What to do when

[DrDrToBe]

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To give some background: So far in my clerkship I have been very fortunate to have attendings who love to teach and no matter how busy the day is, they take a few minutes to talk with me. I am outpatient medicine right now, so I rotate in a variety of different specialty clinics. Today I was in cardiology clinic, and the attending is phenomenal. The previous two times, it was just the two of us seeing patients (no residents or other med students); and before each patient when he reviewed the patients chart, he would do it me, he'd quiz me on the EKG's, explain angiograms, etc. All in all it's an awesome learning experience.
Today, we had a family medicine resident who was also working with him, so he reviewed stuff with the two of us. Whenever he asked me a question, clearly addressed to me (he was trying to explain some stuff to me, so he was asking me prompter questions to see if I understood, and they were basic questions a med student should know), the resident would mouth/whisper the answer to me, or point at her heart or her foot etc (I'm sure the attending saw her doing this). I found it very distracting and disconcerting since this was my first time meeting her and she is a resident for cripes sake, clearly everyone knows she knows the answers! What would you do in this case so she stops doing this?

 

[ArcGurren]

To give some background: So far in my clerkship I have been very fortunate to have attendings who love to teach and no matter how busy the day is, they take a few minutes to talk with me. I am outpatient medicine right now, so I rotate in a variety of different specialty clinics. Today I was in cardiology clinic, and the attending is phenomenal. The previous two times, it was just the two of us seeing patients (no residents or other med students); and before each patient when he reviewed the patients chart, he would do it me, he'd quiz me on the EKG's, explain angiograms, etc. All in all it's an awesome learning experience.
Today, we had a family medicine resident who was also working with him, so he reviewed stuff with the two of us. Whenever he asked me a question, clearly addressed to me (he was trying to explain some stuff to me, so he was asking me prompter questions to see if I understood, and they were basic questions a med student should know), the resident would mouth/whisper the answer to me, or point at her heart or her foot etc (I'm sure the attending saw her doing this). I found it very distracting and disconcerting since this was my first time meeting her and she is a resident for cripes sake, clearly everyone knows she knows the answers! What would you do in this case so she stops doing this?

I am so confused. You are upset that a resident is helping you get through pimp questions??

 

[DrDrToBe]

I am so confused. You are upset that a resident is helping you get through pimp questions??

No, that's just the thing- it wasn't a pimp session and she wasn't helping me. By her doing that, it made it seem as though I couldn't answer even the questions which were simple straightforward questions. Not only that, SHE was pimping me throughout the entire day in front of the attending, and I am not even working with her! For instance, the attending was explaining something to both of us, then she turned to me and piped in "Do you know the CHADS2 criteria?" I was like no I don't, but I can read up on it later (keep in mind this is my second week as a 3rd year, 3 day in cardiology clinic. She goes, oh it's in your pocket medicine (which I had in my pocket), you should really try to read and absorb as much of that book as you can. Ughhh!

Ps: this after she told me how they suddenly have a ton of med students from my school rotating through the hospital where she works, and 1 she can handle but now they have 3 or 4 to a resident

 

[2012mdc]

No, that's just the thing- it wasn't a pimp session and she wasn't helping me. By her doing that, it made it seem as though I couldn't answer even the questions which were simple straightforward questions. Not only that, SHE was pimping me throughout the entire day in front of the attending, and I am not even working with her! For instance, the attending was explaining something to both of us, then she turned to me and piped in "Do you know the CHADS2 criteria?" I was like no I don't, but I can read up on it later (keep in mind this is my second week as a 3rd year, 3 day in cardiology clinic. She goes, oh it's in your pocket medicine (which I had in my pocket), you should really try to read and absorb as much of that book as you can. Ughhh!

Ps: this after she told me how they suddenly have a ton of med students from my school rotating through the hospital where she works, and 1 she can handle but now they have 3 or 4 to a resident

I would just address her about it. definitely didn't sound like a pimp session, more like a teaching session where she needs to be quiet

 

[Mr hawkings]

Just ignore it. Why risk offending someone who might oneday potentially be asked for input that will go on your evaluation.
She obviously isnt trying to be an *******. Distracting as it may be, i would just let her do her thing. Otherwise, one day, you may really need her input on something and not get it.

 

[2012mdc]

Just ignore it. Why risk offending someone who might oneday potentially be asked for input that will go on your evaluation.
She obviously isnt trying to be an *******. Distracting as it may be, i would just let her do her thing. Otherwise, one day, you may really need her input on something and not get it.

