what's the reason for some attendings and upper year residents completely ignoring the presence of med students? almost going out of their way to do so. some also give off the vibe that you're not to speak to them. is it a power trip thing? like a "i'm too high up in the hierarchy to acknowledge a med student" type of thing.
why do some attendings/residents ignore med students?
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In most cases it's laziness/business. It's also possible you weren't assertive enough and they don't think you're interested. A lot of tough nuts can be cracked just by asking them to get involved in something. "Hey you think I can try that IV?"
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I'm going to respond, although I thought it would be funnier to ignore this post.
A lot of times there's an ingrained hierarchical culture at some places. The med students interact with the interns, the interns interact with the seniors, and the seniors interact with the attendings. In other cases, the attendings prefer to only reach out and teach once they know somebody is actually going into their field. The one thing that I've heard attendings say is frustrating is where you spend a month working with someone who says they are going into your field, only to find that they matched into something totally unrelated shortly thereafter. So many simply save their breath for the categorical residents who they know are going to use those pearls.
I don't think it's really a power trip thing. A power trip thing would be yelling at med students just because you can. Ignoring them is more a sign that they are someone else's baggage to attend to, not theirs.
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I decided before 3rd year even began that I was paying way too much money to not get taught by the attendings and residents who were supposed to be teaching me. So if they attempt to turn me away, I still chime in with relevant questions, a goofy-ass perma-grin, a chuckle at each of their terrible joke attempts, and an air of positivity until they cave in. It works well - I've been surprised at how far it's gotten me most of the time.
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It may be a regional thing, as Oklahoman's are overall incredibly friendly people, but I've had only maybe a handful of residents act this way. Most are very personable and willing to chat. Whether they want to teach or not is a whole other topic, though I feel that is a lack of experience/skill thing for most. I mean, have you been taught how to teach as a med student? I sure haven't been. So I have no idea how I'll be able to teach a new crop of 3rd years every month as an intern. So I don't hold it against them if they can't either.
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As a former person who thought his **** didn't stink, I can tell you a lot of people don't realize they're doing it.
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yeah some of the time it's unconscious/conscious "don't **** with me vibe" because they are just so jam-packed with work they really feel like they can't take the interruption without totally losing it
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Great little necro-bump on this thread. Even 2010 seems like such a quaint time, but the issue at hand is atemporal. People will generally show you the respect that you demand, not the respect that you deserve.
Also, some people are good teachers. Other people aren't, for a variety of reasons.
Also, some people are good teachers. Other people aren't, for a variety of reasons.
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Yes, as a med student, be sure to demand respect from your superiors. Report back.
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I think you took me too literally. And clearly I didn't mean demanding any more respect than is appropriate for an M3 student. Maybe "command respect" is better phrasing? A student clearly doesn't command his/her superiors!
EDIT: anyways, what is with this attitude that the student shouldn't be respected? It's a malignant notion! This idea that we must disrespect and abuse those who are lower on the hierarchy of medical education? Personally I would be impressed if my student (not my "inferior"!) demanded respect from me (NOT demanded I give respect! There's a difference) ... for example by being punctual, well-read, engaged, interested, etc
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People are busy. Med student role is to help the intern. Receiving one's time is a bonus not a requirement, although occasionally some docs really make strong effort to teach. Occasionally people are closed off by default because they're used to dealing with med students who have no clue how to put anyone but themselves first. The worst thing is to not work with the team, show up late, etc., and then expect people will cater.
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It is unfortunate when attendings do not want to teach. If they hold this attitude, they should not work in academics.
However, there is also a time to teach and a time to work. Expect teaching during rounds, at conference, in the OR. Occasionally between patients in clinic. However, also be respectful of the time of those above you. Remember, teaching doesn't replace the other work they have - it is in addition to it.
However, there is also a time to teach and a time to work. Expect teaching during rounds, at conference, in the OR. Occasionally between patients in clinic. However, also be respectful of the time of those above you. Remember, teaching doesn't replace the other work they have - it is in addition to it.
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when you have a census in the double digits along with getting new admissions, phone calls, follow ups, etc. unfortunately there are times when a student will bog you down. It's not that we don't want to teach you, it's that we don't want to be still writing notes at 11pm after getting there at 7am
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Then the same goes for my tuition.
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While I understand this sentiment and wholeheartedly believe that academic faculty should teach, it is important to understand that your tuition dollars do not go to clinical faculty.
Clinical faculty are typically paid from a combination of clinical revenues and research grants. The medical school takes a cut of the clinical revenues in the form of a "dean's tax."
