What do you expect of a resident?

[GeneGoddess]

---

Members do not see this ad.

Since I am finally "one of them", I wanted to get some opinions of what third year students expects from us. In my currect rotation, I'm getting new students every week, so it's not a month thing. I think egotistical pimping is utterly useless, but I love teaching. If I ask a question you don't know, I want you to walk away thinking, "Wow...I didn't know that!" instead of "What a complete witch! Why would she ask that?"

So, besides asking "What would you like to learn/do this week?" and "What specialty are you interested in?", what would you guys most like from a resident?

 

[Pox in a box]

Since I am finally "one of them", I wanted to get some opinions of what third year students expects from us. In my currect rotation, I'm getting new students every week, so it's not a month thing. I think egotistical pimping is utterly useless, but I love teaching. If I ask a question you don't know, I want you to walk away thinking, "Wow...I didn't know that!" instead of "What a complete witch! Why would she ask that?"

So, besides asking "What would you like to learn/do this week?" and "What specialty are you interested in?", what would you guys most like from a resident?

Learn their names. It's sad that people can memorize a patient's disease but can't remember their patients' name. The same is true with students. It gets on my nerves when someone refers to me as "You," especially if I've been working with this person all day or more than a few days.

 

[kam730]

Please just try to remember what it was like as a med student, esp. a 3rd year when you don't know anything. As a brand new 3rd year (first week) I am having trouble getting residents to answer basic questions such as how do I get a path report or how do you want the labs written up or where do I find what meds a patient is on. I mean, I have barely ever been in a hospital let alone worked in one. Not that its entirely the fault of the residents...I don't understand why there couldn't be some kind of "orientation to how hospitals work", just simple stuff, like how to look up patient records, how to write orders, read charts, I mean it would only take a day or two, but everyone just assumes you know how to do all that even though I have never touched a patient chart until 4 days ago. Sigh...sorry for the rant, it has just been a frustrating first week. I am so far behind on reading, because I have spent most of my free time just trying to figure out how to do basic tasks that everyone assumes I know how to do.

 

[oompaloompa]

I think the fact that you actually care if you're doing a good job or not already tells me you're one of "the good ones". Fortunately my resident is awesome and very helpful, but not all of my friends are so lucky. One of my friends feels like her resident treats her like "the help". Of course, as students we know we're subordinate to you, but it's the beginning of third year, we're already scared sh*tless and there's really no need to further intimidate us or buy into that whole "academic hazing" culture. One specific tip I heard is if you are going to "pimp" is to start out easy and then if you sense the student knows more about the subject, continue along that line. Even if the student doesn't know precise details, they can at least build from an existing knowledge base. It will be easier to remember after going through the basic facts and plus - it won't be as big an ego blow since the student might have gotten something right. I think pimping on highly detailed, specific subjects is not only very stressful, but also useless if you don't know the basic info (and don't assume we do!)
Thanks for taking an interest in helping us, I know your job doesn't require it, but it's nice to see a friendly face when you're a novice third year in a scary new environment!

 

[greets fr. nyc]

highly effective resident (and beautiful also!) did the following things during my stint on her team:

1) met w/ me for 5 minutes to explain what was expected of me
2) explained what she felt her role was / answered any of my questions.
* number 1 and 2 were crucial = set up good communication and laid down the expectations and responsibilities. they didn't take long either.

3) mentioned good resources to read/use during rotation
4) if she didn't know the answer she would say just that.
5) explained her reasoning of why she was ordering things / thinking certain things (ddx / etc)
6) was curious about medicine and fun to just chill with.
7) treated her patients with humanity (you don't know how big an effect role models are sometimes )
8) when something serious came up (after a code / pt dying / family meeting); the resident would have a quick debriefing with us medical students. nothing long, but just to review what happened and to re-mention that the lines of communication were open if anybody wanted to discuss something later on...

that resident was tops!

----------

9) further on in the year: this became also key: (another resident) would basically say to me, "what do you think we should do?" and "try to go thru your reasoning with me" and then he would order the things i had said. pretty darn quick I took on the responsibility to really get my thinking together so as to not screw someone up. scary but highly effective~! (of course he would also order the stuff i missed saying)

then over the course of the next week I was pretty much operating on the level of a sub-I working in concert with him for my patients (he was a R2 so he was responsible of course for the two other intern's load too, but we would all get together at various points in the day to "run the list"). tough, but a real learning experience.


best of luck, 😀



~! woo hooo , 4th year here I come!

