, this is the scenario where you're most likely to get in trouble.

8) On conforming
You have to conform to the group, and need to avoid being "that guy" for any particular reason. Don't be the person who asks too many questions, wears crazy ties, plays on his PDA or ipod way to often.

I could probably keep adding

 

[OveractiveBrain]

Great advice so far. Some of the really clutch stuff. I'll add a couple more, but you've definitely hit many highlights.

1) On Residents
Yessa Massa is the name of the game. Even if the resident is clearly inferior, sour, mean, degrading, AND A failure, if they tell you to do something or tell you fact, say "yessa please, thank you so much!" and move on. If it was inappropriate you can follow up with someone else, but some one else later. This is not a problem for well-minded, thoughtful teachers, but when you run into that one who has been dumped on his entire career and FINALLY has some one else to dump on, **** flows downhill. It is an unfortunate (and hopefully dwindling) right of passage, but be willing to accept crap during the day. Sometimes, you just have to wade through the crap and emerge on the other side

3) On Other Medical Students
Let the person present their patient. Even if you have some piece of knowledge they dont, some bit of information, do NOT steal the limelight by saying what you found. Obviously, if prompted, give information. That means SHARING information with your fellow student. When the team looks good, you look good, team work really pays off. Plus, as you mentioned, after the HPI, no one is listening anyway, and a second med student voice offering more useless information makes people annoyed.

 

[CardiacIntensivist]

You make some good points but oi...it sounds so cynical. It sounds like being a clerk is all about playing defense all the time. ::shakes head:: I guess that's why they are the unspoken rules. Anyway, these are all rules that with a little bit of observation and common sense, anyone should be able to figure out (note the emphasis on common sense).

I disagree with rule #1 though. I have almost always felt free to ask my residents and interns questions. 99% have been very open and willing to discuss. For the one resident who was a snarky with answers, I learned quickly to ignore her. I think that as long as you pick appropriate times and appropriate questions, no one can fault you. As a general rule, questions that need specific values, basic science knowledge or one worded-easy to google answers are probably not the best questions. Conceptual questions, questions on a resident's thought process, questions that will further management skills tend to be better ones.

 

[thechad]

Even though I'm nearly done with it, I'm curious what people think are unwritten rules of 3rd year. Anyone care to share what they think? Some random thoughts although most of this is common sense.

1) On Residents
Never ask a resident questions unless thinking about it beforehand and also timing it appropriately. Basically just don't ask since you can just ask another medical student later or look it up rather than bother them. Instead just agree with whatever they're saying and laugh at their jokes, move along. If the resident is teaching you a procedure or talking to you directly, it may situationally OK to ask random questions, but use discretion.

I don't see any problem with asking a question, I do it from time to time (as do most people I assume). Don't ask for an algorithm to treat AFib or something, but a simple question won't hurt, and I see nothing wrong with it.

2) On Attendings
Since you sometimes you rarely get to interact with your attending, being able to present a patient or two when given the opportunity can potentially be your entire grade so the first couple you do with a new attending are more important than the later ones since that's when they make their first impression.

As a 3rd yr, I present every pt I'm following. They expect good presentations for every pt, not just the first couple...

Also, we round everyday and present our pts progress notes...don't you? (I ask b/c you say you barely interact with your attending, are students not allowed to present in your school?)

Figure out how your attending wants to present since the intro line can cause them annoyance since each one wants it a different way. If you don't know, then just pick a way and talk confidently and try to get through it without allowing all the residents\attending to nit pick until afterwards or on someone else. Watch the way the residents and team presents as well to mirror the intros. By the time you get past the HPI, people are beginning to lose interest anyways.

Yeah, definitely annoying, but shouldn't take more than a day to adjust.

3) On other Medical Students
If you're paired with another student, watch what they do. If you're getting there at 6AM, and the other student is there at 5:30AM, then that means you're late for work. If you both get there at 7:30 AM, then there is no problem at all. Sometimes people arrive early for no reason, and it doesn't matter, but sometimes it does so use discretion. I'm not saying to try to outcompete people, but just make sure that the other person doesn't make you look bad. Same thing if the other medical students are presenting patients, find yourself a patient!

Not necessarily. If one student gets there at X time, it might just take them longer b/c they are slow, or maybe they are carrying more pts. I would suggest getting there when you need to so you can present a pt fully. In a hospital system I'm familiar with, I can arrive later than people who are not familiar with the system. You should know this by feedback from residents/attendings or questions. If they ask questions, you aren't presenting the ALL of the appropriate material.

