What can med students do to make you guys like them?

[MedScat]

Incoming 3rd year med student here...starting rotations in a month. Now that rotations have been shortened and my admin told me we will be spending less time in the hospital, how do we make a lasting impression on attendings/residents? I am interested in EM and don't rotate in it until 4th year...how can I gain exposure during 3rd year and how do we impress you guys other than by not being annoying?

Also, side post - got a 233 on step, match in NYC possible? (I WANNA COME HOME!)

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[MedScat]

Honestly not being annoying and just working hard is pretty much it.

And yes you could match in NYC. But just remember if you match in NYC you’ll be doing residency both as a doctor and a nurse.

so I've heard this before about the doctor/nurse thing in NYC...can you expand? Is this even at places at NYU and Columbia Presb?

 

[Rekt]

so I've heard this before about the doctor/nurse thing in NYC...can you expand? Is this even at places at NYU and Columbia Presb?

Understaffed, superiority complexes, and laziness combined with a strong union means you get to do lots of ancillary staff/nursing things that don't contribute to your learning whatsoever. And yes, it happens at nearly ever hospital in NYC, some are a lot better than others. This has been discussed everywhere so you'll either need to rotate or research the places that have the least scut work.

 

[NYEMMED]

so I've heard this before about the doctor/nurse thing in NYC...can you expand? Is this even at places at NYU and Columbia Presb?

You will put in all the IVs, push many of the meds yourself.
You will push the patients to xray or imaging.
You will prep for all procedures (this one isn’t bad)
You will ambulate the patient if needed
You will put on the monitor leads
You will do the nebulizer treatments

basically any little tasks, the residents do them.

 

[gamerEMdoc]

Thread by @GamerEMDoc: Every year I get asked by students for tips on how to look good on their EM sub-I's. So, here you go, here are my tips on little things you…

Thread by @GamerEMDoc: Every year I get asked by students for tips on how to look good on their EM sub-I's. So, here you go, here are my tipse things you can do or not do to make a good impression. Go earn those good SLOEs... 1. Show up 10 min early to e…

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[oldiebutgoodie1211]

You will put in all the IVs, push many of the meds yourself.
You will push the patients to xray or imaging.
You will prep for all procedures (this one isn’t bad)
You will ambulate the patient if needed
You will put on the monitor leads
You will do the nebulizer treatments

basically any little tasks, the residents do them.

this is so insane haha ny residents are being abused but they signed up for it so they deserve it

 

[AlmostAnMD]

this is so insane haha ny residents are being abused but they signed up for it so they deserve it

this x1000

you have literally zero right to complain about it if you rank those places. I'd rather just scramble into some other specialty than spend all this money and time just to be a nurse with occasional medical decision making

When you're done you'll also get the privilege of working for 40/hr or whatever they're getting paid in NYC

 

[The Knife & Gun Club]

Incoming 3rd year med student here...starting rotations in a month. Now that rotations have been shortened and my admin told me we will be spending less time in the hospital, how do we make a lasting impression on attendings/residents? I am interested in EM and don't rotate in it until 4th year...how can I gain exposure during 3rd year and how do we impress you guys other than by not being annoying?

Also, side post - got a 233 on step, match in NYC possible? (I WANNA COME HOME!)

Just an about to start-PGY1, but some thoughts From when I rotated:

Golden rules:
Never lie
never be late
never speak negatively about a patient, nurse, physician, or anyone else
If someone looks sick, turn 180*, leave the room, and get an adult.
never, never, never lie. Seriously

less important stuff:

1) Be cognizant of your attendings time. Your goal should be to complicate their job as little as possible while still learning and being involved. For example, wait for a lull in the flow to ask questions about management. Try not to interupt when they’re charting.

2) if you’ve got a problem, try to couple it with a solution. For example saying “Hey the patient in hall 2 is now complaining of nausea, what do you think about giving some zofran?” Is better than “hey the guys nauseous now”

3) keep your presentations short and relevant. Have auxiliary info loaded up if they ask for it (for example you should know thePt has a history of gout, but it doesn’t need to be in the presented)

4) When presenting, be sure to include an assessment and plan. Don’t stop after the physical. Commit to a likely diagnosis, propose what tests you’d like, and what interventions you’d like. For example “I think this is gout. But it could be septic arthritis. I’d like to get a CBC, bmp, and an analysis of the joint fluid. In the mean timeI’d like to treat their pain with Tylenol”

I’m sure I’ll think of more over time.

you’re gonna do great regardless. Expectations are low for us med students.

 

[RustedFox]

this x1000

you have literally zero right to complain about it if you rank those places. I'd rather just scramble into some other specialty than spend all this money and time just to be a nurse with occasional medical decision making

When you're done you'll also get the privilege of working for 40/hr or whatever they're getting paid in NYC

Reason #452289 why NYC is teh sukk.

