When I am a resident, I will... (feel free to add your own)

Discussion in 'Clinical Rotations' started by Ypo., Jun 21, 2008.

  1. Ypo.

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    1. Make my expectations clear to students (ie not expect them to read my mind).

    2. Treat nurses with respect, even if they are completely rude.

    3. Never give a student a bad evaluation without talking to them about it first and giving them a chance to improve.

    4. Encourage medical students to write orders.

    5. Help out the medical students with their presentations and SOAP notes in the beginning of third year.

    6. NEVER disparage a medical student's choice of specialty.

    7. Give medical students a chance to do some procedures (assuming I already have a few under my belt:D).

    8. Not be obsessed with hierarchy.
     
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  3. Ashers

    Ashers Bacteria? Don't exist.
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    Let students leave when there's nothing to do.
     
  4. smq123

    smq123 John William Waterhouse
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    :thumbup: And never let a med student's choice of specialty affect the grade that he/she gets from me.

    When I am a resident, I will...

    9. Defend the med students from the nurses, and request that the techs treat the med students like human beings. (Novel concept, I know. :rolleyes:)
     
  5. flumazenil

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    I will...
    1) understand the fact that students generally want to be at home reading up or catching up with other nonmedical issues.
    2) when there is down time I will let them go home
    3) encourage them to actively take part in medicine
    4) NEVER say anything ( or try to at least ) to discourage them
    5) make sure they treat everyone with respect
     
  6. haveaniceday

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    1. remember what it was like to be a MS3
    2. treat MS3s like the adult humans that they are, not like infants
    3. be happy that I never have to go through MS3 year again

    I have been a MS4 for 2 months now, and I am still not fully over the frustrations of 3rd year, 4th year is infinitely better. :D
     
  7. Law2Doc

    Law2Doc 5K+ Member
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    From personal observation, the most useful thing you can do for med students is help them learn. It's not about making it easy. Letting them go home early or defending them from the nurses is well and nice, but not particularly high on the list. Along that line,
    (1) You pimp the med students daily on things you think they should know, make them look stuff up that they don't, but never be mean about it.
    (2) Make sure they get good at presenting things, and have them pre-present to you so that it's perfect when they present to the attending. When they look good, the attending is happy and your life is easier.
    (3) Make sure they get to scrub in on everything, even if the attendings ignore them.
    (4) Make sure they get a hand in on any procedure going on. Most aren't going to be as assertive as you can be.
    (5) Make sure they don't get kicked out of the room during patient exams (esp.. There are ways to ask patients if it is ok that they stay that give patients the option to say no, and there are ways to phrase the "question" that lets them stay. The better residents do the latter.
    (6) If they survive the above reasonably well, you give them high praises when asked about them by attendings. If you make them jump through hoops, and they do, they get rewarded with a treat (a nice eval) just as any circus animal. :)

    As far as nurses, the residents who really know what they are doing,
    (1) Bring them food,
    (2) Know them by name,
    (3) Share the plan with them, and make them part of the healthcare team.
    Because there is nobody who can make your life harder, and cost you more hours of sleep than a nurse who dislikes you.
     
  8. Ashers

    Ashers Bacteria? Don't exist.
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    Ask the student if there is some concept which he or she doesn't understand very well, and do brief teaching times.

    I had a resident go over electrolytes with me during surgery, what happens when they're high/low, and presented in the form of the:

    ___|___|___/
    .....|.....|....\

    That saved me on peds and medicine. It somehow stuck in my head way better than all lectures, so if I could do mini-teaching things like that in downtime in the middle of the day, I think it'd be good.
     
  9. doc20

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    not date the hottest med student chick and instead leave the meat for the poor med students lol
     
  10. 78222

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    1. Pay attention to the medical student and at try to put a little effort in to teach them when not busy. My interns on my first month of IM were awesome. They would give me and the other medstudent afternoon teaching sessions on stuff they thought was useful.
    2. Let the student finish his exam before jumping in and starting from scratch. This month I haven't been able to do a single H&P from start to finish. I will go in and get 2 minutes into the history before the intern comes in and starts from scratch. A few minutes later the resident will show up and want to start from the beginning again.
    3. Let the student go when there is nothing to do.
     
