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Discussion in 'General Residency Issues' started by TKD0205, Aug 15, 2011.
(Thanks for the empathic responses out there.)
Interns do not get to bitch about med students in August...end of discussion. May? Sure. But you're <60 days removed from being "one of them." Have a little compassion and tell your senior do his/her damn job (which is to teach the med students 6/7 days/week).
I started as an intern on an intern only team with two medical students. So all the teaching was up to me and the attending. Luckily, the attending did a fair share, but it still honestly felt like a huge burden at the time. Medical students can make stuff harder, and having interns be their primary educator is not ideal either for them or for you. Unfortunately, it's just part of the system that you largely have to get used to.
Be nice but give feedback. Sending them away to read is occasionally acceptable.
LOL, I remember a while back feeling the same way about the frustratingly useless interns under my charge as the OP seems to feel about all the frustratingly useless med students. They take too long to do things you could more easily bang out yourself in half the time. As gutonc correctly points out, the line of distinction between 4th year med student and an intern just starting out is very fine -- if not for the longer coats most of us would not be able to tell you guys apart by your abilities -- you both are pretty clueless most of the time. The learning curve is steep, and anyone still on the climbing phase is very far down looking up -- from much higher up you both look like ants.
But it really is your job to teach underlings on this path, partly because it's how they learn, and partly it's how you learn. Most importantly though it's your job, as much as all that other stuff you feel like you ought to be doing. If you didn't want med students, you should have picked some community hospital that doesn't have any.
Don't assume that I was a med student <60 days ago.
I feel your pain. That being said, part of being efficient means learning how to be an efficient resident, in spite of the time obstacles around you. And that includes having a med student on your team.
Maybe you could have them see the patient WHILE you do other stuff? Don't go together to see the patient, and have to wait while the med student does the initial H&P.
You CAN interrupt them while they present, if you are truly strapped for time. Is it nice? No. Are you going to be the last person to interrupt them as they struggle through an H&P? No.
Or, you can let them know that, usually, when they present a patient in this specialty, they should include XYZ, where as ABC are less important. They need to learn at some point.
That IS something you address - if it's that bad, and it's just out of carelessness (not because the student has some kind of palsy that makes it hard to grip a pen), that's something worth mentioning. Bad handwriting can be dangerous if it causes confusion.
The other thing you could do is just flat-out tell the med student to not write an H&P but just gather data. They can take notes, but you write the bulk of the H&P while they present to you. That could save some time, because I bet that part of the thing that takes up so much time is waiting for the student to write the H&P up. (That could also be why their handwriting is so bad; they feel rushed to hurry up.)
If they're being obnoxious, you can send them away if they're taking up space. You're their resident now, TALK to them about unacceptable behaviors. It's ok. Be nice about it, but just say, "It's kind of hard to concentrate in such a small room when you guys talk so loudly, and there are so many people in such a small area. Can you guys go to the cafeteria or something? Come back in an hour."
I'm a 4th year and what I don't get is that while the OP is a resident at some point in his career the OP was also that clueless medical student who didn't know how to do anything, and took forever to get things done (unless you started rotations at the same caliber you are now) have you forgotten your time in school already?
Just remember as you now find students annoying, when you were a student residents found you annoying. Instead of griping about it teach them to be more effective and a better clinician, it'll help out everyone in the long run
Another tool for medical students is thinking of creative ways that they can be beneficial. Need someone to call a family for info? Med student. Need someone to f/u on radiology results? Med student. Need someone to get a social history from a pt? Med student. Guaiac? Med student.
At our university system, medical student notes don't count for anything, and you have to cosign them. So yeah, they create more work -- there's no way around that. However, you can find some ways to have them help you out.
I'm still agreeing, though, that dealing with medical students is a hard task for interns, and we probably don't get enough guidance for how to do it.
I find the bolded statement very hard to believe
I can only imagine what the OP will be like as an attending... God help us all!
I will say that managing people under you is part of the hidden curriculum of med school and to a greater extent residency- in the future it will either be dealing with residents as an academic attending or MAs/Nurses/PAs/NPs in practice. It does get frustrating because you're expected to just do it when it is a separate skill set that we often get little instruction in...
That being said, take a breather. If you had an hour and a half to staff with your attending, why couldn't you have read then? If your senior made you wait on your med student to staff, I'd say that was really more of a problem with your senior than your student IMO. Assuming they are MS3s and just starting clinicals of course they are going to be inefficient and have issues, try to give them some advice on making things go quicker. I remember my first admit as an MS3 I did a 2 hour H&P because the guy was 90 and a vet with like 15 chronic medical conditions, but I'm better now because along the way people helped teach me. It didn't happen overnight, and I'd say teaching students is not too tough if you just explain the reasoning behind the decision making on your patients and theirs and give 1 good piece of advice a day about being more efficient clinically. They can get their formal lecture at grand rounds
So you've never, ever been annoyed by your med students? We've got a judgmental crew here on SDN these days.
