What do attendings expect from us?

[LadyJubilee8_18]

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I'm on my first rotation (psych) and I got my mid-rotation feedback from my attending. It was as follows: Good: "You're H&Ps are really good, you're enthusiastic, I can tell you really want to learn, you have a great ability to be empathetic with the patients, you have good rapport with the team and nurses."

Bad: "Your attention to detail needs work. I don't think you're performing at the level I'd expect from a student starting her first rotation."
Barring the fact that she's never had second years starting their first rotations, WTF? I thought as a student I was supposed to be taking good H&Ps, being enthusiastic, wanting to learn, and having a good rapport with patients/members of the team. I guess I don't understand what's expected of me. I tried to get my attending to give me more concrete examples and she just said, "There's no big thing that you did, just lots of little things." I really don't get it. As a new student, what am I supposed to be doing to perform up to the standards of an attending?

 

[mfreema1]

...because your story is confusing.

first, it's january. are you in a special program? because you said you're a 2nd year. why are you starting rotations in your 2nd year?

second - it's january. why are you starting rotations in january?

 

[Jolie South]

...because your story is confusing.

first, it's january. are you in a special program? because you said you're a 2nd year. why are you starting rotations in your 2nd year?

second - it's january. why are you starting rotations in january?

I think the OP might be at at a school with an accelerated pre-clinical program (i.e. 1.5 years preclinical, 2.5 years clerkships).

 

[colbgw02]

Maybe she expected you to spell the word "rapport" correctly.

She's just one person, so who knows what she wants or expects? Don't worry about it too much for now. If you keep getting these comments, then worry. In the meantime, just try to take charge of your patients. Act as if something won't get done unless you make sure it gets done.

 

[mashnuts]

Bad: “Your attention to detail needs work. I don’t think you’re performing at the level I’d expect from a student starting her first rotation.”

I guess I don’t understand what’s expected of me. I tried to get my attending to give me more concrete examples and she just said, “There’s no big thing that you did, just lots of little things.”

I hate feedback like that. I would actually erase all the "good" as the "bad" feedback sounds quite alarming.

I would go back and gently prod (not pester) the attending into giving better examples. Directly ask, "What's expected of me? What level are you expecting? Attention to detail in what? My history? My physical exam? My notes?"

To get feedback of "no big thing, just lots of little things" is trash. Gently push further and ask, "Like what? What kinds of little things? Could you give me an example from today? From yesterday?"

If you are really not performing up to the level of the attending's expectations on a day-to-day basis, he/she should be able to provide you with plenty of examples.

 

[Law2Doc]

"I don’t think you’re performing at the level I’d expect from a student starting her first rotation.”

This is bastard-attending-speak for -- "I don't think you are particularly good compared to your peers, but I'm too lazy to think of any examples (and maybe don't even have any)". It's a bad mid-rotation eval to get because it doesn't give you any direction to fix things. And if you already went to her for better feedback, you are SOL, because I suspect that further pestering will find its way into the final eval in some fashion ("doesn't take criticism well", "doesn't seem to understand what's expected of her"). All you can probably shoot for is a "showed improvement" eval at the end, so do your best. And don't get hung up on the one or two a-holes you will come across every now and then. Most aren't so petty.

 

[mashnuts]

It's hard to take a psych eval seriously too. My evaluator circled outstanding all down my grade sheet (not that I'm complaining).

Of course, if that grade sheet were to go under further scrutiny, I think people would find it odd that my "Ability to perform technical procedures" was rated so highly on a psych rotation.

Unless they were referring to my ability to wield a pen and run it dry within one week thanks to the daily 3+ pages of progress notes.

 

[Tired]

This is bastard-attending-speak for -- "I don't think you are particularly good compared to your peers, but I'm too lazy to think of any examples (and maybe don't even have any)".

She should have given examples, but I think sometimes these evals are generated by an overall impression that students give, rather than specific incidents. The student who chronically shows up to rounds 30 seconds late, has to flip through a stack of papers to find the correct H&P, stammers a lot when presenting, can't answer many pimp questions, and asks too many simple questions isn't really doing anything particularly wrong. But they also obviously aren't the best student.

Some day attendings will learn to write honest evals that say, "This student was neither particularly useful to the team, nor very pleasant to be around. He/she was mediocre in both personality and scholastic ability. I will forget his/her name and face five minutes after the end of the block, and it will not impact my team or my patients one iota to have them gone."