  11. PeepshowJohnny

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    I'd love to see someone come on here and say "When I'm a resident, my students fetch all my charts and take my car in for maintenence..."

    But anyway, when I'm a resident:

    A) All students get my full disclosure up front that none of the following things will affect your grade: Your choice of specialty, doing scut work, or not leaving to show your dedication. I WILL ask your choice of specialty so that I can try to make your learning experience relevent when you're on another rotation. If you want to do favors for me, do it as a friend but it won't help or hurt you. And if I tell you to go study because nothing's going on, go. It's not a trick question to prove to me that you're a quitter for wanting to go read.

    B) The default grade is a good one. The third year grading system is so silly and capricious anyway, why not just help them along. Of course, bad behavior will drop it, but they're starting out on high footing not the "you're average until you prove me otherwsie"

    C) Encourage reading. Usually this means if they're not actively doing anything, they're free to go read. Students have pagers and cell phones, if there's an admission or something interesting I will call them and let them go. There's no reason to lapdog behind me while I do boring stuff.
     
  12. NPR

    NPR
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    I think a lot of this depends on how my 4th year and match process goes.

    I'd hate to perpetuate the cycle of abuse but a rough match process could make more even more bitter than I already am.

    But until then, I promise not to passively-aggressively torment my students by telling them they're doing a great job and then turning around and giving them a pass.
     
  13. Ashers

    Ashers Bacteria? Don't exist.
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    Ohh. So true.
     
  14. SLUser11

    SLUser11 CRS
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    This is simultaneously the truest and least popular post ever.

    As an intern, I was always doing the popular thing such as sending the students home, etc. As a PGY-2, I began to realize that we have an obligation to teach, and being liked and easy-going is not as important. So, I make my medical students work hard, and I have high expectations. Sorry.
     
  15. BigRedBeta

    BigRedBeta Why am I in a handbasket?
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    1) Have several topics to go over with students, even if they don't have questions. Personally, I'm not good at coming up with items on the spot when a resident asks me if I have anything I want to go over, and often times when I think of a question, my first thought is that I can just go look it up myself, even though I know having the resident go through it will make it click much better.

    2) Talk to med students about things other than medicine. Everyone has a life outside of med school, they should be able to talk about other things that matter to them.

    3) Be very clear from the start what is expected of them, when to show up, when they can expect to leave most days (but with the understanding it could be earlier or later). Definitely would make it clear that at a minimum, they need to do the things they're capable of without necessarily being told - like a doing post-op check for a patient that had surgery that morning (I'm not going into surgery, but it's a good example of something I've done that's so simple but always seems to impress residents)

    4) Also be clear about what sorts of skills they should be competent at by that point in the school year. Early on, history taking and physical exam (though it will be enough to say "there's something that's not normal, would you listen/feel/observe?"). Their A/P will definitely not be taken to task. Middle of the year, short differential and at least a couple appropriate labs/imaging. Towards the end, they should have a more succinct treatment plan for things common across specialties (ie, patient has nasal congestion, you should be able to do something about it as a fourth year student). Bonus points if they have good explanations/understanding for their choices.

    5) Give constructive criticism within 24 hours of the incident, and explain why I feel it's a problem.

    6) Do whatever I can to get students to chill out while they're on service with me. I'm very laid back, and the know-it-all students will not impress me.
     
  16. DrDre311

    DrDre311 Makaveli
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    I personally like to pimp medical students on completely random ****. Like pop culture stuff, movies, and music that I personally like. I do it Regis Philbin style, too--I ask a question and then stare at the student intensely; then, even after I get the answer, I wait a good ten seconds before I say if the answer is satisfactory. Example:

    Student: "Dr. Dre, I have a question about Mrs. X. I don't really understand why pulselessness is a late finding in compartment syndrome when it seems to me that pallor--"

    Dre (interrupting): "Let me answer your question with a question: can you name three guitarists for the Red Hot Chili Peppers in the order in which they played with the band?"

    Student (blank look, slightly put off): "Ummm...Brian May, John something, I don't know. What does that have to do with compartment syndrome?"

    Dre (waits fifteen seconds, all the while staring at the student in an intimidating fashion): "..."

    Dre: "I'm sorry, that is incorrect. Brian May played guitar for Queen. The answer is Hillel Slovak, John Frusciante, and Dave Navarro, followed by John Frusciante again."