 

[deleted547339]

You will put in all the IVs, push many of the meds yourself.
You will push the patients to xray or imaging.
You will prep for all procedures (this one isn’t bad)
You will ambulate the patient if needed
You will put on the monitor leads
You will do the nebulizer treatments

basically any little tasks, the residents do them.

So what is it the nurses do?

 

[Fox800]

So what is it the nurses do?

Go on union-mandated breaks.

 

[The Knife & Gun Club]

So what is it the nurses do?

My understanding is that there 2 components to the problem:

1) not enough nurses. There was recently an article about Sinai having ED nursing ratios as high as 17:1! I don’t care if you’re the best nurse on the planet, at that ratio there just isn’t enough time do do all the nursing tasks. And the nursing unions have tight control over the nurse supply in the city

2) politics of promotion - because it’s near impossible to fire a nurse because of unions, often times bad nurses are “promoted” to admin roles where they do little work. That’s how you end up with more nurse admins than floor nurses, like at Sinai.

 

[NYEMMED]

So what is it the nurses do?

Honestly in NYC, ED Nurses really don’t do much. Probably aren’t needed because The residents are the backbone of the hospitals, and Those Hospitals would fall apart without residents.
Problem is reality strikes when these residents go to any non urban non academic community hospital to work.

They are great at IVs suffer a bit in doing MDM on numerous patients at once. There was no way for them to learn to handle volume doing all those extra tasks in residency. But the trade off is they usually have well known attendings teaching them and newer research trends... Each person has to decide what’s a right fit for them.

 

[gamerEMdoc]

This is unbelievable. It always shocks me how different experiences can be from place to place. My residents go in to suture, a surgery tech has set up the lac tray and has their correct glove size on the tray for them. I've never seen a resident start an IV other than US guided IV's when nurses have failed and IV team has failed or is slow to respond. Transporting patients? You have got to be kidding me. How is this a valuable use of physicians? Completely absurd.

 

[HoosierdaddyO]

So it sounds like the union has benefited the nurses... correct me if I’m wrong?! If so, then why cant what I would assume to be a smarter cohort find a way to take back their profession lol?!

 

[deleted547339]

Honestly in NYC, ED Nurses really don’t do much. Probably aren’t needed because The residents are the backbone of the hospitals, and Those Hospitals would fall apart without residents.
Problem is reality strikes when these residents go to any non urban non academic community hospital to work.

They are great at IVs suffer a bit in doing MDM on numerous patients at once. There was no way for them to learn to handle volume doing all those extra tasks in residency. But the trade off is they usually have well known attendings teaching them and newer research trends... Each person has to decide what’s a right fit for them.

aren’t the residents unionized there, too?

 

[RustedFox]

So it sounds like the union has benefited the nurses... correct me if I’m wrong?! If so, then why cant what I would assume to be a smarter cohort find a way to take back their profession lol?!

Laws.

 

[GeneralVeers]

Laws.

What if collectively the doctors (attendings and residents) simply refused to do the scut work. What would these craphole NYC hospitals do then?

 

[The Knife & Gun Club]

So it sounds like the union has benefited the nurses... correct me if I’m wrong?! If so, then why cant what I would assume to be a smarter cohort find a way to take back their profession lol?!

We’ve got a resident union down in Miami! They get us things like higher wages, dirt cheap insurance, Got us PPEwhen the crisis started, and just last week sent out instructions for how to Look up a nurses supervisor to report a bad nurse.

It’s certainly possible and I don’t know why the NYC hospitals don’t do this

 

[NYEMMED]

aren’t the residents unionized there, too?

At some hospitals yes, but only a few.
The union however is not for the residents, it is for the other hospital employees.
Since the residents are a small percentage of the unions total number and are seen as “transient”, the union really does not care about going to bat for the residents

 

[NYEMMED]

What if collectively the doctors (attendings and residents) simply refused to do the scut work. What would these craphole NYC hospitals do then?

patients would wait and die.

the physicians would get sued and the nurses would feel no pain of it...

 

[deleted859535]

Just an about to start-PGY1, but some thoughts From when I rotated:

Golden rules:
Never lie
never be late
never speak negatively about a patient, nurse, physician, or anyone else
If someone looks sick, turn 180*, leave the room, and get an adult.
never, never, never lie. Seriously

less important stuff:

1) Be cognizant of your attendings time. Your goal should be to complicate their job as little as possible while still learning and being involved. For example, wait for a lull in the flow to ask questions about management. Try not to interupt when they’re charting.