 

[domer621]

This is bastard-attending-speak for -- "I don't think you are particularly good compared to your peers, but I'm too lazy to think of any examples (and maybe don't even have any)".

Exactly.

Welcome to 3rd year (or 1.5 year?).

 

[mashnuts]

She should have given examples, but I think sometimes these evals are generated by an overall impression that students give, rather than specific incidents. The student who chronically shows up to rounds 30 seconds late, has to flip through a stack of papers to find the correct H&P, stammers a lot when presenting, can't answer many pimp questions, and asks too many simple questions isn't really doing anything particularly wrong. But they also obviously aren't the best student.

True but it wouldn't be too hard to rattle off this list for that student.

"I expect you to show up on time, I expect you to be prepared, I expect you to give a fluid presentation at rounds, I expect you to read, and I expect you to ask appropriate questions."

With that kind of explanation, then you can justify telling a student "You are performing below expectations."

 

[Law2Doc]

She should have given examples, but I think sometimes these evals are generated by an overall impression that students give, rather than specific incidents. The student who chronically shows up to rounds 30 seconds late, has to flip through a stack of papers to find the correct H&P, stammers a lot when presenting, can't answer many pimp questions, and asks too many simple questions isn't really doing anything particularly wrong. But they also obviously aren't the best student.

Some day attendings will learn to write honest evals that say, "This student was neither particularly useful to the team, nor very pleasant to be around. He/she was mediocre in both personality and scholastic ability. I will forget his/her name and face five minutes after the end of the block, and it will not impact my team or my patients one iota to have them gone."

See, I think such attendings sort of are missing their role in a mid-rotation evaluation, which is to get the med student back on track. It's not useful to say a student sucks (or what you wrote above). There's value to constructive criticism, but no value to just being critical. All med students who get to rotations are going to become doctors, whether an attending or two likes it or not. The window of opportunity to push someone out of this career path came and went years ago. So an attending saying someone isn't at the level they should be in a rotation isn't really adding any value, and the attending doesn't understand their role. If anything, they are going to make such a person worse not better, because they are creating a degree of insecurity and self doubt, but no real direction to learn from. Instead of adding value, they are subtracting. The med student is now worse off then when they started -- the attending has now added to the neurosis in the profession, but has passed the buck on actually teaching to whomever the next attending may be. Basically the attending is not doing his/her job at a teaching hospital. Doesn't matter how lousy the med student is, and what grade the student will eventually be given, the attending's role is still to leave them better then whence they found them. Otherwise they go on to be lousy residents, and eventually lousy attendings, and the cycle will continue.

If an attending said, this person isn't where they should be yet, but I'm going to ride them for the next few weeks and see if we can fix things, then one could accept and respect that. Or an evaluation spelling out areas the person is weak in and should work on, a road-map to improvement. But an eval which is the equivalent of "I don't like her" is a waste.

 

[LadyJubilee8_18]

She should have given examples, but I think sometimes these evals are generated by an overall impression that students give, rather than specific incidents. The student who chronically shows up to rounds 30 seconds late, has to flip through a stack of papers to find the correct H&P, stammers a lot when presenting, can't answer many pimp questions, and asks too many simple questions isn't really doing anything particularly wrong. But they also obviously aren't the best student.

Some day attendings will learn to write honest evals that say, "This student was neither particularly useful to the team, nor very pleasant to be around. He/she was mediocre in both personality and scholastic ability. I will forget his/her name and face five minutes after the end of the block, and it will not impact my team or my patients one iota to have them gone."