 

[fuzzyerin]

Please just try to remember what it was like as a med student, esp. a 3rd year when you don't know anything. As a brand new 3rd year (first week) I am having trouble getting residents to answer basic questions such as how do I get a path report or how do you want the labs written up or where do I find what meds a patient is on. I mean, I have barely ever been in a hospital let alone worked in one. Not that its entirely the fault of the residents...I don't understand why there couldn't be some kind of "orientation to how hospitals work", just simple stuff, like how to look up patient records, how to write orders, read charts, I mean it would only take a day or two, but everyone just assumes you know how to do all that even though I have never touched a patient chart until 4 days ago. Sigh...sorry for the rant, it has just been a frustrating first week. I am so far behind on reading, because I have spent most of my free time just trying to figure out how to do basic tasks that everyone assumes I know how to do.

Kam, just remember that some of the interns you're working with right now are going through the exact same thing. I'm still learning my new hospital's system, I have no idea what orders I'm supposed to write, the charts are in a different order than they were when I was in medical school, and the computer system is both antiquated and confusing. I keep wondering what it is that I know that I could even begin to teach a third year medical student! Now, if it's an upper level resident, that's a different story.

 

[Ramoray]

it would be nice if a resident was hot and put herself together each day, i think it would make a tiring day go alot better if you had a hottass resident to work with all day, would realllly make it easier to get up at 5am i suspect. so maybe go tanning on your spare time and get a makeover before your next batch of students? IMO peace

 

[nutmegs]

Having done this for a grand total of 3 days, I really wish my residents would give me a little more of an idea of what students typically DO on that service... I often find myself wondering if I should be doing more/something else. It's one of downsides of being on a pretty laid back, cool service...

 

[Smurfette]

Kam, just remember that some of the interns you're working with right now are going through the exact same thing. I'm still learning my new hospital's system, I have no idea what orders I'm supposed to write, the charts are in a different order than they were when I was in medical school, and the computer system is both antiquated and confusing. I keep wondering what it is that I know that I could even begin to teach a third year medical student! Now, if it's an upper level resident, that's a different story.

I know the feeling. I barely know what's going on...hopefully later this week once the students come I'll have a better handle on everything.

 

[klubguts]

Kam, just remember that some of the interns you're working with right now are going through the exact same thing. I'm still learning my new hospital's system, I have no idea what orders I'm supposed to write, the charts are in a different order than they were when I was in medical school, and the computer system is both antiquated and confusing. I keep wondering what it is that I know that I could even begin to teach a third year medical student! Now, if it's an upper level resident, that's a different story.

This is so TRUE! I can barely keep my own head above water right now....I want to help the studs, but it's tough as a brand new intern to have any time to teach anything (since i'm so disorganized). Explaining why i'm doing things (besides my senior told me to) and clarifying expectations is a good idea. Good luck to all the new MS3's and remember, your interns are probably as scared as you are (if not more)!!!

 

[Pox in a box]

Please just try to remember what it was like as a med student, esp. a 3rd year when you don't know anything. As a brand new 3rd year (first week) I am having trouble getting residents to answer basic questions such as how do I get a path report or how do you want the labs written up or where do I find what meds a patient is on. I mean, I have barely ever been in a hospital let alone worked in one. Not that its entirely the fault of the residents...I don't understand why there couldn't be some kind of "orientation to how hospitals work", just simple stuff, like how to look up patient records, how to write orders, read charts, I mean it would only take a day or two, but everyone just assumes you know how to do all that even though I have never touched a patient chart until 4 days ago. Sigh...sorry for the rant, it has just been a frustrating first week. I am so far behind on reading, because I have spent most of my free time just trying to figure out how to do basic tasks that everyone assumes I know how to do.

Even the residents don't know how to do this half the time. No wonder so many people die in July in a hospital.

 

[debvz]

it would be nice if a resident was hot and put herself together each day, i think it would make a tiring day go alot better if you had a hottass resident to work with all day, would realllly make it easier to get up at 5am i suspect. so maybe go tanning on your spare time and get a makeover before your next batch of students? IMO peace

"Spare time"? Surely, you gest.