2) if you’ve got a problem, try to couple it with a solution. For example saying “Hey the patient in hall 2 is now complaining of nausea, what do you think about giving some zofran?” Is better than “hey the guys nauseous now”

3) keep your presentations short and relevant. Have auxiliary info loaded up if they ask for it (for example you should know thePt has a history of gout, but it doesn’t need to be in the presented)

4) When presenting, be sure to include an assessment and plan. Don’t stop after the physical. Commit to a likely diagnosis, propose what tests you’d like, and what interventions you’d like. For example “I think this is gout. But it could be septic arthritis. I’d like to get a CBC, bmp, and an analysis of the joint fluid. In the mean timeI’d like to treat their pain with Tylenol”

I’m sure I’ll think of more over time.

you’re gonna do great regardless. Expectations are low for us med students.

This is good advice to start with. Be receptive, humble, do something like this, and you'll be fine.

 

[GeneralVeers]

patients would wait and die.

the physicians would get sued and the nurses would feel no pain of it...

I dealt with similar nurses in LA County. Why any physicians would choose to deal with a system like that is unclear. I get that people love living in NYC, but is it really worth it when you have to work at a terrible job?

I barely have enough time to see patients, and do charting. There's simply not enough time to do IVs, and other assorted nursing/tech tasks.

 

[NYEMMED]

I dealt with similar nurses in LA County. Why any physicians would choose to deal with a system like that is unclear. I get that people love living in NYC, but is it really worth it when you have to work at a terrible job?

I barely have enough time to see patients, and do charting. There's simply not enough time to do IVs, and other assorted nursing/tech tasks.

I agree, definitely not a situation or place I want to be in...

 

[RustedFox]

I dealt with similar nurses in LA County. Why any physicians would choose to deal with a system like that is unclear. I get that people love living in NYC, but is it really worth it when you have to work at a terrible job?

I barely have enough time to see patients, and do charting. There's simply not enough time to do IVs, and other assorted nursing/tech tasks.

This was my experience (lazy nurses counting down the minutes until their next break, letting students/rezzies do the actual work) in north NJ as well.
I was SO out of there.

 

[TheComebacKid]

I don't mean to be callous, but NY has had some pretty high profile suicides of residents, likely for a reason.

Under no circumstances would I ever recommend doing residency, especially EM, in NY. While I was enamored to meet Goldfrank when I interviewed there, and see all these other "historic hospitals", the residents often seemed miserable. I wasn't blown away by the training either, but I won't bash the NY programs because I didn't rotate there and my impressions could be wrong.

One of my friends from med school is doing residency (another specialty) in NY. He has overall had significant financial hardship, his quality of life has gone down considerably, all things which are not worth dealing with as a resident.

NYC is a hell hole for a multitude of reasons, but I will avoid sharing my political and economic views here. But take it from a born and raised New Yorker. Not worth it.

 

[MedScat]

this is so insane haha ny residents are being abused but they signed up for it so they deserve it

Unfortunately my family (for reference, I'm married, hoping to have kids soon, not just sad about leaving my mommy and daddy) lives here so its either leave my family or take the abuse....great

Any hospitals AROUND NYC that are better?! this is horrifying

 

[RustedFox]

Unfortunately my family (for reference, I'm married, hoping to have kids soon, not just sad about leaving my mommy and daddy) lives here so its either leave my family or take the abuse....great

Any hospitals AROUND NYC that are better?! this is horrifying

Move your family.
Don't have kids immediately.

 

[MedScat]

Move your family.
Don't have kids immediately.

My husband has city pension job and can't move. Already doing medical school semi-long distance (me Philly him in NY). Also im old i need to have kids. Guess its nursing for me

 

[RustedFox]

My husband has city pension job and can't move. Already doing medical school semi-long distance (me Philly him in NY). Also im old i need to have kids. Guess its nursing for me

The phrase: "I'm old I need to have kids" (sic) should give you some pause. You can't have it all in this life. That's not to say that you can't have kids; but you likely can't have kids now, be a resident, and be a resident at the place you want to be all at once.

 

[HemeOncHopeful19]

My husband has city pension job and can't move.

This might actually be a good topic for a separate thread: “how much would they have to pay you to do residency in NYC?”

I suspect that for some people in this thread that number might be higher than the pension is worth . Honestly will also be interesting to see this year if NYC programs take a hit in applicant interest due to COVID

 

[MedScat]

let me rephrase, I WANT kids, not need. Ive sacrificed enough of my family planning priorities to my profession. Don't get me wrong I love medicine and have never doubted my decision, its just interesting how something such as nurses unions factor into my decision of what specialty I end up choosing in order to fulfill the things I feel are my priority. Never thought that would be the case On to the psych forum...