Ok, here’s the deal. I’m on the psych consult team, and it’s very unstructured. I spent the first two weeks just trying to figure out what I was supposed to be doing. No one really sat us down and told us our roles as medical students, we just sort of had to do stuff and hope it was right. If it was wrong, we’d be corrected. So I’m just starting and I’m carrying 4-5 patients at a time, I’ve got to call family members to get collateral information, send out release of medical records forms, red flag people to outpatient clinics, update the patient list twice a day, get rules for when certain behaviors have to be reported, etc. I’ve been called on doing things wrong that I was never told not to do. For example, I’d called a pt’s mom to get info on where he’d been committed before, and she didn’t pick up the phone. I left a message for her to call us back at the office phone. Apparently, we aren’t supposed to give out our office number because families would just call us all the time. I understand why I shouldn’t have done that, but I would have liked to be told before hand. Also, I’m sure some of my pt presentations have been poor for reasons I feel were either partially or completely beyond my control. Once I didn’t get a full history because my patient was Spanish only, and the translators blew me off all morning. Another time I got in trouble for not knowing how the primary team changed my pt’s meds because the pt went off to X-ray and they took the chart while I was interviewing him so I didn’t get a chance to write the med levels before rounds. Another time I got a consult thirty minutes before rounds. I went to do the interview, but didn’t have time to write a note, so I had to dream up the H&P for the first time in front of my attending. Just today, I have a patient who won’t talk to us because he’s angry we saved his life. I was supposed to get more information from his sister, but she didn’t pick up the phone in the morning. I was told to go home and call on my cell, and she still didn’t pick up. Now I’m going to have to present a sparse history to my attending at rounds tomorrow. I’m not sure how to rectify these issues, but I also don’t want to look like a ***** in front of my attending. Any suggestions?

 

[LadyJubilee8_18]

Maybe she expected you to spell the word "rapport" correctly.

She's just one person, so who knows what she wants or expects? Don't worry about it too much for now. If you keep getting these comments, then worry. In the meantime, just try to take charge of your patients. Act as if something won't get done unless you make sure it gets done.

Thanks for making me feel more like an ass, I'm sure I don't feel bad enough right now

 

[LadyJubilee8_18]

...because your story is confusing.

first, it's january. are you in a special program? because you said you're a 2nd year. why are you starting rotations in your 2nd year?

second - it's january. why are you starting rotations in january?

my school only has 1.5 years of basic sciences

 

[haveaniceday]

Ok, here’s the deal. I’m on the psych consult team, and it’s very unstructured. I spent the first two weeks just trying to figure out what I was supposed to be doing. No one really sat us down and told us our roles as medical students, we just sort of had to do stuff and hope it was right. If it was wrong, we’d be corrected. So I’m just starting and I’m carrying 4-5 patients at a time, I’ve got to call family members to get collateral information, send out release of medical records forms, red flag people to outpatient clinics, update the patient list twice a day, get rules for when certain behaviors have to be reported, etc. I’ve been called on doing things wrong that I was never told not to do. For example, I’d called a pt’s mom to get info on where he’d been committed before, and she didn’t pick up the phone. I left a message for her to call us back at the office phone. Apparently, we aren’t supposed to give out our office number because families would just call us all the time. I understand why I shouldn’t have done that, but I would have liked to be told before hand. Also, I’m sure some of my pt presentations have been poor for reasons I feel were either partially or completely beyond my control. Once I didn’t get a full history because my patient was Spanish only, and the translators blew me off all morning. Another time I got in trouble for not knowing how the primary team changed my pt’s meds because the pt went off to X-ray and they took the chart while I was interviewing him so I didn’t get a chance to write the med levels before rounds. Another time I got a consult thirty minutes before rounds. I went to do the interview, but didn’t have time to write a note, so I had to dream up the H&P for the first time in front of my attending. Just today, I have a patient who won’t talk to us because he’s angry we saved his life. I was supposed to get more information from his sister, but she didn’t pick up the phone in the morning. I was told to go home and call on my cell, and she still didn’t pick up. Now I’m going to have to present a sparse history to my attending at rounds tomorrow. I’m not sure how to rectify these issues, but I also don’t want to look like a ***** in front of my attending. Any suggestions?

Welcome to 3rd year! This is the exact litany of exasperations each and every 3rd year med student across the country experiences at one time or another. Very rarely will you be told your role as the medical student, when you do it is golden. Part of med school is learning how to be resourceful and to use common sense in certain situations. This is a skill you must have throughout your career, so take these opportunities to refine it. The best evals I've received involve attendings commenting on my ability to get things done in the face of normal obstacles encountered in medicine.

The attending knows that it is difficult to get info about patients and your h&p's are going to be limited for that reason. So, what they are looking for is a student who works with the info they have and still formulates a good assessment and plan based on that. Don't make excuses, present the info as you know it...and don't blame others.

Again, 3rd year is hard for everyone and you are experiencing exactly why. It isn't the material or the hours. It is exactly the frustrations you are experiencing.

I also agree with what Tired wrote, so pay attention to that kind of stuff. Present yourself as someone others would like to work with, because in the end the attendings are just at work (albeit in a teaching role) and I'm sure it is nice to have students who are involved and easy to work with.