 

[djipopo]

i'm a rising 4th year, but the best interns and residents are the ones who you know have your back. if something comes up and you know the student is being treated unfairly, speak up for us. if the attending asks the student why something did or didn't happen -- and you know you had something to do with it, speak up!

anything else is butta 👍

 

[kam730]

Kam, just remember that some of the interns you're working with right now are going through the exact same thing. I'm still learning my new hospital's system, I have no idea what orders I'm supposed to write, the charts are in a different order than they were when I was in medical school, and the computer system is both antiquated and confusing. I keep wondering what it is that I know that I could even begin to teach a third year medical student! Now, if it's an upper level resident, that's a different story.

Just wanted to clarify...I'm with a fellow and a pgy-3, no interns (I suppose that could be part of the problem).

 

[VincentAdultman]

Since I am finally "one of them", I wanted to get some opinions of what third year students expects from us. In my currect rotation, I'm getting new students every week, so it's not a month thing. I think egotistical pimping is utterly useless, but I love teaching. If I ask a question you don't know, I want you to walk away thinking, "Wow...I didn't know that!" instead of "What a complete witch! Why would she ask that?"

So, besides asking "What would you like to learn/do this week?" and "What specialty are you interested in?", what would you guys most like from a resident?

If I get referred to as "student" I'm gonna punch em in the face.

Not really, but I'll dream of it.

 

[HiddenTruth]

Even the residents don't know how to do this half the time. No wonder so many people die in July in a hospital.

Yup, esp in the late 1960's in PA, cuz someone only had an iq of 110 😉

 

[HiddenTruth]

to the new residents: TEACH! Seriously, on my IM rotation, I spent so much time doing BS paper work. WHile I think it's important to learn how to do that stuff, it shouldn't be our responsibility to do the discharge orders and all the paper work that we do FOR the residents. I understand that residents are busy, and these things help them out, etc., I think it is absolutely garbage that we spend so much time on paperwork, and doing scut work. And, whether you wanna call it sucking up or simply doing what you're asked, we all do it to an extent I am sure. I think interns inadvertantly use students as an extra arm to do a lot of their work. While the residents (R2), and attending on the team like to teach, it seems as if you're an automaton at times, being the interns little hoe, helping them with all their crap. I don't mind helping and doing all this, but this time can be better spent teaching, at least something. I think an intern underestimates how much they know RELATIVE to the new M3. Even little things that are run of the mill for anyone in the envt after a few weeks are noteworthy for the new buddy on the rotation. So, I really suggest the new interns to do some teaching, after all, i pay a crap load of tuition, and it shoulnd't be spent to satisfy my intern so I can HOPE that she gives me a good eval. Anybody else has similar feelings?

 

[Pox in a box]

Yup, esp in the late 1960's in PA, cuz someone only had an iq of 110 😉

You mean Redding, Pennsylvania?

 

[electra]

Hidden truth, I've think you've got a little growing up to do.

1. Like you said, you pay your school...not your intern. Your intern is lucky to be making $8.00/hour. That's about what people get paid to flip burgers these days. If you're unhappy with tuition (and who among us aren't?) take it back to your school.

2. One of the ways you learn is by getting in and actually doing things. There's no magic to medicine. It's experience and seeing things over and over again and asking questions and reading and thinking...and working. One reason many interns seem so weak when they first start is that they weren't ever allowed to actually run any part of the service when they were a student. Hence, lack of organization, lack of speed, etc.

3. You're talking that you want teaching and yet you seem completely disinterested in doing the work that gets done in the hospital every day. I suppose seeing patients is probably a lot of work that you have to do for your intern too, right? That work you're bitching about IS medicine. Go see the patient. Examine them and take a history (the daily history for the SOAP note IS a history.) Look at the labs. FORMULATE A DIAGNOSIS. This doesn't mean telling the attending the final answer. It means figure out why that patient is hypotensive/feverish/weak/short of breath, etc. Decide what tests and labs to order. Write the orders yourself. Present the patient and what your plan is to the intern or resident or attending. You get your teaching when you go through these steps and get feedback. That's the teaching.

4. Every day I see students who think all I have to do is make up lectures and power point presentations. Then they sit in the lecture room, eat, fall asleep, etc. You don't get any learning from that. You learn when you recognize the value of the patient interaction.