4) On criticism from residents
If a resident gives you some crazy procedure or task, and then makes fun of you or pressures you, they are probably just testing your confidence to see if you crack. Attendings also occasionally do this with your answers asking you if you're sure of that answer. Just stick with it most of time since they like to see if people will become unsure of themselves. I like to just say I don't know if I actually am unsure.

This seems crazy. I have NEVER had a senior ask me to do a procedure I am unfamiliar with, let alone make fun of me for it. "I don't know," is NEVER a wrong answer.

5) On Attending Pimping
Attendings like to state random facts during rounds, and then they pimp you or the group on what they said 2-3 days later. It's worth writing down the musings of attendings on a notepad whenever possible because even the stuff that you think is trivial tends to come back up.

I've never had this delayed kind of pimping. I've had on the spot pimping, which I assume is the norm.

6) On walking rounds
Keep track of the room numbers of the patients so you can get the chart as soon as the group arrives (kind of obvious but sometimes people don't.)

Umm.....I guess useful in your hospital/school. You can't print a pt list?

7) Lunch breaks\studying
ALWAYS let one of the residents know where you're going if you're going to study or go eat even if the resident thinks they don't need to know. I've seen people get in trouble for taking things too loosely, and then getting in minor trouble over it. Also again if it's a group of medical students it probably doesn't matter because groups rarely get in too much trouble, but if one student is present while one is not, this is the scenario where you're most likely to get in trouble.

Well, I just hang out around them if I have nothing to do and study (after my notes are done and my misc duties for the day). If they need anything, they can ask since you are right there (but you should ask if THEY need anything). Also, they have your pager/cell phone # anyway.

 

[Phur]

Re question asking: First thing to realize is that there is a time and a place to ask questions. For example asking a surgeon a question during a difficult dissection, not ok. Also, the type of question is important. An attending put it to my team this way. He's there to teach us clinical things he's learned from experience, not to reteach basic science. If it's something you can look up later, don't ask. Example... Bad question: What type of bugs does drug X cover? Good question: Why did you choose drug X over drug Y since they both have similar coverage?

Just use common sense in general, and you'll be ok.

 

[Rollo]

Great thread. Keep it folks.

What about reading priority? I.E. what do you read to prepare for rotations? I heard anatomy is top priority for surgical rotations while pathophys is top priority for IM rotations?

 

[Orange Man]

Even though I'm nearly done with it, I'm curious what people think are unwritten rules of 3rd year. Anyone care to share what they think? Some random thoughts although most of this is common sense.

1) On Residents
Never ask a resident questions unless thinking about it beforehand and also timing it appropriately. Basically just don't ask since you can just ask another medical student later or look it up rather than bother them. Instead just agree with whatever they're saying and laugh at their jokes, move along. If the resident is teaching you a procedure or talking to you directly, it may situationally OK to ask random questions, but use discretion.

2) On Attendings
Since you sometimes you rarely get to interact with your attending, being able to present a patient or two when given the opportunity can potentially be your entire grade so the first couple you do with a new attending are more important than the later ones since that's when they make their first impression.

Figure out how your attending wants to present since the intro line can cause them annoyance since each one wants it a different way. If you don't know, then just pick a way and talk confidently and try to get through it without allowing all the residents\attending to nit pick until afterwards or on someone else. Watch the way the residents and team presents as well to mirror the intros. By the time you get past the HPI, people are beginning to lose interest anyways.

3) On other Medical Students
If you're paired with another student, watch what they do. If you're getting there at 6AM, and the other student is there at 5:30AM, then that means you're late for work. If you both get there at 7:30 AM, then there is no problem at all. Sometimes people arrive early for no reason, and it doesn't matter, but sometimes it does so use discretion. I'm not saying to try to outcompete people, but just make sure that the other person doesn't make you look bad. Same thing if the other medical students are presenting patients, find yourself a patient!

4) On criticism from residents
If a resident gives you some crazy procedure or task, and then makes fun of you or pressures you, they are probably just testing your confidence to see if you crack. Attendings also occasionally do this with your answers asking you if you're sure of that answer. Just stick with it most of time since they like to see if people will become unsure of themselves. I like to just say I don't know if I actually am unsure.

5) On Attending Pimping
Attendings like to state random facts during rounds, and then they pimp you or the group on what they said 2-3 days later. It's worth writing down the musings of attendings on a notepad whenever possible because even the stuff that you think is trivial tends to come back up.