So, you are not subsidizing the salaries of clinical faculty. Rather, the clinical faculty are subsidizing your school.
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I realize this, but I'm paying the university and they're the ones who are supposed to ensure I'm getting an education. Hiring some looney tune who thinks like the poster I quoted is not providing me with an adequate education.
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They're applying an old model of teaching with a new model of tuition. Which is why from day 1 I've always been incredible skeptical of paying for a medical degree, never mind, paying full tuition for years 3 and 4. And here I am, like a sucker, paying an insane amount of money for my medical degree.
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Buddy you are paying for a degree, not the quality of the education. The sooner you accept that, the easier it will be. American medical education is so low-quality and overpriced these days, they'd never be able to get away with it if it weren't for the moral hazard of government-guaranteed student loans.
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Utterly stupid question...degree is what you are paying for. Learning is totally in your own hands and your attitude is the main factor. Try to create and deliver value in every tiny thing you do and things will change forever...
I second this. I can't stand when people complain about how their school isn't teaching or providing enough to them. It's 2017, the information is everywhere, nobody is withholding it from you. So they may have krap teachers sometimes, but so what..no excuse to let things slip. Since you pay for your education you should be at the helm. You are training to be a doctor so that you can direct care, learn and apply medical theory, and become an independent professional. If you can't do those things then PA school is always an option.
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I have a GREAT offer for you. I'll sell you a car for 50,000 USD, and since there are so many resources out there and youtube videos you can build it yourself! I'll just provide you with the parts. Deal?
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Mostly because they are tired, overwhelmed with workload or burned out themselves and can't find the initiative to reach out and engage you if you're quietly in the corner. Unfortunately. Display some enthusiasm and curiosity and initiative and you will bring out the best in your team. Keep a checklist of tasks discussed in rounds and follow up on them, report results you've been waiting on, volunteer to go talk to patients about this and that and you will lighten the workload and leave more time to give you attention. Ask questions about your learning goals...could we talk about this or that topic that came up in caring for patient X.
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I fully agree we should be educated thoroughly and also agree it is overpriced. But american med education is NOT low quality. Equivalent european/japanese/canadian/australian/whatever medical students would get smoked on the USMLE. We learn a lot of material and learn it very indepth. Also got the best med schools globally...
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Umm I'm guessing because their curriculum is not designed with USMLE in mind? Not sure if you have met medical students from most of those places, but they are just as proficient, and just as smart.
It is odd to say you are only paying for the degree. You are in fact paying for everything; the research opportunities, the network, the experience, the infrastructure, the training etc. Yes, as much as learning is in your hands, it is your school's responsibility to provide you with the resources you have in fact paid for, and those that will help you succeed. What you do with it is, however, up to you.
Will they give it all to you? No, but I don't think attendings that are willing to teach or even teachers that are invested in their students is too much to ask. If we are going to DIY our medical education, great, but then that price should also be slashed by like 80%. There are schools that go as far as giving their students UWorld subscriptions, as much as I think this is rather fantastic, it is a bonus. Providing your students with great rotation sites on the other hand should be basic/standard.
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Hmm...let's let you take a national licensing examination in a foreign language when your curriculum hasn't been geared toward that examination, nor do you have books specifically designed to help you pass that examination and see how you do. Even so, this ignores the fact that many of these students do extremely well on the USMLEs.
Your ethnocentrism is showing. Students all over the world are just as smart and hard working as American ones. And please don't tell Oxford, or the Karolinska Institute that America has the best schools.
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Yeah it is very low-quality. Students learn the majority of what they need for board exams via 3rd-party private resources. And don't get me started on the clinical training here - it is an absolute abomination in all but a minority of cases.
Your comment about Euros, Japan, Candians, Aussies, etc. is just ridiculous. There is exactly 0 evidence for that claim, and I would not doubt if most of those countries have better medical education than we do, because of the the simple fact that they actually let their medical students do things clinically during M3/M4 whereas there is an epidemic of shadow-heavy rotations allowed by the LCME.
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How much do you actually know about medical training outside of the US? Based on this commentary, I'd say not much...
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Few things to realize here:
First, most residents are exhausted. You may be showing up rest and relaxed at 0700, but they very well may have been getting phone calls all night or even been in the hospital on call--or had an in-service exam coming up, boards to study for, etc. As bad as it seems in med school, the time pressure during residency is generally worse.