5. The discharge summary is quite possibly the most important document that you can prepare. That summary of the person's hospital stay, complications, consultations, diagnostics, etc., is something the patient takes to the primary physician and keeps in their record. It also allows you to gauge what could have been done sooner, better, etc.

Learning is an opportunity. Think about this.
"People miss opportunity because it's dressed in overalls and looks like work."
Thomas Edison.

 

[DOtobe]

Great post, electra. 👍

I agree that interns should take some time to teach students, and I will make every effort to, but we as interns just have SO MUCH to do that there isn't much time. H&P's, consults, discharge summaries, calling consultants, calling radiology for reports, pagers going off every fifteen minutes with questions from the floors...doesn't leave much teaching time. Doing things like discharge summaries is NOT scutwork - it is an important piece of paperwork that needs to be done. Scutwork is having the med student run to Starbucks to get the team coffee. Doing H&P's, discharge summaries, etc. is great practice for internship - I wish I would have done more discharge summaries as a student, because my first couple as an intern were kind of bad. You should take every opportunity you can to do these things - and your intern will greatly appreciate it! We're in the hospital 80-90 hours a week, so any bit of help you can give us is appreciated.

We're not just there to entertain the med students. 😡

 

[HiddenTruth]

1. Like you said, you pay your school...not your intern. Your intern is lucky to be making $8.00/hour. That's about what people get paid to flip burgers these days. If you're unhappy with tuition (and who among us aren't?) take it back to your school. .

With all due respect to you, Dr. ----, D.O., I think you should read my post a bit more carefully instead of making ASSumptions. I came to medical school to LEARN and to be TAUGHT, and that is what I am paying tuition for. One of the responsibilities of a resident is to actively TEACH. Whether they are getting paid for it or not, it is part of their job.

2. One of the ways you learn is by getting in and actually doing things. There's no magic to medicine. It's experience and seeing things over and over again and asking questions and reading and thinking...and working. One reason many interns seem so weak when they first start is that they weren't ever allowed to actually run any part of the service when they were a student. Hence, lack of organization, lack of speed, etc. .

I never said that I was disinterested or not willing to work hard. Infact, I am very willing to work hard, i.e getting there at 5:30 AM, looking up the labs, doing my routine h/p, formulating a ddx, doing reading on a topic that i am not certain of, etc. etc., all the things which you ASSumed that I disregarded as some sort of learning.

3. You're talking that you want teaching and yet you seem completely disinterested in doing the work that gets done in the hospital every day. I suppose seeing patients is probably a lot of work that you have to do for your intern too, right? That work you're bitching about IS medicine. Go see the patient. Examine them and take a history (the daily history for the SOAP note IS a history.) Look at the labs. FORMULATE A DIAGNOSIS. This doesn't mean telling the attending the final answer. It means figure out why that patient is hypotensive/feverish/weak/short of breath, etc. Decide what tests and labs to order. Write the orders yourself. Present the patient and what your plan is to the intern or resident or attending. You get your teaching when you go through these steps and get feedback. That's the teaching. .

Nice ASSumption... you should go back and read my post.
Getting dinner for my resident is NOT medicine. There is a LOT of what we do as students that does not make up most of private practice medicine. It's reasonable to assume that a lot of people do end up in pvte practice.

5. The discharge summary is quite possibly the most important document that you can prepare. That summary of the person's hospital stay, complications, consultations, diagnostics, etc., is something the patient takes to the primary physician and keeps in their record. It also allows you to gauge what could have been done sooner, better, etc.