    Student: "Are you going to answer my question?"

    Dre (walks away abruptly): "..."
     
  17. smq123

    smq123 John William Waterhouse
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    Defending your students from the nurses isn't about being liked, or about being popular. And it's DEFINITELY not about "making it easy." It's just about basic courtesy.

    When you stand back and let a nurse abuse the med student (or, even worse, join in yourself), you're sending a very clear message to the med student that the med student does not matter. At all. And if you don't have the respect for them to say something to either the nurse, or at the very least, keep your own mouth shut, then should you really expect your med student to have respect for you?

    Without respect for my residents, no matter how much they taught, I was too angry and resentful to absorb much, to be honest.

    I mean - the best way you can teach your students is to get them involved, and feel part of the medical team. But who wants to "get involved" if that means working with people who stand back and watch you get abused? I was pretty hardcore on surgery, but even I would have had difficulty digging up enthusiasm.

    (And yes - I know that as residents, you have to work with these nurses again, so it's not smart to burn bridges. But it doesn't take a whole lot. On surgery, I got yelled at by a circ for putting on my left glove before my right one before putting in a foley. :confused: The intern pulled me aside while we were scrubbing, and said, "You know that you put that foley in perfectly, right? And that circ is f***ing crazy?" That's all that it takes sometimes.)
     
  18. Ypo.

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    This is why I quit asking residents questions. That and they simply don't know the answer a good 50% of the time. :p
     
  19. Thievery Corp.

    Thievery Corp. Covert Hipster
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    Praise in public, rebuke in private.

    The resident that I learned this from was a former sailor, and he said that this was what they were taught as officers. It seems perfectly logical to me. With that, you save your student public embarassement, while not letting them off of the hook. As far as I'm concered when I had an attending or resident chew me out in front of others, I didn't learn anything other than those guys were complete *ssholes.

    When I get to be a resident, that mantra is what I will follow with my students.
     
  20. Mayhem

    Mayhem Scut Bear
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    ...try to stay far away from medical students because sadly med school has made me warped and bitter and it's very likely i'll treat them the way I was treated. It's awful but I think it's better that I ignore them instead of treat them like crap.
     
  21. MeowMix

    MeowMix Explaining "Post-Call"
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    It seems to me that these contradict each other. If I send students home, they are not going to be around when the next interesting procedure or patient shows up. So they cannot be as actively involved as someone who is willing to do their reading in the hospital (let's be honest, the "catching up" is usually screwing around). You get a choice: either you can be involved in everything, or you can go home and get more free time. You can't imagine that the resident is going to save the fun stuff for while you are around.
     
  22. DrDre311

    DrDre311 Makaveli
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    Ha! I assure you that it is very, very rare that I am asked a question I can't answer (by anyone).

    Students should just be able to read my mind if they want me to teach them.
     
  23. Droopy Snoopy

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    What I will do:

    1) I'll let my students know where they stand in, day one, in terms of receiving a good/bad eval and the top few things they should learn during their week/month.

    2) Going home at 11:30am if nothing's happening or working their asses off until 7pm if there is, whatever the case may be, but I'll be conscious of their presence and not have them stand there watching me text my wife or dictate discharge summaries.


    What I won't do:

    1) Stop working to give a lecture on hyper/hypokalemia or something. I will be happy to answer questions and talk about the stuff I'm doing, like why I wrote for warfarin instead of lovenox on this patient we're admitting, but not if it means I get a minute's less sleep or a minute's extra time at the hospital.

    2) Dole out the scut. Some medical students have a mistaken idea of what it is, but anything that has any remote connection to patient care is not scut. But I can make my own coffee and would fully expect to be told to go **** myself if I slipped up and asked a student to fetch me some.
     
  24. NPR

    NPR
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    The other thing to consider is what pressure the school or clerkship director may place on residents.

    At our school, some ridiculous % like 2% receive a nomination for honors. In which case, trying to be nice and giving everyone high marks will ensure that the clerkship director ignores all of your eval forms.
     
  25. dienekes88

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    When I am a resident, I will...