 

[DoctorFunk]

No one really sat us down and told us our roles as medical students, we just sort of had to do stuff and hope it was right. If it was wrong, we’d be corrected. So I’m just starting and I’m carrying 4-5 patients at a time...

Even if they don't spell out your duties for you, it is your responsibility to ask someone what exactly your role on the team should be. Are there any interns or residents working with you? If so, ask them how you can maximally contribute to the team, and at the same time ask for their midterm feedback. If they spontaneously repeat things mentioned by your attending then consider that skill a legitimate thing to work on.

I also think that it is ludicrous to expect a student in their first rotation to carry 4-5 patients, even if they are consults. You should really probably be restricting yourself to 1-2 patients at this point, trying to work up to 3 or 4 if you're a superstar at the end of the month. It takes time to learn how to efficiently write consult notes and play phone tag with others to get the info you need. Perhaps you've bitten off more than you can chew at this point and you need to take a step back and reassess your patient load.

 

[Ypo.]

This happens to everyone. In a few months you will look back at this and wonder why you let it get you so bent out of shape. By the end of the year, you will have learned how to avoid evaluations like this. Attendings don't have realistic expectations sometimes, because they have no clue what level we are supposedto be functioning at. Sometimes they only notice when you aren't functioning close to an intern's or resident's level, because that's what they are most used to dealing with.

It sounds like they are not making their expectations clear, which is actually not uncommon for third year. I've had that happen to me more than a handful of times, so I hate to say it, but you have to learn how to function without being told what to do, and how to make your educational experience worthwhile while still making yourself look good. Fourth years know how to make themselves look good with the minimum amount of effort. You'll get the hang of it eventually. It's really a game like anything else. In the meantime, know that your frustration is shared. YOU know you are a good student, even if some random attending who has no idea how to give a proper evaluation doesn't. However, there is still something you can learn from that evaluation, even if it means talking to the attending, so don't completely blow it off. The best way to get feedback is to ask them before they write the eval; that way they know you are trying and they remember it when they go to write the eval.

 

[Acherona]

Just today, I have a patient who won’t talk to us because he’s angry we saved his life. I was supposed to get more information from his sister, but she didn’t pick up the phone in the morning. I was told to go home and call on my cell, and she still didn’t pick up. Now I’m going to have to present a sparse history to my attending at rounds tomorrow. I’m not sure how to rectify these issues, but I also don’t want to look like a ***** in front of my attending. Any suggestions?

Most of third year is like this. Very very frustrating. What i've found is the best strategy in cases like these is to first of all *never* remind the person who assigned you the task that you were unable to do it. 80% of the time they will not remember they asked you so don't bring it up. If they do ask, do not become defensive, *do not* go into how you tried to call 5 times but the sister never picked up unless you are asked for detail. Depending on how much history you do have, either just present the info you have, or put in one phrase that history was limited due to the patient being a "poor historian" or due to "limited communication". This happens *all the time* with patients so if you present it properly it will not even cross their minds that it has anything to do with you. Be confident and understand the big picture about why this patient is behaving the way he is and what the differential is.

 

[LadyJubilee8_18]

Most of third year is like this. Very very frustrating. What i've found is the best strategy in cases like these is to first of all *never* remind the person who assigned you the task that you were unable to do it. 80% of the time they will not remember they asked you so don't bring it up. If they do ask, do not become defensive, *do not* go into how you tried to call 5 times but the sister never picked up unless you are asked for detail. Depending on how much history you do have, either just present the info you have, or put in one phrase that history was limited due to the patient being a "poor historian" or due to "limited communication". This happens *all the time* with patients so if you present it properly it will not even cross their minds that it has anything to do with you. Be confident and understand the big picture about why this patient is behaving the way he is and what the differential is.

I got a bit of vindication yesterday! I learned that being a good medical students means shutting up and doing your work. I typed out my H&Ps based on what I knew and brought them on a flash drive, so I could easily change them based on the new labs and resident's comments. I practiced presenting to my fiance the night before. I got two new patients, so I got to present two separate H&Ps in front of my attending and I nailed them! I finally talked to that family and wrote a soap note in about 30min, got the pt to sign a release of records form, and spoke to the family about helping us get an emergency detention order. By the end of the day, everything was squared away and my residents had to do very little for my pts. My Attending was finally impressed with my work. I was a bit offended because she seemed surprised I could do so well, but whatever. I'm still happy, maybe I'm figuring out what to do in rotations.