Yes, the discharge SUMMARY is important, I agree, but not the discharge ORDERS (i.e, the ability for me to write those FOR the resident) Seriously, I don't gain anything, or sharpen my skills by taking the chart and copying the diagnosis and the exact medications on a piece of paper, and then leaving it there for the intern to simply come by and sign it and do their dictation. I am sorry, but yes, I am not interested in that. And, I know that is part of the routine of a normal admission and dc, however, there is plenty of opportunity to do all that later on. That is a learning experience that is gained the first time, and does not bring you any return after doing it a number of times. After the first few times, you are simply makign the residents job easier. A 5 y/o can do that if u teach 'em how to copy things ONCE. These are the little things that I am implying by scut work, and useless things that we spend a good portion of the time doing, which can be better spent reading on your own. While, learning is an opportunity, and I value it to every extent and level, some of it should be done in the form of active teaching by residents. While the definiton of teaching varies in everyone's books--and varies by your medical school, I can atleast attest to my experience and say that the bed side teaching and learning is absolute and imperative, but often times it is limited by only attendings. I think residents can do a better job at simply talking to you and helping you think in certain directions, and formulate ddx, etc. You made a lot of assumptions, and figured that I wanted to be spoon fed. That is clearly not what I am referring to. I just think that students, especially if u spend a lot of time with itnerns (which is usually the case after morning rounds), end up getting the shaft a lot of times. The interns are more concerned with getting things done quickly and moving on. And, that is understandable as they are carying a huge load, and have a crap load of work to do. However, I think there can be some passive teaching that can be done during a workup of a patient. And, this means talking to the student rather than ebing busy wring their orders, doing their dictations, and then going up to grab dinner before they get paged again. And, while I agree that you have to ask questions and there is a lot of self learning, there is often a ceiling to what u can ask before you look like 1. a dumass, and 2. annoy the intern. My whole jist was that I think the interns can do a better job and actively involve the student in what and WHY they are doing, rather than assuming that the student either knows, or will just read up on it. On more than one occassion, my resident made me go get something out of his car, and not to mention, to get him food. While it's easy for you to say and interpret that this may be "learning" that I am disinterested in, it is clearly something I am disinterested in as you say. Likewise, there is still a good amt of paperwork (besides writing orders, HPI, dc SUMMARIES) that does not involve any learning, and is simply the art of being able to use your hand and write, and make the residents' life easier. As you guys are not there to entertain us, I don't think it's our responsibility to make your life easier. And, I don't mean this offensively, and hopefully none taken. Like I stated earlier, I pay tuition; you are a resident, and one of the responsibilities you have as being a resident (irrelevant of how much u get paid--it is inane to even bring that up--we all know how much residents get paid) is to do some active teaching with students. My arguement lies in what kind of teaching should be expected of residents.

 

[HiddenTruth]

We're in the hospital 80-90 hours a week, so any bit of help you can give us is appreciated.

We're not just there to entertain the med students. 😡

Honestly, a lot of hard working med students are in the hospital/school for not a whole lot less time than you are (q3-4 may be an exception, of course).

You hit the jackbot snoopy! "any bit of help you can give us is appreciated". This was the point I was trying to get across. A lot of med students, being as insecure and vulnerable as they are, go the extra mile to help you out. And, the reasoning is very clear; whether or not it is effective or not, could not say, but ignoring the "request" definately can go in harms way. Evaluations are very subjective as we all know. Infact, there was a recent poll thread that indirectly referred to this exact political schema and selfish acts that we all have to play inadvertantly to survive (aka: play the game to attempt to get that letter H). And I am certain, as I have experieced it first hand, that residents do take advantage of this. And, it's no that hard to understand, because after all, they're working 80-90 hrs/wk.

 

[blue2000]

I think that one of the thing that's really hard about the whole intern teaching issue is that there is literally not enough hours in the day to do the work that an intern needs to do. Every time I run the list with my senior, I feel like I say "I don't know, I need to check on it" a dozen times. If I say it more than a dozen times, I get the look (what HAVE you been doing then?) or the "you really need to be more efficient with your time." That stings, because I am doing the best I physically and mentally can.

So, many interns realize that not teaching the med students will not provoke exasperation from their uppers/attendings, and that having med students do scut will make them look more efficient in the eyes of their uppers. So that's what gets the shaft in many cases as far as teaching.

It's not right and it's not fair. I felt, as a med student, that if I was paying all that money to the school, I deserved to be taught by attendings, not people who were 24 months further into their education than I was (not that interns don't have things to teach med students). I think the fact that many med students spend the majority of their days with interns is, quite frankly, crap.

As an intern, I strive to teach and involve my med students. If the balance between scut and teaching from the intern was more even, would it seem better? For example, 15 minutes of discharge bs for 15 minutes of teaching? Or is the bs beneath a med student completely?

 

[phllystyl]

Maybe I view things a touch differently than say, some other posters on this thread that had a hard time with their IM rotation but...

IMHO, being part of the "team", which is actually when i personally enjoyed third year the most, involved sharing the load with the residents and terns. And often times, by simply helping out when things were getting a bit crazy and not bitching about it or making faces or appearing miserable but by actually attemtping to be helpful, I was rewarded at the end of the day or after rounds etc with more teaching. So in short, I feel it IS our responsibility to be part of the team and help out if we can in some way, especially as we progress through third year and can do more.