    1) be sleepy
    2) be old
    3) attempt to marry a managing director at an investment bank

    Alright, T-1000. :laugh:
     
  26. Huh? What? :confused:

    Crazy circulator. :rolleyes:

    Easy there, buddy. Lots of non-trads here. :) If "by old" you mean that you'll be 26...well, that's not old. :laugh:
     
  27. SLUser11

    SLUser11 CRS
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    I don't know how you extrapolated from my post that I allow my students to be abused by nurses......that is a privilege that I reserve for myself!

    Actually, I'm in an environment now where the majority of nurses are good to the students, but I remember the constant abuse I incurred as a student, and I empathize with your plight.

    Still, I would say that as much as you want your heroic resident to come to your rescue, losing all respect for them if they don't is pretty ridiculous. A big part of functioning in a medical team, like it or not, is learning to have a thick skin and choosing your battles wisely.

    As long as it's a Rap question.;)
     
  28. smq123

    smq123 John William Waterhouse
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    Fair enough.

    But I still would find it hard to respect a resident that joins in. Not speaking up is one thing, but jumping in is something else.
     
  29. SLUser11

    SLUser11 CRS
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    Most of those residents you speak of are merely a product of medicine's crappy environment, unable to break free of the circle of antagonism (Student yelled at by nurse-->becomes resident/staff-->yells at nurse-->nurse yells at student, etc).

    There's nothing worse than watching the transition from nice intern to more confident and meaner resident as their a-hole tendencies come out. I guess one of the best ways to break the chain is to make threads like this. Still, I would bet that the majority of students posting here will develop their resident's bad habits in a short time.....
     
  30. getunconcsious

    getunconcsious Very tired PGY1
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    I will force the students to be my friend if they want a good eval! I'll be a smothering 'buddy boss'!

    But, in return I won't make them do anything or learn anything unless they want to, especially if they're not going into my specialty.
     
  31. DrDre311

    DrDre311 Makaveli
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    You forgot this very important (and common) variation:

    Student yelled at by nurse-->Dre, happening by, becomes enraged by student's complete lack of knowledge about Kurt Russell's minor league baseball career-->Dre administers savage physical beating and self-esteem-decimating verbal tirade to student-->Student becomes resident-->Yells at nurse but fails to acquire adequate pop culture knowledge-->Dre, happening by again, becomes enraged by now-resident's complete lack of knowledge about obscure 80's bands and equally obscure basketball players-->Dre administers another savage physical beating but due to time constraints forgoes the self-esteem-decimating verbal tirade-->Now-resident and nurse make themselves feel better by ganging up on another hapless med student, all the while basking in Dre's awesome fearitude

    I know a little bit about sports, movies--and surgery, too.
     
  32. Ashers

    Ashers Bacteria? Don't exist.
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    :laugh: That's great. I had a resident try that this year. It was weird. She kept telling me stuff about her personal life.

    Dude, I'd fail in your eyes. Unless you asked me about ska. =(
     
  33. Ypo.

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    Nurse, shmurses. They can't evaluate us. Just treat 'em with respect and know that the petty ones are often not very smart or else very frustrated with their job, in which case I pity them.
     
  34. tkim

    tkim 10 cc's cordrazine
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    I read that as "the pretty ones are often not very smart".
     
  35. gotgame83

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    haha, I read it like that too. Infact I didnt understand your response until I read the original post two more times very slowly.
     
  36. cool c

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    HAHA. I also read it as that. I had to go back and read again to see what you were talkin about. Either way, I kind of agreed with the comment even when i thought it sd "pretty" and not "petty".

    I will echo an earlier comment, and say that when i am a resident, every student will start out at "honors" level and that grade will stay unless they do something absolutely absurd to convince me to lower it.
     
  37. Biscuit799

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    That's okay... the pretty ones marry cardiologists and retire at 32.
     
  38. Dr McSteamy

    Dr McSteamy sh*tting in your backyard
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    you guys are so holy

    i think i will

    1) abuse medical students. make them my personal secretaries.
     
  39. toothless rufus

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    How do you read this?
     
  40. Law2Doc

    Law2Doc 5K+ Member
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    Top to bottom left to right you fill in the spaces on that figure with: Sodium, Potassium, Chloride, bicarb, BUN, creatinine, and glucose. It's just a quick convention of how things get documented shorthand in the charts. Don't worry, you'll be checking and documenting this and the CBC and other lab values so often on rotations that you can do it in your sleep. Knowing what the lab values you get on a particular patient mean is a different, and harder story.
     