Edit: also this is very good advice. Before I'd been letting people know if I couldn't get info and why, but they really don't want to hear that. I feel like I'm being dishonest if I don't tell them, but yesterday I just worked with what I got and it worked out well. Thanks

 

[LadyJubilee8_18]

Even if they don't spell out your duties for you, it is your responsibility to ask someone what exactly your role on the team should be. Are there any interns or residents working with you? If so, ask them how you can maximally contribute to the team, and at the same time ask for their midterm feedback. If they spontaneously repeat things mentioned by your attending then consider that skill a legitimate thing to work on.

I also think that it is ludicrous to expect a student in their first rotation to carry 4-5 patients, even if they are consults. You should really probably be restricting yourself to 1-2 patients at this point, trying to work up to 3 or 4 if you're a superstar at the end of the month. It takes time to learn how to efficiently write consult notes and play phone tag with others to get the info you need. Perhaps you've bitten off more than you can chew at this point and you need to take a step back and reassess your patient load.

I think carrying that many patients is ludicrous too, but that's what I've been given. When pt's come in, we get assigned to them and get to work.

 

[Top Gun]

I got a bit of vindication yesterday! I learned that being a good medical students means shutting up and doing your work. I typed out my H&Ps based on what I knew and brought them on a flash drive, so I could easily change them based on the new labs and resident's comments. I practiced presenting to my fiance the night before. I got two new patients, so I got to present two separate H&Ps in front of my attending and I nailed them! I finally talked to that family and wrote a soap note in about 30min, got the pt to sign a release of records form, and spoke to the family about helping us get an emergency detention order. By the end of the day, everything was squared away and my residents had to do very little for my pts. My Attending was finally impressed with my work. I was a bit offended because she seemed surprised I could do so well, but whatever. I'm still happy, maybe I'm figuring out what to do in rotations.

Edit: also this is very good advice. Before I'd been letting people know if I couldn't get info and why, but they really don't want to hear that. I feel like I'm being dishonest if I don't tell them, but yesterday I just worked with what I got and it worked out well. Thanks

Sounds like you're beginning to get a handle on your responsibilities as a third-year med student. Keep up the good work, and I'm sure it will reflect well in your final eval.

 

[Droopy Snoopy]

I got a bit of vindication yesterday! I learned that being a good medical students means shutting up and doing your work. I typed out my H&Ps based on what I knew and brought them on a flash drive, so I could easily change them based on the new labs and resident's comments. I practiced presenting to my fiance the night before. I got two new patients, so I got to present two separate H&Ps in front of my attending and I nailed them! I finally talked to that family and wrote a soap note in about 30min, got the pt to sign a release of records form, and spoke to the family about helping us get an emergency detention order. By the end of the day, everything was squared away and my residents had to do very little for my pts. My Attending was finally impressed with my work. I was a bit offended because she seemed surprised I could do so well, but whatever. I'm still happy, maybe I'm figuring out what to do in rotations.

Edit: also this is very good advice. Before I'd been letting people know if I couldn't get info and why, but they really don't want to hear that. I feel like I'm being dishonest if I don't tell them, but yesterday I just worked with what I got and it worked out well. Thanks

Sounds good. Most of the other problems you mentioned above will be solved in a similar fashion. The rest you just have to say f it -- do the best you can and be satisfied with that.

 

[ms. a]

I got a bit of vindication yesterday! I learned that being a good medical students means shutting up and doing your work. I typed out my H&Ps based on what I knew and brought them on a flash drive, so I could easily change them based on the new labs and resident's comments. I practiced presenting to my fiance the night before. I got two new patients, so I got to present two separate H&Ps in front of my attending and I nailed them! I finally talked to that family and wrote a soap note in about 30min, got the pt to sign a release of records form, and spoke to the family about helping us get an emergency detention order. By the end of the day, everything was squared away and my residents had to do very little for my pts. My Attending was finally impressed with my work. I was a bit offended because she seemed surprised I could do so well, but whatever. I'm still happy, maybe I'm figuring out what to do in rotations.