And to the OP, I agree that you are already a step ahead by even asking that question. I think the time I enjoyed most during thrid year were when I was placed in a position of seemingly total control of my patients. And it may be a semester or so before alot of the med students are ready for that, but when you feel they are, let them. I truly enjoyed writing the H+P for a patient, forumlating the plan, presenting, seeing them every day, and then preparing them for discharge at the end of their stay. I enjoyed being the go to person to arrange consultations, discuss with the ancillary staff etc. It made me even feel sort of like I was going to be a doctor some day.

 

[GoodMonkey]

Maybe I view things a touch differently than say, some other posters on this thread that had a hard time with their IM rotation but...

IMHO, being part of the "team", which is actually when i personally enjoyed third year the most, involved sharing the load with the residents and terns. And often times, by simply helping out when things were getting a bit crazy and not bitching about it or making faces or appearing miserable but by actually attemtping to be helpful, I was rewarded at the end of the day or after rounds etc with more teaching. So in short, I feel it IS our responsibility to be part of the team and help out if we can in some way, especially as we progress through third year and can do more.

And to the OP, I agree that you are already a step ahead by even asking that question. I think the time I enjoyed most during thrid year were when I was placed in a position of seemingly total control of my patients. And it may be a semester or so before alot of the med students are ready for that, but when you feel they are, let them. I truly enjoyed writing the H+P for a patient, forumlating the plan, presenting, seeing them every day, and then preparing them for discharge at the end of their stay. I enjoyed being the go to person to arrange consultations, discuss with the ancillary staff etc. It made me even feel sort of like I was going to be a doctor some day.

nice post frizzle. 🙂

 

[Noelle]

AMEN!!! I was a little Grumpy to my med students the other day and felt awful. I apologized the next day. Hopefully we can have a chance to do more stuff together tomorrow when we're on call.

This is so TRUE! I can barely keep my own head above water right now....I want to help the studs, but it's tough as a brand new intern to have any time to teach anything (since i'm so disorganized). Explaining why i'm doing things (besides my senior told me to) and clarifying expectations is a good idea. Good luck to all the new MS3's and remember, your interns are probably as scared as you are (if not more)!!!

 

[DireWolf]

Since I am finally "one of them", I wanted to get some opinions of what third year students expects from us. In my currect rotation, I'm getting new students every week, so it's not a month thing. I think egotistical pimping is utterly useless, but I love teaching. If I ask a question you don't know, I want you to walk away thinking, "Wow...I didn't know that!" instead of "What a complete witch! Why would she ask that?"

So, besides asking "What would you like to learn/do this week?" and "What specialty are you interested in?", what would you guys most like from a resident?

What kind of utopian place are you at where residents are actually concerned about teaching med students?

I'm tempted to buy you a treat or give you a backrub or something.

 

[chicamedica]

Since I am finally "one of them", I wanted to get some opinions of what third year students expects from us. In my currect rotation, I'm getting new students every week, so it's not a month thing. I think egotistical pimping is utterly useless, but I love teaching. If I ask a question you don't know, I want you to walk away thinking, "Wow...I didn't know that!" instead of "What a complete witch! Why would she ask that?"

So, besides asking "What would you like to learn/do this week?" and "What specialty are you interested in?", what would you guys most like from a resident?

Well, as a student who prefers residents/attendings to teach socratically, I feel that mean pimping has more to do with the resident's reaction after the student answers than with the actual question being asked. For the "wow, i didn't know that" feeling, if the student gives the wrong answer (which in my case is often the case), be pleasant and explain the right answer. For the "what a complete witch" feeling, seem exasperated and give the correct answer without explaining (or worse no correct answer at all).

I love residents who want to teach me and give me some guidance at least until i know how things work on that rotation. Also, VERY important--despite the guidance aspect, I dislike it when the resident writes notes and puts in orders on my patient. The guidance comes in with showing me HOW to put in the orders the first time, critiquing my notes, etc. You're not doing me any favors by putting in orders for me (if that's the only way to do it, at least take me with you to see what it is you're ordering).

For the new interns--I totally understand if you don't really have time to teach and are figuring out how the hospital works too. Letting me write notes and put in orders on my patients will lessen your workload. Also, the teaching doesn't have to be a 10-minute spiel, it can be as simple as taking the student with you to see some interesting procedure or physical finding.