6) On walking rounds
Keep track of the room numbers of the patients so you can get the chart as soon as the group arrives (kind of obvious but sometimes people don't.)

7) Lunch breaks\studying
ALWAYS let one of the residents know where you're going if you're going to study or go eat even if the resident thinks they don't need to know. I've seen people get in trouble for taking things too loosely, and then getting in minor trouble over it. Also again if it's a group of medical students it probably doesn't matter because groups rarely get in too much trouble, but if one student is present while one is not, this is the scenario where you're most likely to get in trouble.

I could probably keep adding

This is pretty good and essentially true except the stuff I bolded above. Residents are WAY too busy and concerning themselves with patients to care about 'testing' medical students or dropping them in the deep end. This is not a popularity contest and I could care less what a medical student's opinion of me is. Realize that your screw up is my screw up and so I'm never going to ask you to do something I don't think you can do quickly and without risking the health of a patient.

Most medical students are a pleasure to have around, and I always emphasize that the primary role is to learn - not scut.

Here are some problems I've had with medical students:
1. Asking perpetual questions at very bad times (when I am on the phone with a consult, during signout when we have to really focus, during a peri-code situation etc.). This is usually from the more self-centered medical students who only see their own goals for the day rather than understanding the team dynamic. Everyone makes mistakes (I did!) but use common sense and learn, then pick your timing. Everyone remembers the irritating medical student and, if you are that person, you kill the harmony of our team for the 1-2 weeks that we have to tolerate you, and you'll get a bad evaluation at the end without us thinking twice about it.

2. Not knowing the details of your patient - if it's YOUR patient, show it by taking ownership. If there is an MRI pending, take initiative and call up the MRI suite to make sure it gets done, then call radiology for a wet read. This is a massive help to the team, trust me. That might save your resident 20-30 minutes (which is huge). There's nothing more annoying that asking a medical student the status of a study on their patient to have them not know or say they have not checked yet. Where I train, medical student have 1-2 patients. I have ten times more than that on a good day. There is no excuse for you not knowing. You should be in a situation where you know as much about the status of your patient as I do.

3. Don't be entitled. You are there to learn, not to be spoon-fed and babied. I once had a medical student walking around slamming doors like a spoiled child because they felt like we should be looking at them more when we are discussing their patient.

MSIII is rough. I remember all the residents that abused me and the ones that were kind - sometimes when I least deserved it. You basically have two choices: become one of the natives and do what they do, realizing the onus is on you to learn or try to force things your own way. I strongly suggest the former.

The medical students I have given the best evaluations to have shown two critical things: 1. reliability. 2. enthusiasm. Even if you are not going into my specialty (which I don't even care about), to have a student who wants to learn as much as possible about my specialty impresses me. The medical students I have given the worst evaluations to have been the ones that are most annoying and ruin the team dynamic (perpetually interrupting at bad times, arrogant, evasive, not knowing their patients etc.) and take up time that should be spent caring for patients.

I hope that helps.

 

[C5toC9]

How do you guys transfer from Step 1 brutality to day 1 of M3? Probably only a few days for me

 

[Marcus Brody]

Good grief...lists like this are why med students typically are the most hyper-analytical, neurotic, and generally annoying, people in the hospital.

 

[SouthernSurgeon]

This is pretty good and essentially true except the stuff I bolded above. Residents are WAY too busy and concerning themselves with patients to care about 'testing' medical students or dropping them in the deep end. This is not a popularity contest and I could care less what a medical student's opinion of me is. Realize that your screw up is my screw up and so I'm never going to ask you to do something I don't think you can do quickly and without risking the health of a patient.

Most medical students are a pleasure to have around, and I always emphasize that the primary role is to learn - not scut.

Here are some problems I've had with medical students:
1. Asking perpetual questions at very bad times (when I am on the phone with a consult, during signout when we have to really focus, during a peri-code situation etc.). This is usually from the more self-centered medical students who only see their own goals for the day rather than understanding the team dynamic. Everyone makes mistakes (I did!) but use common sense and learn, then pick your timing. Everyone remembers the irritating medical student and, if you are that person, you kill the harmony of our team for the 1-2 weeks that we have to tolerate you, and you'll get a bad evaluation at the end without us thinking twice about it.