Second, attending physicians at academic centers are not always that interested in teaching anybody, much less students. I agree that you've paid a ton and should get the appropriate attention from attending physicians. But the reality is that doctors go into academic practices for a variety of reasons. Some really enjoy teaching and interacting with residents and students. Relish those always! Others did it primarily because they like research, administration, or seeing more complex patients--or perhaps for more practical reasons like less call, not having to write notes (because residents do it), etc. Sometimes, you're just not going to get the gung-ho teaching attitude you're looking for.
Third, the above posters are correct that sometimes there definitely is a hierarchy system in place, whether explicit or implied. Attending physicians teach fellows, who teach residents, who teach interns, who teach students, who occasionally mentor some pre-med. And that's how it goes. But this also sometimes occurs because attending physicians may not feel as comfortable knowing what a student knows and doesn't know--given the many years separating them from med school. Not saying that's an excuse, but it is sometimes a lack of knowing what and how to teach more than it is an overt attempt to disrespect students and put them in their places.
Finally, there are of course some big-league a-holes who got crapped (or perceived it as such) all through their med school experiences and are now perpetuating the behavior onto you. Let's hope that's the minority, but I can't deny that's not out there.
First, most residents are exhausted. You may be showing up rest and relaxed at 0700, but they very well may have been getting phone calls all night or even been in the hospital on call--or had an in-service exam coming up, boards to study for, etc. As bad as it seems in med school, the time pressure during residency is generally worse.
Second, attending physicians at academic centers are not always that interested in teaching anybody, much less students. I agree that you've paid a ton and should get the appropriate attention from attending physicians. But the reality is that doctors go into academic practices for a variety of reasons. Some really enjoy teaching and interacting with residents and students. Relish those always! Others did it primarily because they like research, administration, or seeing more complex patients--or perhaps for more practical reasons like less call, not having to write notes (because residents do it), etc. Sometimes, you're just not going to get the gung-ho teaching attitude you're looking for.
Third, the above posters are correct that sometimes there definitely is a hierarchy system in place, whether explicit or implied. Attending physicians teach fellows, who teach residents, who teach interns, who teach students, who occasionally mentor some pre-med. And that's how it goes. But this also sometimes occurs because attending physicians may not feel as comfortable knowing what a student knows and doesn't know--given the many years separating them from med school. Not saying that's an excuse, but it is sometimes a lack of knowing what and how to teach more than it is an overt attempt to disrespect students and put them in their places.
Finally, there are of course some big-league a-holes who got crapped (or perceived it as such) all through their med school experiences and are now perpetuating the behavior onto you. Let's hope that's the minority, but I can't deny that's not out there.
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Having close family who studied/trained & now teach at medical schools in 2 other continents is one part. Family who have studied/trained elsewhere and did residency here is another part. The only people who disagree that USA is superior are in fact those with 0 knowledge of foreign education/training systems.
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You mean other than the 2 FMGs sitting in our resident library with me right now waiting to give sign out and the dozens of others that most of us have been exposed to in our training.
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I wasn't referring to you necessarily. But the USMLE exams are the toughest licensing exams out there. Clinical training in the US also means a very heterogeneous patient population.
There is a reason Saudi Arabia pays for residency spots in USA & Canada and not the UK for example. Similar reasons as to why carribean medical schools came to exist targeting Americans & Canadians whereas a true equivalent does not exist for Europeans.
(I don't think it's fair to compare homogeneous countries btw)
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LOL.
Have you taken the USMLEs? Having taken training, licensing and certification exams in two countries, I can tell you that the USMLE and ABS exams were much easier than the Royal College exam which has a 30% pass rate.
The reason the Caribbean schools target Americans is because we are closer, have more money, more interest in medicine and are willing to pay for it. I suspect the reason Saudi pays for positions here is 1) the US welcomes money from Saudi and 2) the NHS likely prohibits people paying for training or its too hard to figure out.
There's no doubt that the US has great training and certainly better than many countries, but is it the best in the world? There are certainly great places outside of the US and on par with our education here.
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Through friends I am familiar with Royal College exams and various Commonwealth countries. They are brutal. Much worse than USMLE or my speciality boards.
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Royal College exams in Canada?
as a resident I know I likely was guilty of this at times, but it wasn't intentional, just a result of having an overwhelming amount of work. you'll see, it will happen to you when you become a resident. showing interest and helping out will usually overcome this
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To answer the OP's question, I think medical students would be pretty shocked at just how little clinical departments think/care about medical students. My N=2 here, so I don't want to speak too authoritatively, but my experience has been that medical student education is a service requirement, whereas resident education is considered an important factor in promotion and sometimes remuneration. Residency program director is a coveted position, whereas I can't even name the medical student coordinator for my department. No one cares if a medical student doesn't like me, but if I get enough bad resident/fellow evaluations, then I'll get called into the chair's office.