Edit: also this is very good advice. Before I'd been letting people know if I couldn't get info and why, but they really don't want to hear that. I feel like I'm being dishonest if I don't tell them, but yesterday I just worked with what I got and it worked out well. Thanks

That's great! The Taub is definitely a sink or swim place, and it looks like you're starting to swim. That's really unfortunate that you had to start off with a more difficult attending. I'm glad that you were able to show them what you are capable of before you go to a new site on Monday. The advice in your edit is very good. Psych especially is hard, in terms of getting info, and I've heard that the Taub consult service is one of the hardest. Luckily I never was on it, but I had friends that were. Saying things like "pt is unable to recall" or "due to limited communication" is much better than detailing your frustrations for your attending. Where are you for your next psych month?

 

[LadyJubilee8_18]

That's great! The Taub is definitely a sink or swim place, and it looks like you're starting to swim. That's really unfortunate that you had to start off with a more difficult attending. I'm glad that you were able to show them what you are capable of before you go to a new site on Monday. The advice in your edit is very good. Psych especially is hard, in terms of getting info, and I've heard that the Taub consult service is one of the hardest. Luckily I never was on it, but I had friends that were. Saying things like "pt is unable to recall" or "due to limited communication" is much better than detailing your frustrations for your attending. Where are you for your next psych month?

I'm going to the VA next for outpatient. Are you a Baylor student too?

 

[doctorperez]

I'm going to the VA next for outpatient. Are you a Baylor student too?

Congrats on your improvements!
If you go by radiology, please tell Dr. Gomez I said hi 🙂

 

[ms. a]

I'm going to the VA next for outpatient. Are you a Baylor student too?

4th year (see my sig?). I recall most people enjoying the VA. Ben Taub consult was always the worst one. Long hours and, well, Taub is just hard to start off with - for any rotation. You'll get the hang of it, trust me!

Depending on when you do peds, I may be your intern next year!

 

[jocg27]

See, I think such attendings sort of are missing their role in a mid-rotation evaluation, which is to get the med student back on track. It's not useful to say a student sucks (or what you wrote above). There's value to constructive criticism, but no value to just being critical. All med students who get to rotations are going to become doctors, whether an attending or two likes it or not. The window of opportunity to push someone out of this career path came and went years ago. So an attending saying someone isn't at the level they should be in a rotation isn't really adding any value, and the attending doesn't understand their role. If anything, they are going to make such a person worse not better, because they are creating a degree of insecurity and self doubt, but no real direction to learn from. Instead of adding value, they are subtracting. The med student is now worse off then when they started -- the attending has now added to the neurosis in the profession, but has passed the buck on actually teaching to whomever the next attending may be. Basically the attending is not doing his/her job at a teaching hospital. Doesn't matter how lousy the med student is, and what grade the student will eventually be given, the attending's role is still to leave them better then whence they found them. Otherwise they go on to be lousy residents, and eventually lousy attendings, and the cycle will continue.

If an attending said, this person isn't where they should be yet, but I'm going to ride them for the next few weeks and see if we can fix things, then one could accept and respect that. Or an evaluation spelling out areas the person is weak in and should work on, a road-map to improvement. But an eval which is the equivalent of "I don't like her" is a waste.

👍 good post...

 

[LadyJubilee8_18]

4th year (see my sig?). I recall most people enjoying the VA. Ben Taub consult was always the worst one. Long hours and, well, Taub is just hard to start off with - for any rotation. You'll get the hang of it, trust me!

Depending on when you do peds, I may be your intern next year!

I'm on peds next, which sucks because I want to do Neonatology, and I wanted to do peds next year. I think I can pull it off though. I'm trying to get peds at TCH so I can do neo there.

 

[Marigold]

Just wanted to add that a lot of the frustration you are feeling comes from being a brand new wards student. I, too, felt totally clueless during my first rotation (Taub OB/GYN...I'm a Baylor 4th year) but once I kinda got the hang of things, it was better. Honestly, I felt clueless (although less and less as time went on) for the first couple of days of every new rotation, just because you have to figure out how they do things in that specialty and conform accordingly. It sounds like you're figuring things out, though! As Ms. A said, consult at Taub is pretty notorious for being one of the more difficult rotations...I think outpt at the VA will be better for you.

And, if it makes you feel any better, Psych was my last core rotation (did it back in April/May of 2007) and even though I was at the end of third year, experienced, doing what I thought was a good job, I still got kind of a weird eval from my attending. And one of my fellow 4th years also did Psych recently and got a strange eval. Maybe there's a pattern here? 🙂

 

[ms. a]

I'm on peds next, which sucks because I want to do Neonatology, and I wanted to do peds next year. I think I can pull it off though. I'm trying to get peds at TCH so I can do neo there.