2. Not knowing the details of your patient - if it's YOUR patient, show it by taking ownership. If there is an MRI pending, take initiative and call up the MRI suite to make sure it gets done, then call radiology for a wet read. This is a massive help to the team, trust me. That might save your resident 20-30 minutes (which is huge). There's nothing more annoying that asking a medical student the status of a study on their patient to have them not know or say they have not checked yet. Where I train, medical student have 1-2 patients. I have ten times more than that on a good day. There is no excuse for you not knowing. You should be in a situation where you know as much about the status of your patient as I do.

3. Don't be entitled. You are there to learn, not to be spoon-fed and babied. I once had a medical student walking around slamming doors like a spoiled child because they felt like we should be looking at them more when we are discussing their patient.

MSIII is rough. I remember all the residents that abused me and the ones that were kind - sometimes when I least deserved it. You basically have two choices: become one of the natives and do what they do, realizing the onus is on you to learn or try to force things your own way. I strongly suggest the former.

The medical students I have given the best evaluations to have shown two critical things: 1. reliability. 2. enthusiasm. Even if you are not going into my specialty (which I don't even care about), to have a student who wants to learn as much as possible about my specialty impresses me. The medical students I have given the worst evaluations to have been the ones that are most annoying and ruin the team dynamic (perpetually interrupting at bad times, arrogant, evasive, not knowing their patients etc.) and take up time that should be spent caring for patients.

I hope that helps.

Strongly agree with all of this. Residents are not out to f*** you over. We all remember what it was like to be in your shoes, and we want to help contribute to your education as much as we can.

The only times I get frustrated with students are, as Orange Man said, when they don't seem to understand the dynamic of the team and put their own priorities ahead.

 

[lildave2586]

Never tell an attending something important about a patient that your resident doesn't already know.

 

[DirtyNetter]

bump.

 

[J ROD]

Never tell an attending something important about a patient that your resident doesn't already know.

def dont do that...

in fact, never try and show someone up....even another med student.

it will follow you too!!

 

[Bluesaurus]

I often tell the attendant or chief stuff my residents don't know not because I intend too, but they You don't have time to check and verify they know it before rounds. You just present whatever you got.

On the questions, I don't like to ask questions. Often if they start questioning me, I will try to lead the discussion to something I know a lot about rather than ask questions about some area I know nothing of.

 

[Perrotfish]

I cringe when I see lists like this. I really think that one of the hardest, but also most important, things to accept about the third year of medical school is that it has no rules. Or rather, that it has a completely different set of rules made up by each and every resident and attending. There is no universal etiquite, no unwritten code that everyone is following. Something that's an automatic fail with one resident can be a requirement from another resident on the same service and you just have to deal with it. The worst attendings won't even be consistent with their own rules day to day. The only 'trick' I've figured out is to talk with other people coming off the service to see what the team wants, and the the corner the attending and resident during the first few days to ask them to give feedback on my note and presentation. I've found the the annoyance the doc feels about being cornered is forgotten long before grading, and I deny them the chance to nurse some secret grudge against some minor detail in my presentation style that they think defies 'common sense'.

 

[unsung]

I often tell the attendant or chief stuff my residents don't know not because I intend too, but they You don't have time to check and verify they know it before rounds. You just present whatever you got.

On the questions, I don't like to ask questions. Often if they start questioning me, I will try to lead the discussion to something I know a lot about rather than ask questions about some area I know nothing of.

Wow, why does this sound SO bad to me... I mean, if this doesn't typify the med school culture or med student personality, I don't know what does. 😉

Um... I thought the point of asking Qs was to try and learn something new about an area that I don't know a lot about.

Whoops! Silly me, forgot I was in med school. Forgot I'm surrounded by med students. More important to ask Qs for the sake of showing off and demonstrating superiority. 🙄

 

[vicinihil]

I think lists like these are highly institution dependent. A student in a malignant atmosphere will need to learn to act differently than one in a more collegial environment. I can only speak of the latter because I guess UVA is one of the most collegial and friendly residency/medical schools around according to a lot of attendings and interns.

1) Make what you do sound like a lot
- Residents and attendings have no idea how much trouble you go through to get xrays, read them with a radiologist, look at slides with pathologists, call family, call PCP's. Make it a point that you did it. It's a show, yes, but you did the work. Make sure they recognize you. Petty? Maybe, but so are evaluations.

2) Know your stuff.
- I can't emphasize this enough. When attendings and residents begin to respect you because of what you know on a patient's disease or on the patient themselves, it makes the work environment much less "I'm big you're small I'm smart you're dumb" and more of a "I scratch you back and you scratch mine."