"For instance, the attending was explaining something to both of us, then she turned to me and piped in "Do you know the CHADS2 criteria?" I was like no I don't, but I can read up on it later (keep in mind this is my second week as a 3rd year, 3 day in cardiology clinic. She goes, oh it's in your pocket medicine (which I had in my pocket), you should really try to read and absorb as much of that book as you can. Ughhh!"

I think it's obvious she's trying to be a *******

 

[Rollo]

Pimp her back.

 

[Mr hawkings]

"For instance, the attending was explaining something to both of us, then she turned to me and piped in "Do you know the CHADS2 criteria?" I was like no I don't, but I can read up on it later (keep in mind this is my second week as a 3rd year, 3 day in cardiology clinic. She goes, oh it's in your pocket medicine (which I had in my pocket), you should really try to read and absorb as much of that book as you can. Ughhh!"

I think it's obvious she's trying to be a *******

This is not a battle you want to fight. There is no upside.
Unless if this is the program you want to match into, i would let it go.

 

[DrDrToBe]

Honestly I was pretty shocked at the whole thing since I don't think I've really heard of residents making the med student look bad. At my other clinics, the residents are really busy and sometimes don't really have much time to teach, but they are generally nice. Plus, in the past when I've presented to a resident, they've given me feedback on how to improve my presentation so when present to the attending it sounds a lot better. I was wondering if she has something against students from my school and I just happened to be in the wrong place wrong time.

The problem is that this clerkship is pretty short and I only have a few sessions with that attending. The couple times when I was with him things went well, but that last session with the resident was pretty bad. If I have another repeat session like that I can't imagine I would get a good eval 🙁

 

[Mr hawkings]

Honestly I was pretty shocked at the whole thing since I don't think I've really heard of residents making the med student look bad. At my other clinics, the residents are really busy and sometimes don't really have much time to teach, but they are generally nice. Plus, in the past when I've presented to a resident, they've given me feedback on how to improve my presentation so when present to the attending it sounds a lot better. I was wondering if she has something against students from my school and I just happened to be in the wrong place wrong time.

The problem is that this clerkship is pretty short and I only have a few sessions with that attending. The couple times when I was with him things went well, but that last session with the resident was pretty bad. If I have another repeat session like that I can't imagine I would get a good eval 🙁

The attending is likely to ask for the resident's input before he fills out an eval form anyway. You're lucky to be getting any face time with the attending anyway. Dont read too much into it. Finish your rotation and move on.

 

[2012mdc]

This is not a battle you want to fight. There is no upside.
Unless if this is the program you want to match into, i would let it go.

yea on second thought he probably shouldn't say anything. must have been the 4th year in me talking

 

[ArcGurren]

No, that's just the thing- it wasn't a pimp session and she wasn't helping me. By her doing that, it made it seem as though I couldn't answer even the questions which were simple straightforward questions. Not only that, SHE was pimping me throughout the entire day in front of the attending, and I am not even working with her! For instance, the attending was explaining something to both of us, then she turned to me and piped in "Do you know the CHADS2 criteria?" I was like no I don't, but I can read up on it later (keep in mind this is my second week as a 3rd year, 3 day in cardiology clinic. She goes, oh it's in your pocket medicine (which I had in my pocket), you should really try to read and absorb as much of that book as you can. Ughhh!

Ps: this after she told me how they suddenly have a ton of med students from my school rotating through the hospital where she works, and 1 she can handle but now they have 3 or 4 to a resident

Oooh okay, now I understand. Yeah she's a supreme b***h but like others have said don't pick fights, unless you really just don't care about your eval (which, you really should). Also, she can't handle more than 1 student at a time? Er. wow. At my school it's routine for a single intern/senior/attending team to handle 1 or 2 acting interns and up to 3 medical students at a time...

 

[DrDrToBe]

Um, what? You have a resident rotating through the clinic you're in, and you don't think you work with her? Is this like a "I was here first" situation?

Actually, I'm not sure but I don't think she'll contribute to my eval, and people with more experience can chime in and let me know what you think. It's a private clinic with about 4 attendings, and each may have 1 med student or PA student with them, so there is usually no resident. However, this resident has been there for the past few days, and she's essentially shadowing the attending. Do you think the attending would ask her to contribute to my eval although I'm not working directly with her?

By the way, she's still pimping me and I've just been sucking it up 🙁 The other day the attending actually defended me to her and said I wasn't expected to know to interpret angiograms at this level of my training. Still, it sucks to be made to feel this stupid. Only two more weeks to go...

 

[Rollo]

On this thread, you're coming off as though you don't have any reason to pay attention to what the residents think. If you're perceived that way in the real world, you're going to have a lot of difficulties.

This is really important.

The more and more I hear about this story, more I'm lead to believe that the resident is just pimping you so you can learn things. Forget any of her comments like "you should know this or know that book, etc."