I wouldn't worry about that too much. Fortunately, Peds people are much better than Psych people in general. As a whole, they are all much more willing to help out and explain/teach you things. Don't get too caught up in where you are doing which peds rotation. Everyone does a month at Taub and a month at TCH. One month is wards, one is 2 weeks neo, 2 weeks clinic. So one of your months will definitely be at TCH. Neo at Ben Taub is definitely less busy than at TCH, but you see the same attendings and get to know your babies perhaps a little more. The only bad possibility is if you get neo at 12 Oaks, which is notoriously boring. It's great on your schedule, but you learn squat. Just show up, be interested and ready to learn. They'll love you.

 

[roja]

Keep in mind that the vast majority of attendings don't really know how to give constructive criticism. And while this may just be one person, there might be truth in what is being said (I would be shocked if it wasn't bieng this is your first rotation).

So, what do attendings expect (get a glass ball....) but in general, this is what they should expect: show up on time, work hard while you are there, get along with people, show interest. when you are given feedback, respond to it. Think about your patients and say what you have been thinking (no one expects for you to be right, just that you are thinking about your patients). that you take initiative and read and follow up on your patients (this often will set one apart).

When you get mixed feedback, or feedback that doesn't really make sense, go to the attending and ask for specific ways to improve. So in your case, say: I was wondering if you could give me some examples of ways I could improve my organization.

Best of luck!

 

[Anka]

I think the most important, and most oft missed, piece of advice is NEVER MAKE EXCUSES. Never even come close to making an excuse. Making excuses is the fastest way to be marginalized as a medical student. It also makes you appear more incompetant than you are. Here are some cases.

CASE I
MS3: I tried to find out whether she had family by calling her home, but no one picked up, and then I called her school, but it was closed for the day. Finally, I asked her whether she had any family, but she wouldn't talk to me...
Comment: This is making an excuse.

Redo: No family could be found.
Comment: Despite what your English teacher told you, the passive voice is extremely useful in medicine.

CASE II
Resident: Fill out Ms. Homeless's discharge paperwork.
MS3: Oh... no one showed me how to do that yet.
Comment: This is making an excuse [I can't because no one has showed me how to do it].

Redo:
Resident: Fill out Ms. Homeless's discharge paperwork.
MS3: Yes,sir.
[run off to find nearest RN or intern...]
MS3: I'm trying to figure out how to fill out discharge paperwork... can you help me?
RN: Oh, sure, here's the forms!
[MS3 fills out forms, brings them to the resident]
MS3: Could you check this discharge paperwork for Ms. Homeless?
Resident: Sure. [stares for a minute]. Can't you even fill out a simple form? I mean, she needs wound care, obviously.
MS3: Okay. I'll call social work...
Comment: Notice, it is better to be wrong than to make an excuse... and the response to having a mistake pointed out is to tell them what solution you are going to implement. This will keep you from making an excuse.

Case III

Attending: Retract!
MS3: [can't see field, struggles to retract]
Attending: You know, I can operate better if I can see what I'm doing.
MS3: I'm trying, I can't see the field!

Comment: EXCUSE!!! yes, a completely reasonable one. But resist!

Redo
Attending: Retract!
MS3: [can't see field, struggles to retract]
Attending: You know, I can operate better if I can see what I'm doing.
MS3: Yes, sir. [Struggles to retract]
Attending: *sigh* *foot stomp* *sigh* EXPOSE THE FIELD!!!!
MS3: [Adjust retractor]
Attending: Can't you even retract? A monkey can retract.
MS3: Yes, sir. [Adjust retractor]
Attending: Okay, I don't know how else to tell you this, but get the bowel out of my way so I can see what I'm doing.
MS3: Yes ,sir.

Comment: You'll notice this is very repetative. It costs you far less psychic energy to say "yes sir" and try to do what he's telling you to do, then start making excuses and still not be able to do what he's telling you to do. So, just keep trying and saying yes sir.

Now, does this sort of thing happen often? No. But when it does don't make excuses.

Best,
Anka

 

[Ypo.]

Anka, that was an excellent post. 👍

It took me about 4 months to figure that all out. It was a hard lesson to learn (hope I'm not alone). You stated it very well in several paragraphs.

