Working with med students during residency

[JustPlainBill]

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So I'm finishing up residency and I'm getting assigned to work more and more with med students.....as are all of my PGY3 colleagues....

and my clinic dwell times have gone from ok to atrocious -- 90 to 100 minutes...most of my colleagues have a similar complaint so it's not just me....

Anyone have suggestions/tips for integrating students without turning it into a 2 hour visit each time?

Also, some of the female students push the edge of clinical attire with the latest fashions -- seems that spandex tights and long shirts are now the rage in women's fashion....some of our medical students don't realize that it doesn't become professional attire when you throw a white coat and ankle boots on --- how would you address that one?

And finally, we've had a few that obviously didn't want to be there and would attempt to "correct" the resident in front of the patient and/or in front of the attending or to attempt to address the laundry list of problems rather than top 2-3 with frequent RTC -- suggestions on that one -- slap 'em down hard or try to be subtle?

sorry but I've got enough time traps with attending who comfortably seated and decide to pick the morning when I've got 2 roomed and 3 arrived plus a med student to discuss proper screenings and complete workups before referral with latest conflicting evidence and their personal choice of which evidence to believe....any suggestions that worked well for you?

 

[smq123]

Anyone have suggestions/tips for integrating students without turning it into a 2 hour visit each time?

The medical student does not need to see every single patient on your panel. If they're reasonably seasoned MS3s, they can see maybe every other patient on your schedule. If they're new and/or slow, maybe one an hour. Play it by ear.

For example, if your 8 AM patient is in a room and is ready to be seen, and your MA is getting vitals on your 8:15 patient, go in and see your 8AM patient and tell the med student to see the 8:15 patient when the MA is done. By the time you're ready to send your 8AM patient home, the med student should be ready to present your 8:15 patient to you. Most med students appreciate the chance to see a patient by themselves, without feeling rushed to see every patient that walks through the door.

Also, some of the female students push the edge of clinical attire with the latest fashions -- seems that spandex tights and long shirts are now the rage in women's fashion....some of our medical students don't realize that it doesn't become professional attire when you throw a white coat and ankle boots on --- how would you address that one?

Tell them, gently but firmly, that their clothes do not meet the program or the clinic's dress code for employees. A female resident or attending would not be able to see patients wearing that, and neither should they. If they don't get the message the first time, be sure to include it in their evaluation.

Remember, having med students to teach is as much about your education as it is about theirs. It is a chance for you to learn how to act as the leader of the clinic team, how to give constructive feedback for less experienced coworkers, and how to juggle the many demands that you will have to take care of simultaneously as an attending.

And finally, we've had a few that obviously didn't want to be there and would attempt to "correct" the resident in front of the patient and/or in front of the attending or to attempt to address the laundry list of problems rather than top 2-3 with frequent RTC -- suggestions on that one -- slap 'em down hard or try to be subtle?

Do you tell the med student your expectations before the day starts? If not, then how can they expect to know what to do in a given situation?

Lay out the ground rules before clinic starts. Address only a few problems at a time; the patient can always come back (med students forget this! They're used to the inpatient mentality where you have unlimited time with each patient and little f/u options.) If they have a question, they are free to bring it up AFTER the patient left, not while everyone is in the room. If they go into a room, they have about 15 minutes to get a history and do a basic physical - after that, you come in and pull them out.

If you explain the rules and expectations before clinic starts, then they know what to try to do and what to try and avoid. If you don't, then don't be surprised when they accidentally screw you up or make you run late or make a mistake.

 

[Bostonredsox]

If you truly think some do not want to be there, make them come in to every pt you see and stand next to you. Do not allow them to sit, nor speak. Do not let them examine the pt. Make them stand there and listen while you go through your visit and ask if they have questions, they wont, and then go onto the next pt. It is absolute torture to have to stand and do absolutely nothing for 8-9 consecutive hours. After a few hours they will probably ask why you are making them stand there at which point you can tell them they clearly do not care about this rotation and have shown no interest so you see no reason to waste your time. If they do not promptly apologize and request a second go round, take that response to the PD and request they make a phone call to their school and ask for them to be taken off your schedule.

If they correct you in front of a patient take them aside outside the room and tell them if they ever discredit your integrity in front of a patient again you will fail them. If they disagree with what you are telling the patient they can ask you about your thought process in a learning manner AFTER you have finished seeing the pt and left their room. Medical students are easy to crush and the thought of failing their rotation will make even the most pompous, unprofessional ones shape up fast.

If they do not respond and/or your PD does not seem inclined to make them improve than request no residents on your service. If they still make you take them then again, just make them stand there with instructions to not speak to the pt. They will probably request another resident or atleast if they realllly dont care, wil lstand there silently and no longer slow you down.