3) Befriend residents
- This sort of follows the back scratching saying. Get them food if they seem busy, talk about them in down time, laugh with them, share jokes, and talk about interesting things. This will go a long way.

4) Reverence
- Be NICE to everyone. Even if you think the attending is the biggest tool shed in the world and the resident knows less than your left butt cheek, still make them feel smart. Don't question what they say but offer your opinion without speaking down to them. When they find out you're right, they'll think "wow, he's smart and humble."

5) Rock the shelf
- Even if it's 20% of your grade, doing well on it will bump your grade. If everyone gets similar evals your objective rating will put you ahead of the pack.

6) Grades matter more than comments
- an A or an Honors is worth more than the comment of "best medical student ever so I give him a Pass!" This echoes advice 5 regarding the shelf. You can stick around all day and work your butt off and not study for the shelf and end up doing mediocre on it. You end up getting an A- or high pass but your comments are gleaming. In the end, the guy with the honors and good comments will get to MGH and you will have to settle for Hopkins. =) you get the point.

 

[cpants]

I cringe when I see lists like this. I really think that one of the hardest, but also most important, things to accept about the third year of medical school is that it has no rules. Or rather, that it has a completely different set of rules made up by each and every resident and attending. There is no universal etiquite, no unwritten code that everyone is following. Something that's an automatic fail with one resident can be a requirement from another resident on the same service and you just have to deal with it. The worst attendings won't even be consistent with their own rules day to day. The only 'trick' I've figured out is to talk with other people coming off the service to see what the team wants, and the the corner the attending and resident during the first few days to ask them to give feedback on my note and presentation. I've found the the annoyance the doc feels about being cornered is forgotten long before grading, and I deny them the chance to nurse some secret grudge against some minor detail in my presentation style that they think defies 'common sense'.

There's no hard and fast rules but there are general guidelines for success:
1. Be a good person: No backstabbing, and try to make your teammates look good.
2. Be enthusiastic: Put in a good effort, don't try to get out of work or leave early.
3. Be professional: On time, well dressed, good breath, respectful to others.
4. Be prepared: Know about your patients and their diagnoses. Read a lot.
5. Go with the flow: Be prepared to adapt to your team's rules and style. Have a thick skin. Be ready to adapt your schedule and your plans at a moment's notice.
6. Have fun: This isn't supposed to be torture, and if it is, maybe you chose the wrong career. Crack a joke or a smile when appropriate, and try to enjoy your first real taste of clinical medicine.
7. Kill the shelf: The only surefire way to get the elusive H. At most schools it is the differentiator, not any clinical grades.

If you stick to these guidelines, you'll be fine on clinical evals, even with the most ornery of surgery teams.

 

[Perrotfish]

There's no hard and fast rules but there are general guidelines for success:
1. Be a good person: No backstabbing, and try to make your teammates look good.
2. Be enthusiastic: Put in a good effort, don't try to get out of work or leave early.
3. Be professional: On time, well dressed, good breath, respectful to others.
4. Be prepared: Know about your patients and their diagnoses. Read a lot.
5. Go with the flow: Be prepared to adapt to your team's rules and style. Have a thick skin. Be ready to adapt your schedule and your plans at a moment's notice.
6. Have fun: This isn't supposed to be torture, and if it is, maybe you chose the wrong career. Crack a joke or a smile when appropriate, and try to enjoy your first real taste of clinical medicine.
7. Kill the shelf: The only surefire way to get the elusive H. At most schools it is the differentiator, not any clinical grades.

If you stick to these guidelines, you'll be fine on clinical evals, even with the most ornery of surgery teams.

See, I think that everything you said is true, but I don't think that's what what this list is about. Your rules are 'unwritten' because they're good manner and common sense. Work hard, study hard, and be a good person are great advice but what people are asking for here is much more specific, and my point is that yo can't give any general advice more specific that what you said.

The questuions debate in this thread is a good example. I've had attendings that think a never ending stream of inane questions is a sign of interest and will honor you for it, and attendings that would be offended by any question that has an answer anywhere in the literature (I.e. any question at all) because you could have looked it up rather than wasting their time There's no rule that's going to work for everyone, so you need to feel out each attending and resident to see what they want

 

[gstrub]

You guys are a bunch of pansies. Write down what the attending said on rounds to be prepared for pimping 3 days later? Get to work before the other medical students? GET THE RESIDENTS FOOD? Are you sh**ting me? It's this kind of crap that makes 3rd year so annoying. People should just be themselves and work hard. There is no secret formula. It is not that hard.