Realize that many, many residents aren't very good teachers. Yes, they might know the information and they may be able to pass it off to you in the form of "teaching" but teaching in and in of itself is an art that doesn't come naturally to many people.

So she might be trying to teach you and help you pick up clinical things, you might be perceiving it as her trying to make you look like a fool. Who really knows her intentions besides herself?

I say stop worrying about how you look or are perceived in front of everyone, and start being a massive sponge who absorbs all the new information that gets thrown around by attendings, residents, nurses, etc.

Don't make it personal because the fact is that this is temporary and you will be with a new group of attendings and residents sooner rather than later.

 

[ZagDoc]

This is really important.

The more and more I hear about this story, more I'm lead to believe that the resident is just pimping you so you can learn things. Forget any of her comments like "you should know this or know that book, etc."

Realize that many, many residents aren't very good teachers. Yes, they might know the information and they may be able to pass it off to you in the form of "teaching" but teaching in and in of itself is an art that doesn't come naturally to many people.

So she might be trying to teach you and help you pick up clinical things, you might be perceiving it as her trying to make you look like a fool. Who really knows her intentions besides herself?

I say stop worrying about how you look or are perceived in front of everyone, and start being a massive sponge who absorbs all the new information that gets thrown around by attendings, residents, nurses, etc.

Don't make it personal because the fact is that this is temporary and you will be with a new group of attendings and residents sooner rather than later.

This was exactly my first thought.

Good Socratic method teaching guides you through how you should think through a problem using questions. For example:
"What sort of things are you worried about the first night after a free flap surgery?"
"How are free flaps different from normal tissue? Where are the places a flap can run into trouble?"
"What would a clotted venous anastamosis look like? What about the arterial? How would a hematoma affect the anastamosis?"
"How would you assess that?"
The order of the questions is as important as the questions themselves, because it guides your thinking. It's not about having the answers but learning the order to think through things.

Unfortunately, most residents, and a lot of attendings, suck at the Socratic method of teaching. They highlight minutiae to demonstrate intellectual seniority without teaching you how to think about a problem. But the good ones are really good at it. You don't even realize you're learning a process until you come back to it later and are like "hey"

I'm just an intern, but when I'm trying to teach the little I know, I always ask the MS a bunch of questions. No, I'm not pimping you. I'm not thinking less of you if you don't know the answer. I'm just trying to get you to use your brain a little bit. I can easily regurgitate the information at you, but you aren't going to remember it and you sure as hell aren't going to be able to use it unless you think a little bit. Asking a question isn't always pimping.

 

[Rollo]

This was exactly my first thought.

Good Socratic method teaching guides you through how you should think through a problem using questions. For example:
"What sort of things are you worried about the first night after a free flap surgery?"
"How are free flaps different from normal tissue? Where are the places a flap can run into trouble?"
"What would a clotted venous anastamosis look like? What about the arterial? How would a hematoma affect the anastamosis?"
"How would you assess that?"
The order of the questions is as important as the questions themselves, because it guides your thinking. It's not about having the answers but learning the order to think through things.

Unfortunately, most residents, and a lot of attendings, suck at the Socratic method of teaching. They highlight minutiae to demonstrate intellectual seniority without teaching you how to think about a problem. But the good ones are really good at it. You don't even realize you're learning a process until you come back to it later and are like "hey"

I'm just an intern, but when I'm trying to teach the little I know, I always ask the MS a bunch of questions. No, I'm not pimping you. I'm not thinking less of you if you don't know the answer. I'm just trying to get you to use your brain a little bit. I can easily regurgitate the information at you, but you aren't going to remember it and you sure as hell aren't going to be able to use it unless you think a little bit. Asking a question isn't always pimping.

To add to this, the best teachers I've learned from so far are the ones who rain me down with questions after questions after questions. When I'm in the hot seat, I'm sweating, whimpering, and asking for my mama but somehow being able to REASON my way through the questions and come up with reasonable answers.

Then when I look back over that topic next time, I immediately think of the questions AND the order in which they were asked. And it all comes together! It isn't a random collection of facts and criteria anymore. It is a clinical picture of a disease that starts from patient presentation, H&P, to order of lab/blood tests used to come up with the final diagnosis.

Again to reiterate, most residents/attendings are horrible teachers in a classic definition of "teacher" outlined by Zag here.

 

[mrwesticles]

I really doubt they were trying to show off, maybe you gave off a vibe of not knowing the answer and they were helping you out. If you pause to think they might try to help you to either move the show along.

Conversely, I've had some nicer residents (especially in family medicine) try to give me hints because they hate to see someone squirm.