  41. toothless rufus

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    Cool!Thanks!
     
  42. Biscuit799

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    I had an attending that would ask every student what they wanted to do. He would then attempt to tailor the rotation so that they got an experience that would best benefit them in their chosen career path (i.e. he was a surgeon, and a fellow med student wanted to do cardiology; thus, his goal for her was to really get a lot out of their vascular service). This is by far the best use of the "what do you want to do" question, and the way I will attempt to model my course.
     
  43. Anka

    Anka Senior Member
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    This is a really cool thread. I remember looking at it during the twilight of my M4 year, and I had a bunch of things I would have added had they not already been there. Now, one week into surgical internship, I've gotta say I haven't been living up to any of it. I'm just too wrapped up in trying to get un-lost in this new hospital, figure out how to get blood actually hung on my bleeding patient in less than three hours, and what the dosing for zofran is... and the shame of it is, I've got an awesome medical student who is on top of everything, very helpful to the team, etc. I even tried to go over afib with her once (a little topic thing I used to do all the time when I was an M4), but my pager went off so many times as I was doing it, that I'm sure it was pretty disjointed. Anyway, this is all to say -- try not to judge too harshly until you've been here. Most of us don't wake up in the morning thinking, "jeez, I think I'm going to be a grade A a**hole today!"

    Anka
     
  44. crazylegs

    crazylegs Smellin' the roses...
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    I am a week into my IM internship, and we get our medical students starting tomorrow. I'm in the same boat that you are right now - I'm juggling so many things right now that I have no clue as to how I am going to integrate the students' experience into my day, much less make time for them! :confused:

    I think I will just sit them down and flat out tell them that I'm new at this too, and while I will really try to make their experience worthwhile, it may not happen the way they expect it to. But hopefully they will know right off the bat that I will try to keep their education in mind. (sigh) We'll see how it goes...
     
  45. tkim

    tkim 10 cc's cordrazine
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  46. ceftazidime

    2+ Year Member

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    I disagree with the quoted statement, especially if you're talking about a 3rd year student around April-June.
    These are the things he/she are likely "catching up" on:
    1) Studying for Step 2
    2) Writing personal statement for ERAS
    3) Studying for Step 2
    4) Setting up elective rotations
    5) Figuring out where to live for these elective rotations
    6) Researching what residency programs they will apply to and perhaps still figuring what specialty they want to go into
    7) Getting LORs
    8) Figuring out why their loans have not come in yet

    Sorry to go in this rant, but I feel that this is a stressful time of year and the last thing an M3 needs is for the intern to make them watch a stress echo on a 32 yo male.
     
  47. toothless rufus

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  48. EternalMD

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    For the coags, I've never written it like that. I've been taught that if you flip it upside down, thats the proper way. Now keeping in that format, it would correspond to the placement of other electrolytes - The INR spot is the Ca, PT is the Mg, PTT is the PO4.
     
  49. Scaredshizzles

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    The main electrolytes and CBC one are pretty standard, the other two are not as standard imo. It might save time for surgery notes when PT/PTT/INR may be watched on everyone, but for a medicine note for a patient being titrated on warfarin or whatever, I would just write it out...And the liver panel plus calcium-phosphate, usually you're only specifically looking at certain parts of that, and so rarely is it necessary to write out...if anything, just the abnormal values, and only if you specifically order a liver panel and it is not just some routine labs that get ordered at some places... If it was routine, and the AST/ALT are mildly elevated, I wouldn't even bother mentioning it. When people are ill, their LFTs might be a little off, but they don't really tell you anything.
     
  50. BigRedBeta

    BigRedBeta Why am I in a handbasket?
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    July 1st is closing in, so just a reminder to all those soon to be interns (assuming you have time to really worry about interacting with the med students!)

    Of course I start out on night float, so no worries about this just yet...
     
  51. Rogue Synapse

    Rogue Synapse The Dude Has Got No Mercy
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    When I am a resident, I will make my students use a secret word when presenting in front of the attending on rounds. It could be "nimble", "catharsis", "joyous", any variety of fairly common words that don't quite fit into a standard presentation. That is what I will do. The students will love it or else.
     

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