To medical students, who are paying a huge amount of money to be there, that's probably infuriating. And I feel your pain. If you're not interested in teaching, then don't accept an academic position. But before you egg your attending's house, just remember that your tuition dollars don't pay his/her salary, which is probably tied to a combination of grant money and RVUs. The whole system doesn't provide much motivation to make medical students happy, so the attendings who are teaching are going above and beyond, by a warped perspective.
tl;dr - don't hate the player. Hate the game.
To medical students, who are paying a huge amount of money to be there, that's probably infuriating. And I feel your pain. If you're not interested in teaching, then don't accept an academic position. But before you egg your attending's house, just remember that your tuition dollars don't pay his/her salary, which is probably tied to a combination of grant money and RVUs. The whole system doesn't provide much motivation to make medical students happy, so the attendings who are teaching are going above and beyond, by a warped perspective.
tl;dr - don't hate the player. Hate the game.
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We can't have subpar doctors working for the Queen.
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This sort of attitude ignores a great number of academic positions for physician scientists. I'm not saying they shouldn't embrace all aspects of their position, but there are plenty of people out there who want nothing more than to get through their annual requirement of 6 weeks of service so they can get back to their lab, their mentorship of junior faculty (potentially basic science graduate students and post-docs) and their manuscripts. Academic medicine is the only place for these physicians to land.
As a PICU attending in a decidely non-academic position (working 26 weeks of service a year), I can guarantee that my clinical skill and, by extension, my clinical teaching has developed significantly faster than my co-fellow who was hired as a physician scientist (she is NOT an MD/PhD) and is only working 6 weeks a year in the PICU. Her priorities and what's going to keep her job is what she does in the lab and her development there, not whether she's teaching med students (or even the residents for that matter...she might have an obligation to the fellows).
And despite the medical student complaints above, the type of work my co-fellow is doing is desirable to students. How often are folks on the pre-med boards talking about going to Top 20 schools - all of which are in that position because of their research prowess not because they have engaged faculty - and how important it is for one's medical career to go to a "great" school?
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You bring up good points. I agree there needs to be a place for the physician-scientist. However, when that person is on service, they really ought to make an effort to teach, even if they are not that good at it.
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Your selective quote of my post strikes me as strange, because the overall point of my post is basically in line with yours.
Nonetheless, as @ProfMD pointed out, even if someone is only on service for 6 weeks a year, that doesn't mean they get to ignore the parts of the job they dislike.
After being an intern for a year, the only med students ignored completely so far are the ones that are unteachable (maybe 5-10%). If you are going to be late, do a crap job on numbers, have long meandering presentations and wear yoga pants on rounds, then there is no way it's worth my time to teach. If I say anything I might get written for being mean, I don't know because it hasn't happened, but it's not worth the potential hassle. Therefore you are summarily ignored.
All the other med students get taught to the extent of my abilities and get to do every procedure I feel comfortable giving them. The better the are, the more they get to do. That's a real life answer to your leading question. Sorry you are being ignored, think of ways to be a better student and I wager it would happen less.
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If you're on service and your job requires teaching, then you must do your job. Not sure how it's even possible to argue against that.
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Soooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo
Why are we paying full tuition years 3 and 4?
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I'm not sure. You'd probably need to ask the people who are in charge of collecting and distributing your money.
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To subsidize years 1 and 2.
I guess you could get away with no tuition in 3 and 4 if you payed double tuition in years 1 and 2.
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There's no way my school spends $100,000 per student per year in years 1&2.
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You'd be surprised.
I don't have the graph handy, but there is AAMC data that shows that need student tuition is actually a small percentage of the total med school operating budget.
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https://www.amsa.org/advocacy/action-committees/twp/tuition-faq/
As best as I can tell, this is from 2002. So it's dated, but this stuff isn't getting less expensive.
Bottom line: AMSA says it costs between $121K and $156K per year per student.
As best as I can tell, this is from 2002. So it's dated, but this stuff isn't getting less expensive.
Bottom line: AMSA says it costs between $121K and $156K per year per student.
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I would add that the 36% of the med school budget that comes from "practice plans" is the clinical faculty subsidizing med student education via the dean's tax.
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