 

[DeLaughterDO]

With all due respect to you, Dr. ----, D.O., I think you should read my post a bit more carefully instead of making ASSumptions. I came to medical school to LEARN and to be TAUGHT, and that is what I am paying tuition for. One of the responsibilities of a resident is to actively TEACH. Whether they are getting paid for it or not, it is part of their job.

Ok, HiddenTruth,

I don't think you have even the slightest clue. You went to medical school to learn, not be TAUGHT. People go to middle/high school to be TAUGHT. Be an adult and go out, read and learn on your own rather than bitch that someone is not giving you everything you want. And what is this with the ASSumptions, ASSume, etc? Do you think that helps you make your point? All it does is make you look like even more of a small person than you already seem. Don't strike out at those around you, look within yourself and go the extra step to learn. If you are a team player, everything will fall into place.

I never said that I was disinterested or not willing to work hard. Infact, I am very willing to work hard, i.e getting there at 5:30 AM, looking up the labs, doing my routine h/p, formulating a ddx, doing reading on a topic that i am not certain of, etc. etc., all the things which you ASSumed that I disregarded as some sort of learning.



Nice ASSumption... you should go back and read my post.
Getting dinner for my resident is NOT medicine. There is a LOT of what we do as students that does not make up most of private practice medicine. It's reasonable to assume that a lot of people do end up in pvte practice.



Yes, the discharge SUMMARY is important, I agree, but not the discharge ORDERS (i.e, the ability for me to write those FOR the resident) Seriously, I don't gain anything, or sharpen my skills by taking the chart and copying the diagnosis and the exact medications on a piece of paper, and then leaving it there for the intern to simply come by and sign it and do their dictation. I am sorry, but yes, I am not interested in that. And, I know that is part of the routine of a normal admission and dc, however, there is plenty of opportunity to do all that later on. That is a learning experience that is gained the first time, and does not bring you any return after doing it a number of times. After the first few times, you are simply makign the residents job easier. A 5 y/o can do that if u teach 'em how to copy things ONCE. These are the little things that I am implying by scut work, and useless things that we spend a good portion of the time doing, which can be better spent reading on your own. While, learning is an opportunity, and I value it to every extent and level, some of it should be done in the form of active teaching by residents. While the definiton of teaching varies in everyone's books--and varies by your medical school, I can atleast attest to my experience and say that the bed side teaching and learning is absolute and imperative, but often times it is limited by only attendings. I think residents can do a better job at simply talking to you and helping you think in certain directions, and formulate ddx, etc. You made a lot of assumptions, and figured that I wanted to be spoon fed. That is clearly not what I am referring to. I just think that students, especially if u spend a lot of time with itnerns (which is usually the case after morning rounds), end up getting the shaft a lot of times. The interns are more concerned with getting things done quickly and moving on. And, that is understandable as they are carying a huge load, and have a crap load of work to do. However, I think there can be some passive teaching that can be done during a workup of a patient. And, this means talking to the student rather than ebing busy wring their orders, doing their dictations, and then going up to grab dinner before they get paged again. And, while I agree that you have to ask questions and there is a lot of self learning, there is often a ceiling to what u can ask before you look like 1. a dumass, and 2. annoy the intern. My whole jist was that I think the interns can do a better job and actively involve the student in what and WHY they are doing, rather than assuming that the student either knows, or will just read up on it. On more than one occassion, my resident made me go get something out of his car, and not to mention, to get him food. While it's easy for you to say and interpret that this may be "learning" that I am disinterested in, it is clearly something I am disinterested in as you say. Likewise, there is still a good amt of paperwork (besides writing orders, HPI, dc SUMMARIES) that does not involve any learning, and is simply the art of being able to use your hand and write, and make the residents' life easier. As you guys are not there to entertain us, I don't think it's our responsibility to make your life easier. And, I don't mean this offensively, and hopefully none taken. Like I stated earlier, I pay tuition; you are a resident, and one of the responsibilities you have as being a resident (irrelevant of how much u get paid--it is inane to even bring that up--we all know how much residents get paid) is to do some active teaching with students. My arguement lies in what kind of teaching should be expected of residents.

