What was your most useful contribution to the medical team as an M3/M4?

[SandP]

Just wondering if really mastering the material in the preclinical years can help you save a life or catch something no one else saw.

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[MedLyfee]

got out of the way

 

[bankaix808]

got out of the way

Situational awareness goes a LONG way.

 

[FindMeOnTheLinks]

Go see the patient, get a thorough history and do a solid exam, write a good H&P with a reasonable assessment/plan. Saves the interns a lot of time and they will be thankful for it.

 

[CherryRedDracul]

Here's a few I can think of besides knowing when to get out of the way:

1. I took a good enough family history that we were able to narrow down the cause of a fever of unknown origin. Patient was a 1 year old with recurrent spiking fevers for almost a week's duration but continued to have multiple negative blood cultures so we were thinking of something other than a bacterial infection. I (and no one else) figured out that the family likely had a history of ADPKD, and a renal or liver cyst could be infected. Thus, we pursued a CT of the abdomen, and lo and behold, there was an infected cyst.

2. During my psych rotation, I took upon a challenging eating disorder NOS case where my patient was deathly thin. This patient had failed multiple outpatient eating disorder treatments, and unfortunately, I think it was due to everyone treating it like run of the mill anorexia nervosa. By performing a detailed psychiatric interview, I was able to narrow the source of her eating disorder to very specific familial issues (and I won't reveal much further). I presented the case during our psych grand rounds and changed the course of her future treatment, possibly saving her life. I hope she's doing well because I never had a chance to follow her up.

To sum it up: taking a good history is invaluable. It's not as much about getting as much detail as possible, but knowing what, when, and how much to ask.

 

[Hyahh15]

One of the best things you can do is make it easy for your intern/residents to teach you. Be available and be present. Interns get mad when their student disappears.... plus you'll miss some of the occasions where you can actually do stuff. This sounds basic, but some students will feel awkward following a resident around and just disappear and get yelled at for it later when the resident tries to hunt you down.

Also, scut work isn't that bad when it truly helps your team out. Feeling like you're the tiniest bit helpful is a big win.

 

[operaman]

Really depends on the service, but essentially it boils down to leveraging the fact you have no actual clinical duties to devote your time to anticipating and taking care of things that need doing. Taking detailed medical/family/social histories can be very helpful since these so frequently get autopopulated from prior interviews. Good Med recs are another. Ditto for requesting outside records. Getting supplies for rounds. Just keep your eye out for things that you can do.

 

[SunsFun]

Small talk and jokes!

 

[Tenk]

My index finger for the rectal exams.

 

[DBV]

1. On surg-onc volunteered for the hour long shaking part of the HIPEC so everyone else could get lunch
2. Call hospitals and get records (super annoying and time consuming)
3. Go deal with IV problems if you are good with a needle
4. Learned when to be quiet and out of the way

 

[anbuitachi]

This depends on what rotation you are on.. But i agree with above poster. Situational awareness goes a long way. Knowing where to stand is too. If you happen to be a M3/M4 on anesthesiology rotation. You will quickly learn that standing between me and the ventilator is not a good place. Or standing right in front of my drug/equipment cart so that i need to tell you to move every time i need a drug, is bad too. Other than that, that's pretty much it.. expectations are as low as it can be for med students. I dont really care if you know nothing about anesthesiology, or blow your IV's and arterial lines

 

[Darth Doc]

My index finger for the rectal exams.

And all the vaginal exams on my EM month.

 

[FistLength]

Dx DVT on a patient the attending was swearing was normal swelling of the leg. Because of the thombogenic med the patient was on, I was pretty confident it was a DVT, along with the physical exam. We sent the pt for u/s and it came back that his entire popliteal region was thrombosed, had to be admitted for a week. Looked like an allstar afterwards (even though I have the clinical acumen of a breath mint)

Every dog has his day

 

[akwho]

Sub-i's are critical on the busy orthopaedic services:

1) Bandage bags - keep em stocked and well supplied. 2 minutes per patient on rounds. Running to the supply room on rounds kills efficiency.
2) Procedure kits for ED procedures - know where to find the lidocaine and 5-0 chromic? You are going to be useful.
3) Pre-seeing patient's and getting notes started on new consults - especially helpful when the consult resident is four consults back.
4) Retractor/leg holders in the OR - yeah it's a boring job and we've all been there once.
5) Help the intern get the list ready in the am - room #'s, vitals, overnight events.

You will feel so useful as the sub-i you will wish you were back to being an MS3.