 

[jocg27]

I Case III

Attending: Retract!
MS3: [can't see field, struggles to retract]
Attending: You know, I can operate better if I can see what I'm doing.
MS3: I'm trying, I can't see the field!

Comment: EXCUSE!!! yes, a completely reasonable one. But resist!

Redo
Attending: Retract!
MS3: [can't see field, struggles to retract]
Attending: You know, I can operate better if I can see what I'm doing.
MS3: Yes, sir. [Struggles to retract]
Attending: *sigh* *foot stomp* *sigh* EXPOSE THE FIELD!!!!
MS3: [Adjust retractor]
Attending: Can't you even retract? A monkey can retract.
MS3: Yes, sir. [Adjust retractor]
Attending: Okay, I don't know how else to tell you this, but get the bowel out of my way so I can see what I'm doing.
MS3: Yes ,sir.

Comment: You'll notice this is very repetative. It costs you far less psychic energy to say "yes sir" and try to do what he's telling you to do, then start making excuses and still not be able to do what he's telling you to do. So, just keep trying and saying yes sir.

Now, does this sort of thing happen often? No. But when it does don't make excuses.

Best,
Anka

LOL...hilarious...

but I do have to say that if this is not a frequent occurence, then the student is getting pretty lucky. This was exactly my surgery rotation, every day, for two months.

I'd add:
Attending: You're moving the camera again.
Me: (watching my hand, which to my eye is stably supported and not moving a bit, and watching the view on the screen, which also does not appear to be moving to my admittedly uneducated eye) Yes, sir.
Attending: Okay, I don't know how else to tell you this, but what I need you to do is hold this camera, right here, perfectly still. Play statue. Don't move for anything.
Me: Yes, sir.
Attending: Look, I don't know how else to tell you this, but I don't know what you're even looking at. We moved, you need to adjust. You need to keep us exactly in the center of the screen, no matter where we go.
Me: Yes, sir.
Attending: Why the hell is the camera moving so much?
Me: Yes, sir.

The man gave me hell every surgery of every day, and wrote my best eval of the year, including 'a great performance in the OR.' I'm over halfway through the year and still have no idea how to even begin to answer the original question about what attendings expect from us; I don't think I'll ever really know. But really the closest I've been able to come is to try as hard as you can, keep trying even if (when) you screw up, and as said above, don't complain, don't make excuses...

 

[bjackrian]

Redo
Attending: Retract!
MS3: [can't see field, struggles to retract]
Attending: You know, I can operate better if I can see what I'm doing.
MS3: Yes, sir. [Struggles to retract]
Attending: *sigh* *foot stomp* *sigh* EXPOSE THE FIELD!!!!
MS3: [Adjust retractor]
Attending: Can't you even retract? A monkey can retract.
MS3: Yes, sir. [Adjust retractor]
Attending: Okay, I don't know how else to tell you this, but get the bowel out of my way so I can see what I'm doing.
MS3: Yes ,sir.

Heh. I had this exact conversation with an OB attending. He looked at me like he wasn't sure quite what to do with me since I was polite, but obviously wasn't in any way helpful to him. It was an awkward moment.

 

[Anka]

Yeah... at some point they either need to get a higher level retractor in there or tolerate the best you can do. As far as it not being common -- it's because I'm such a kick ass retractor that I can usually keep the field clear 😉

Anka

 

[Blade28]

Don't be afraid to ask the attending exactly what he/she wants. You can ask:

Pull harder/lighter?
Toe in?
Is my retractor in the right place?

Etc.

 

[persia]

I think what Law2 posted was very accurate and right on. There is alot of truth in those comments.

OP, welcome to third year. It can seem very strange and brutal at times but do your best to not take things personally. If someone is not teaching or is a poor clinician or whatever, do your best to go around them and still maintain a friendly professional attitude. Sometimes the best you can do is to be soft, friendly and SMILE as much as you can. Be amiable and easy going when someone is being strange or rude. I really like the 'yes, sir' line alot! 😉

As the year goes along, you will learn more and more about how to teach yourself things or to find efficient shortcuts or whatever. You will improve your skills and then other people's behavior will bother you less and less since you will be less dependent on them for teaching.

It can be a very hard introduction when you first start on the wards, there is not much that can compare to this system of education. Do your best to protect your selfesteem, and be detached, and you will start to figure out ways to interact with different attendings. After a while, you will feel more comfortable being yourself AND being able to ask: do you want me to do it this way, or that way, sir? Hang in there. 👍