Will agree that sometimes students get the shaft as far as crap work goes, but what do you want? You're basically an unskilled worker at this point - they could have you mopping the floors and pushing stretchers like the other unskilled workers in the hospital. What do you think of that idea?

Also, remember; as medical students/residents/attendings, we are given no formal teaching instruction. The interns are suffering through 2 incredibly steep learning curves: medicine and teaching. Effectively teaching is probably harder to master than learning what to do for a patient with CHF... Anyone can ask asinine questions, but pertinent questions that have learning value AND are tailored to the current knowledge base of the student is harder than you can imagine.

Just be cool, relax, and go along with it. Do your work, see your patients, read, and "suffer the abuse" as you seem to think you must. It will get better in another year or two, when you can be the 'tern and make it all better - because you will be so much better than the current interns, right? You'll never have your students get you dinner or coffee, right? You'l always include them in all your management decisions, because you have infinite time for teaching (and explaining everything to medical students would NEVER slow YOU down), right?

To the OP, thank you for asking the question in the first place - it shows that you care just to take the time to be concerned about teaching. Nevermind the b!tch!ng from some posters here - just keep up the good work.

 

[IV Doc]

So this is a perspective of an medicine intern who also did his third and fourth year in the same hospital that I am at now. My comments are specific to the medicine cleckship but apply to many other fields.

Third year perspective
What am I supposed to be doing here. I don't know where anything is or how to write a note. Why can't the intern just stop for a few minutes and show me how things work. Why don't they teach me something because that is their job to teach the medical students.

Fourth year perspective
Okay I am starting to feel comfortable in the hospital now. Now that I am doing my sub I in medicine I have begun to understand how the interns feel but I only carry 1/3 the patients that they do. This is the time where I spent the most time teaching the 3rd years because I had the time and I remembered what it was like to be a third year. I really enjoyed teaching the 3rd years and I decided that I would not be like the interns who ignored me as a third year. Also I liked having my pager go off because unlike 3rd year now it was usually a nurse and I had to go take care of one of my patients.

Intern perspective
You have no idea how much work their is to do as an intern and I know the hospital well, I feel bad for my fellow interns. For an intern on the medicine floors their is never enough time in the days to get the work done. You are to busy to go to the bathroom or eat lunch. On most days the interns are to busy to go to the noon lecture which is designed to improve our education. So considering all this can you really be surprised that the interns do not have time to teach the medical students. Now remember this is coming from someone who enjoys teaching the medical students. Now you also have to remember that it is the interns job to take care of the patients first and then if there is time then you deal with the medical students second. I realize this sounds bad but it is the way it is. You have to remember that even when medical students help you with the so called scut their presence slows you down. This is okay with me but it is important for the medical students to realize this.

So here are my suggestions to impress the intern and the rest of the team

1. Pick up as many patients as you can handle (2-4) and try and do everything for these patients, like you are their doctor. If you are following a patient you should know all the important details for the patient. You should offer to take care of all paperwork for the patient (lab requests, radiology, discharge summaries, consult requests, etc). In my mind if there is something that needs to be done for your patient then you should do it and this is not considered scut because you are this patient's Dr.

2. Generally I will not ask students to do the above things for patients they are not following but if I am extremely busy I appreciate the offer of help.

3. Every intern can tell the difference between students which want to help out the team and be involved in patients care and the other students who are trying to go home/library to read at every chance they get. For the students which are trying to help I will make every effort to teach them things on each patient we see together. For people like this I will do everything I can to make it a useful experience. I also realize that you need time to read so I will try and get the resident to send you home early if there is nothing useful to see. For the other students who are not helpful I will generally ignore them until I can think of some scut for them to do and I will never call the resident to see if they can go home.

So the take home message is try and be a team player with a good attitude and you will learn a good deal from us interns. Also with students like this I will spend some time with them before rounds to go over their patients so they look good during attending rounds. The students who are not helpful are on their own.

4. Try and spend some time with the senior residents because their day is more interesting than the interns, they see new patients and spend more time doing real medicine instead of paperwork. Also they usually have more time to teach you things.

5. Also when I ask you questions I am not trying to pimp you but instead I want to see if you understand what is going on with your patients. Usually I ask clinically relevant questions like what should we do with this patient, why are we using this tx, etc. It is okay to not know the answer but you should read about the patients disease and know the typical symptoms and tests to dx the disease.

This is all for now but I would be happy to try and answer other questions.