LetItSnow

Skipping the light fandango
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Well, we actually have rotations starting our first year here. I'm still unclear as to the extent of what we will be doing. It sounds like a lot of observation and a lot of technique/skill development in our clinical skills lab, but I know we have some hospital rotations, too.

Does anyone have any advice for a first year that will probably feel like she's in the way of 3rd/4th years and clinicians/residents?

I don't know your school, but I would guess those aren't "real" rotations. We had "mini rotations" at UMN, but they were basically jut going in and observing. There was no true case responsibility. It's very different than fourth year. You don't need any advice; just show up and do whatever you're told to do and try and get something out of the experience.
 
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LetItSnow

Skipping the light fandango
Jan 13, 2011
19,320
18,744
Plymouth, MN, USA
animaltracks.wordpress.com
Status
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This whole thing seems to be "who is busier than whom" ... which is stupid. Everybody is generally performing to the level of their ability, which changes. When you're a first year, you couldn't wipe the butt of your patient without help. When you're a fourth year, 4-5 cases is a big load and feels overwhelming (.... LIS waits for someone to brag about how they handle X cases because they're so amazing .... yawn). When you're an intern halfway through your year, or a resident, you handle all the cases and it feels overwhelming.

Whatever. There are dick students, and there are jerk interns, and there are PITA residents. And there are great people at all those levels.

I just don't get what everyone is arguing abut. Writing SOAPs and discharges is good for you as a student. It forces you to articulate what you know about the case. I disagree with someone who said that if nobody gives you feedback it's useless - it's certainly MORE useful if you get feedback, but it's still a good learning activity even if you don't. I don't write case notes now that have a specific "S: ...., O: ...." etc, but you can be your ass that all that information is in there, and it's mostly in that order. For hospitalized patients, we do one physical exam (S!) every shift. My techs put in test results (O!). I write an assessment (A!). I put in a plan (P!). All that work you're doing as a student is preparing you to do that in the real world. Some of the doctors where I work actually do put it in bluntly as S, O, A, and P.

[Discharges are a different beast. I don't know anybody that writes as detailed of discharges in the 'real world' as in academic medicine.]

But I also agree that nobody likes busy-work, and if some resident is making you do stupid crap just because they know they can - and there are residents like that, no doubt - then yeah, it sucks.

But at the end of the day, individual rotations are short. If you're on one you don't like, just put your head down and barrel through and try to learn what you can.

And if you feel overwhelmed by the number of cases ......... then don't take as many. I had an IM rotation where we had more case-dodgers than case-takers. For the first half, I took more than my share. I got tired of it because I wasn't learning as much because it was more cases than my personal 'sweet spot' of learning. So the second week I took my fair case load and then just sat there and enjoyed the awkward silence with the case folders on the table while the case dodgers all refused to make eye contact with anyone ... and waited them out. Eventually they had to take their cases.

You get out what you put in. You also have a long way to go before rotations, so I wouldn't fret too much yet.

And also for the complainers about SOAPs...i'll tell you exactly what I tell my students. Besides being legal documentation and a great history to go back to in the future, SOAPs show us that you are doing complete physicals each day and understanding the treatments and diagnostics being performed. Senior students are so lucky in that they get one or two patients to really focus on. You know that patient better than we do most of the time. Their quirks. You can pick up on a small change and alert us to it. SOAP formatting is also exactly how you should go about thinking and verbalizing each and every case for the rest of your career.

Well said.

I have definitely seen groups who when we ask them if they want to go over something you hear crickets. There is nothing more rewarding than an engaged group of students.

Eh. That's because half the time asking gets you put on the spot when the resident turns it around and says "Ok, great, why don't you tell us what you know about X and we'll go from there." So people learn quickly to just keep their mouths shut. Residents would get more involvement if they were sensitive about not calling people out (even when it's unintentional - I think it's just super easy as a resident to forget what students know versus what residents at the top of their game know - I had a chief of service on IM once stop a resident and say "Hey now... that's resident-level knowledge. You need to go easier on them."). It's just human nature - very few people are comfortable being put on the hot seat.

you can write soaps in uvis?? wow - we really did not use that program hardly at all. discharges, lab requests, prescriptions and charges. (you can imagine what that does for the rest of the MR like soaps and surgery reports...

Our UVIS maintained Problem Lists for each patient, and you technically were supposed to SOAP each Problem once/day for hospitalized patients (for outpatient, the discharge was considered the SOAP). In practice, most of us would SOAP whatever 'group' of problems made sense, and then just put 'See Problem #1' in the SOAP for the other problems. But it was really ... sporadic how each service went about SOAPing. Critical Care made a big deal out of it and you'd sit down and have hour-long discussions with the resident about your SOAP (those residents worked their butts off for us!!!!). IM made you write them, but it was unclear if anyone read them. Surgery - half the residents didn't even know where to find the SOAPs in UVIS, and clearly didn't care if you wrote them.

Out in the real world, I don't find Problem Lists to be useful, but there are doctors in my practice who literally write out Problem Lists. I guess in the whole lumper vs splitter debate, you could say I'm an ultra-lumper - I just lump everything.






tl;dr: It would do everyone a lot of good to remember that at different stages of your career - first year, fourth year, intern, resident, whatever - you can handle different loads, and the good people are doing their best at their level, and the crappy people will do a crappy job at their level, and that's pretty much how life works. It's not fair for a resident to look down on a student because the student "only" has 3 cases when the resident has a billion, and it's not fair of the student to expect too much personalized attention from any one resident on any one case.
 
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Well, we actually have rotations starting our first year here. I'm still unclear as to the extent of what we will be doing. It sounds like a lot of observation and a lot of technique/skill development in our clinical skills lab, but I know we have some hospital rotations, too.

Does anyone have any advice for a first year that will probably feel like she's in the way of 3rd/4th years and clinicians/residents?

If your in the way, we will tell you. But your first/second clinical year is for you to observe and learn too, and your 4th year buddy is a great resource for learning. Don't be afraid to ask questions (when it is appropriate), and never complain about being tired ;)
 
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