I'll admit, they can be a little annoying. But I have a little more insight and a better memory than the OP. I remember when I was a clueless MS3 just starting, and interns taught me most of the patient management that I know today. Hell, I was a Med student like 5 months ago, and couldn't even put a damn order in the computer without an intern signing off on it. I also realize that I am fairly annoying to my residents now that I am an intern, and have to rely on them any time I am not certain of a patient management/dispo issue. I would never expect my residents to go home and rant on the internet about how annoying I am making their lives, because teaching med students/younger residents is just one aspect of medical training that EVERYONE has to deal with.
Just because everyone has to deal with it doesn't mean it doesn't suck. And ranting is one function of SDN. Better to do it here than leave the poor med student with a bad eval. Maybe the op does have a good memory of what it's like to be a med student -- it still doesn't mean they're not annoying because, dude, they can be. Also, when you're stressed out about getting your job done, it makes you a little less open to thinking about the needs of others (like, say, med students). It's a natural process, and I don't think we should feel guilty for having occasional bad thoughts (and,yes, even posting them on SDN) about MS3s.
Now I'm going to be obnoxious and call rank, but the fact that you're just 5 months out of medical school might mean you haven't had the opportunity to be truly frustrated by med students on your team. Don't worry -- it'll come. I'm sure I annoyed residents when I was a med student, too.
That's the nice thing about the senior/junior resident set up that most teams have -- the senior resident is supposed to be the primary teacher, freeing the intern up to learn how to get more efficient and how to do the basics of their jobs. Unfortunately, in psych, lots of times you're the intern with no senior and a few med students, which is a really a challenging experience partially because we remember too well that we're pretty close to being a med student.
I like teaching med students; you just have to find ways to work their learning into yours so that both of you aren't totally inefficient.
Sometimes what I do if I have a few patients to see is go with the med student to do the first H&P. I let them ask the questions, but I can break in for things they miss, and we can examine the patient together. I write my note while the student is gathering the info so I'll have it done. Afterward, I send the student to go write up their own note, and I go do my next thing. When we're both done, I read over the student's note, make suggestions, and have them practice presenting to me. Then we both can present to the senior. Other times, I have the student go see a patient themselves while I go see the rest of the patients, and I come back and see their patient at the end while they're writing the note. If they're not done with the H&P by the time I get back, I stay in the room for the rest of it and start writing my note.
Once the students get the hang of things, they can be really helpful in terms of getting data you need, drafting notes, writing prescriptions, etc. Try to look at it this way: if you invest some time in them at the beginning, they will be better able and more interested in helping you later on. As for them not wanting to do your specialty, that shouldn't make you feel like you're wasting your time on them. No matter what they go into, they need to have a broad general education first, so it's not like your specialty doesn't "matter" in their education. And who knows, maybe they'll have such a great experience working on your team that they'll change their mind about what they want to go into. It's been known to happen.
this thread makes me very happy to be a pathologist.
Why would I be annoyed?
I appreciate having the opportunity to be in a position to help others learn. I know if I didn't have good mentors to guide me, I would not be where I am today. Medical students are supposed to be naive because they are new and as residents we learn more by teaching and should not be "annoyed" by the job we signed up to do.
I like teaching med students when I can. All these stories of sh!tty med students, I'm sure exist. I've not dealt with one, nor was I one, but I have seen residents taking up computer space while on FB or watching some sports game on some random internet TV website. Work room computers all being used, and of course, I can't ask an upper level to get off the computer so I could do my work. Instead, I have to ask a med student who is doing some reading on a useful topic because I can. I felt bad, but in the past, asking an upper level got me this:
if you really find us that annoying just tell us to leave early. we'll be more than happy to oblige.
So news flash -- it's OK to occasionally be annoyed with people you work with and to be annoyed with doing your job. It's a perfectly appropriate emotion. It's not OK to be mean to medical students or as I mentioned, to give them bad evals for no reason, but yes, it's OK to be annoyed. Even if you overall enjoy teaching and like medical students, they're still occasionally annoying.
Admittedly I'm a little high on concepts of psychotherapy right now, but it's OK to have emotions, even when they're negative. Sometimes these emotions are about our job. Also OK. So I'm not buying that you've never been annoyed by med student (unless you too are an intern and have so far had pretty limited interaction with them). Next you'll tell me you've never been annoyed with anyone you've ever worked with, ever, because you chose this job, so why should you be annoyed. It's BS.
Anyway, we've digressed with this whole everything is perfect in medical land, all the people we work with are great, I love every aspect of my job, etc. discussion. Why not either emphathize with the OP or help him with some solutions to deal with his problem. It's better than judging him for being a perfectly normal intern with perfectly normal feelings.