 

[Mad Jack]

Didn't die, didn't kill anyone

 

[Doctor Strange]

Taking a thorough history and physical for admissions is always great. As a medical student, you have the time to take as long as you want with a patient, and it's always nice when a medical student comes back to me and offers some collateral data. Other than that, doing things like making follow-up appointments, getting outside hospital records, faxing things, and fetching things are always very helpful. Yeah, it sucks, but, trust me, it makes a world of difference when these things just magically appear for me.

 

[Menander's Bust]

On surgery I would be able to explain procedures and what was actually done and why to the patient when I rounded early in the morning since the surgeons I guess did not do this or they did and the patients forgot or were too loopy to remember from the anesthesia. I also assisted during surgeries. Otherwise I served no purpose whatsoever. The interns were new and wanted to do everything themselves. Even though I could take a history and do a physical as well as them, they would redo everything any of us did.

 

[Smurfette]

I had a couple med 3s over the years discover a major problem (as in, need to return to the OR) when doing post op checks and save patients from further problems that wouldn't have been caught until later in the night when the intern finally had time to check on the lower priority patients. And yes, we would give credit to the student when talking to the attending.

 

[Anti-PD1]

1) Closed the loop whenever I could, from booking ORs to talking to floor nurses and relaying plans

2) Tackled social issues, got on the phone as needed

3) Wheeled the patient to DR for stat CT because waiting for transport is *****ic

4) Volunteered for 'scut work' as needed: I'll gladly place a 1000 NGTs, whatever it takes to make my intern year less painful

5) In the OR, read the room, realized being scrubbed in was pointless and useless, and opted instead to help with the C-arm or O-arm, or endoscope screen, or BrainLab navigation system etc.

6) I was easy to be around, i.e. learn to take a joke, don't take yourself too seriously, have some chill.

(and yes, H and Ps, see patients in the ED, first assist in the OR etc)

 

[Split Infinity]

Don’t discount your own clinical acumen just because you’re young! You have the advantage of only having a few patients, so you can pay laser-like attention to what’s happening to them. e.g., diagnosed an NRTI-induced RTA on a patient with undifferentiated “weakness” on the first month of my Medicine clerkship. e.g., while in subI caught acute prostatitis by doing a rectal exam overlooked by the night team on a patient whose fever had previously been attributed to meningitis but whose CSF was bland...you have learned more than you realize, the trick is just putting it into practice in the appropriate time and place.

 

[Stagg737]

Have caught a few things that may have otherwise been missed by reading the patient's charts/history more in depth. Biggest thing I caught from potential pre-clinical knowledge was Stevens-Johnson due to med interactions and knowing the CYP450 system. I've also caught some psych stuff that non-psych attendings missed/had to ask about because they didn't remember it. Also taught some of the interns some minor procedures (DRE, Catheterization) during their first month or two of residency (not kidding) which were things I learned in pre-clinical years.

As others have said, I think the best thing you can do is just stay out of the way, help with the little things when possible, and review the patients' charts really well to fill in pertinent points that the patient may forget to tell the attending/that they might miss.

 

[Brahnold Bloodaxe]

Prevented a Mass Casualty Incident by wielding my bloodaxe in anger.

 

[ortnakas]

Donuts.

But serious answer — you have 2-3 patients and that’s it (no orders, etc) so you have time to know everything about them, and help your team out other than that.

 

[ParallelLines]

Here's a few I can think of besides knowing when to get out of the way:

1. I took a good enough family history that we were able to narrow down the cause of a fever of unknown origin. Patient was a 1 year old with recurrent spiking fevers for almost a week's duration but continued to have multiple negative blood cultures so we were thinking of something other than a bacterial infection. I (and no one else) figured out that the family likely had a history of ADPKD, and a renal or liver cyst could be infected. Thus, we pursued a CT of the abdomen, and lo and behold, there was an infected cyst.

2. During my psych rotation, I took upon a challenging eating disorder NOS case where my patient was deathly thin. This patient had failed multiple outpatient eating disorder treatments, and unfortunately, I think it was due to everyone treating it like run of the mill anorexia nervosa. By performing a detailed psychiatric interview, I was able to narrow the source of her eating disorder to very specific familial issues (and I won't reveal much further). I presented the case during our psych grand rounds and changed the course of her future treatment, possibly saving her life. I hope she's doing well because I never had a chance to follow her up.

To sum it up: taking a good history is invaluable. It's not as much about getting as much detail as possible, but knowing what, when, and how much to ask.

You are a ****ing boss

 

[sliceofbread136]

Nothing big, I had one patient that I had very good rapport with and would open up to me with things that he didn't tell other people and it felt pretty cool. Sealed the deal that I wanted to do peds

 

[WingedOx]

I served as a glorified gauze, kerlex, and 4x4 dispensing machine for the surgical rounds team.

 

[Beargryllz]

I haven't broken anything expensive or killed anyone