Actually this is a tip for med students -- if we ask you to leave, we kind of want you to. BTW, I'm a fan of sending medical students home when I can because I do remember what it's like to waste time hanging around for no good reason. Studying can be more important than watching me do mundane resident tasks.
I couln't agree more. There is always a way to 'get rid' of a med student who's annoying you. If it's early in the day, send them to go look at procedures or something like that. If it's late, just send them to their homes or beds.
About the annoyance, it is usually caused by the circumstances rather than that particular student. On calm days, I rather enjoy having someone around, teaching that person and just having a chat. Particularly the non-traditional types come from all walks of life and I have met some really interesting and nice people that way.
On days when it is very busy or when we have very critical patients/procedures, the med student should be seen and not heard imo. If they don't catch up on that, I just send them home (with no negative effects on their eval).
I agree. The "annoyance" factor is how a person deals with a situation and I haven't had one medical student yet complain about having more time to study.
Who's judging who here? I stated that the original post by the OP was a vent about medical students and how they annoy him or her... I replied back with saying I wouldn't want him or her as my attending because we have all seen the attending/resident/fellow that has forgot what it was like to be a medical student and make their life a living hell for whatever personal grudges they were having.
I also stated that I don't mind teaching medical students because that is how we learn and it is our job to do so. I never said I get along with everybody, but you don't have to, just do your job, go home and vent to your spouse or do something fun. I just don't believe residents should be taking their frustrations out on medical students.
Another thing I would like to add as a medical student: if you (a resident) want to go see a patient by yourself because it will be faster just say so. If you lie to try and protect my feelings and say you just don't want to interrupt my studying because I look busy I am very likely to end up annoying you by trying to convince you that I want to come along and that I really am not too busy to go see another patient.
Dude, you were judging the op for venting about medical students here. There's no implication that anyone, op included, is taking out frustrations on medical students or advocating taking out frustrations on medical students. You were the one who implied that venting at all about medical students is bad, laying on this heavy guilt trip, and stating that the op would be a bad attending just for occasionally having bad feelings about med students.
Maybe you should reread the op's post and your reply to see what I was objecting to.
This right here is a perfectly friendly statement. No judging involved at all.
I'm just going to end this discussion now because obviously you're taking this to mean more then it should. Let's just agree to disagree (your choice) and put this topic to rest. If you want to discuss this more feel free to PM me.
Well, I'm just saying I think you should review your word choices if you can't see why they were deemed as a little holier than thou, judgmental and just plain obnoxious. You said that the op, an intern just starting his/her year, would be a bad attending for being frustrated with dealing with medical students, something that is a completely new and challenging experience for most interns.
And getting back to the thread in general, I still think it's lame that we all jumped down the op's neck for expressing perfectly normal frustration with something that is hard about being an intern. The poor guy went back and deleted his thread.
Way to stand up for the little guy
I'm very passionate about teaching. I actually really like teaching the students and when I was on night float I actually would take the medstudent on call with me to the ICU to do some vent/IVF/pressor teaching.
I put a lot of effort into teaching them. . . . .. . how ever not everyone responds well to my method of teaching. I ask a lot of questions while teaching. This allows me to assess what the student knows and to focus my teaching on their areas of weakness. I actually had one student "ghost evaluate" (an anonymous eval) wherein she complained that my teaching style was composed of a stream of questions unrelated to patient care with out teaching of any kind.
Apparently, she felt that simple questions like "how does morphine work?", and "what antibiotics cover gram negative rods" were unfair. Unsurprisingly, she got very few questions correct.
I think students should be asked questions. It forces them to think about the things we do and more importantly the reasons WHY we do them. No "pimping" them is depriving them of an important learning opportunity.
Anyway, It's margarita time. Hasta'
"Tell me, student, what things cause disease in people?"
Lol, so, basically you offer to teach, then proceed to berate the students w/ a stream of questions? And you're surprised they don't like this method? Does anybody actually like this method of teaching?
But, it's okay--because you "actually really like teaching". Lol, this is too rich.
I think you mean barrage.
Some questioning can be ok, but in general I agree with you. No one likes being pimped to the point of looking stupid, especially when it's done in front of a group of people, and especially when the point of it is for the senior person to put the junior person in their place. Not saying that WFIAW is doing that, but I have certainly seen it done, and probably so have all of you.
IMO it's just as effective and a lot less demeaning to teach by having the student try to do something and then giving them feedback on how to improve. This works well for things like taking an H&P, writing a note, coming up with an A/P, presenting their patient, etc. I also think it's legit to tell the student to look something up if they ask a question that is basic knowledge they really ought to have. But I don't see it as my job to assess their medical knowledge in great depth; that's what the shelf exam is for.
IMO, there is nothing wrong with initially asking medical students questions while trying to teach. Obviously, not all students have the same knowledge base, and I would hate to waste my time and theirs by going over something they already understand. Also, it's very easy for me to forget what I used to know or not know. After many years, I've lost a lot of perspective on what a medical student does or does not know. I often assume that students understand things that they don't, which is probably a symptom of getting old and forgetting what I used to not know (split infinitive, FTL).
That said, if you ask a few questions and the student has no clue, then it should be obvious that you need to change your style. If I'm trying to explain a concept and the student doesn't understand the basics, then I will quickly switch from an interactive mode to more of a lecturing style. Students might not retain as much from having me simply lecture to them, but I assume that's better than having someone ask progressively more difficult questions after the student could not answer the initial ones.
Damn you Microsoft Word thesaurus, you've ruined my vocabulary!!
Full disclosure, I don't mind pimping all that much, as long as it's not ridiculous ("tell me student, why did I choose to give this patient dilaudid rather than morphine"). But, let's be honest, it's a method of evaluation, not teaching--that's BS. Don't offer to "teach" me something and then start pimping me, next time I'll decline your offer.
Interesting that you chose this example. Actually, there are valid reasons for making this opioid selection (hydromorphone vs morphine) that are important for any med student to know/learn (morphine-6-glucuronide accumulation in renal failure, etc...). Re your other point (pimping vs teaching), its often a fine line but there's something to be said for a more active/interactive style vs spoon feeding. In the end, there needs to be a balance of both. My general approach (with med students and junior residents) is to pose a question and then guide the discussion from there based on the response.
Like it or not, as a trainee (med student, intern, resident, etc...), you're constantly being evaluated based on your medical knowledge and clinical acumen. Yes, you absolutely should expect to be well taught/trained. But its not a free ride (tuition/poor pay aside): you have to put time/effort into reading/improving your skills.
Its easy to be sarcastic without actually listening to the message.
The message is, "I take an interest in the students by asking them questions about the various issues that come up with the patients under our care. When they don't know the answer then I explain the answer. I do this on an individual basis, not in front of the group. My goal is always to educate not to embarass or in anyway make them feel bad. I tell them up front that it is ok for them to not know the answer as long as they think about the question. I encourage them to come with me when I am doing floor work so we can talk about the day to day issues that come up with patients and how to manage them. 1 person out of the 11 reviews I have received did not respond well to this method. Though I personally think the socratic method is a great way to learn.
In the end though, if someone doesn't want to learn that is fine with me. You can't force someone to learn and not every teacher works for every student.
This echoes my post almost two years ago saying that the current 3rd-year medical school system is completely bullsh*t, waste of time, extra unnecessary stress for all parties involved, redundant inertia from the past.
And interns are still useless.
Medical school needs to have "majors".
Really, morphine-6-glucuronide accumulation is the kind of thing that any med student needs to learn?
Leaving aside the obvious fact that this is the kind of what-am-I-thinking pimp question that lazy attendings/residents routinely throw out without any particular forethought, just consider the reality of the situation for a sec. Students spend a very short amount of time rotating through any given specialty. Roughly 9/10 of them will go into something else. Teach them something useful, something they'll remember, something they'll be tested on, and something that's bread-and-butter to your field. If what you're talking about doesn't fall into at least two of those categories, you're almost certainly wasting everyone's time in order to mentally masturbate yourself into a feeling of self-importance.
I guess only the 99% of medical students who will at some point during future residency/private practice treat pain with opioids. The other 1% don't need to know
Seriously, this is something anyone going into Primary care or surgery needs to know
It's useful, but prolly better to just teach them that morphine has active metabolites in renal pt's than to try to pimp them on the pathway or the name of the metabolite. They'll remember it instead of thinking it's esoteric mental masturbation.
Done right, pimping is both teaching and evaluation. It helps me figure out what level we're at that week. There is incredible variability between trainees both within and across stages of training. It's rare that I go with "look it up" for anyone other than a senior trainee who is failing on a basic concept. If I ask a question that isn't answered, I'll answer it in detail. You don't want me to waste that 10 minutes if you already know all about it from last week or last year.
Pimping also provides some external motivation to prepare for rounds. Resident tells student, "oh Dr. G always asks students to explain the physiology of ascites"...stud takes that to heart...and we get to have a discussion about the complexities of sodium balance in cirrhosis instead of "what does SAAG stand for".
I don't pimp to make people look/feel stupid. Sometimes it can't be helped. If I told you to look something up and asked about it 2 days later, you should feel stupid if you didn't bother. I like to make the residents look good. I routinely ask them to read on a topic offline and then bring up that topic on rounds. Then they can teach the studs, look good and everyone learns.