 

[BrakngLyv]

If you truly think some do not want to be there, make them come in to every pt you see and stand next to you. Do not allow them to sit, nor speak. Do not let them examine the pt. Make them stand there and listen while you go through your visit and ask if they have questions, they wont, and then go onto the next pt. It is absolute torture to have to stand and do absolutely nothing for 8-9 consecutive hours. After a few hours they will probably ask why you are making them stand there at which point you can tell them they clearly do not care about this rotation and have shown no interest so you see no reason to waste your time. If they do not promptly apologize and request a second go round, take that response to the PD and request they make a phone call to their school and ask for them to be taken off your schedule.

If they correct you in front of a patient take them aside outside the room and tell them if they ever discredit your integrity in front of a patient again you will fail them. If they disagree with what you are telling the patient they can ask you about your thought process in a learning manner AFTER you have finished seeing the pt and left their room. Medical students are easy to crush and the thought of failing their rotation will make even the most pompous, unprofessional ones shape up fast.

If they do not respond and/or your PD does not seem inclined to make them improve than request no residents on your service. If they still make you take them then again, just make them stand there with instructions to not speak to the pt. They will probably request another resident or atleast if they realllly dont care, wil lstand there silently and no longer slow you down.

I really hope this is hyperbole.

 

[DoctwoB]

If you truly think some do not want to be there, make them come in to every pt you see and stand next to you. Do not allow them to sit, nor speak. Do not let them examine the pt. Make them stand there and listen while you go through your visit and ask if they have questions, they wont, and then go onto the next pt. It is absolute torture to have to stand and do absolutely nothing for 8-9 consecutive hours. After a few hours they will probably ask why you are making them stand there at which point you can tell them they clearly do not care about this rotation and have shown no interest so you see no reason to waste your time. If they do not promptly apologize and request a second go round, take that response to the PD and request they make a phone call to their school and ask for them to be taken off your schedule.

If they correct you in front of a patient take them aside outside the room and tell them if they ever discredit your integrity in front of a patient again you will fail them. If they disagree with what you are telling the patient they can ask you about your thought process in a learning manner AFTER you have finished seeing the pt and left their room. Medical students are easy to crush and the thought of failing their rotation will make even the most pompous, unprofessional ones shape up fast.
.

You need to take it easy. You're just a few years removed from where the med student was standing, so try to empathize.

Why torture your medstudent? Yes he may not be thrilled about family med and I agree he/she shouldn't allow his lack of enthusiasm to be a drag on the team, but come on. Forcing someone who HAS to be there and is paying to be there to be miserable and not learn much by virtue of your judgement of enthusiasm? How is that appropriate? When did you decide you wanted to perpetuate the cycle of abuse of medstudents that you probably hated when you were a student?

I agree it's poor form to correct your resident or attending in front of a patient, but all that is needed is to pull the student aside between cases, quietly inform him/her that they shouldn't do that and you would be happy to hear questions about management between cases and move on. Holding the threat of failure over their head is hardly the mark of a good resident and teacher.

There are many solutions to the OPs problem of medical students hampering efficiency.
(1) Tell the medical students your expectations at the beginning of the rotation, including the fact that you can only address a few problems per visit and you would like a faster, more focused H&P. Most students get taught how to do the full, super comprehensive H&P in years 1/2 and aren't used to doing focused ones, so have them practice that, then provide constructive feedback on what info they included that was too much/too little. A prior poster is correct in that many of us are also used to inpatient medicine, where we create an A/P for every problem and don't have follow up.

(2) Don't have the student see every patient. Pick a sample of patients for him with a good mix of problems (e.g. a COPDer, a CHFer, some annual checkups, etc.), tell him to prepare for said topics prior to seeing the patients, and then go from there. If the student is doing a good/efficient job, gradually ramp up the patient volume

(3) Trust your students. We're generally intelligent, motivated individuals lacking only in experience. Nothing makes a visit take longer then when the resident/attending hears my report then goes and asks the EXACT same questions I just asked and performs a repeat of the entire exam. By all means ask some quick clarification questions and double check crucial exam findings, but a full repeat is not necessary. Üse our notes. Document "ägree with medstudent note with following changes:" If we miss something in the H or P, let us know and we'll generally not miss it again. I know for a fact that when I'm with a resident that offers that autonomy, his productivity is increased (he can see one patient while I see the other, then hear my report and do a faster visit), and I learn more from being given more autonomy.

I can appreciate that having medical students can be a drag for residents, but try to think where you would be without the teaching some residents and attendings gave you a few years ago.

 

[Bostonredsox]

1. I never corrected a resident or attending in front of a pt or other resident/attending. Even if I knew they were 100% wrong I kept my mouth shut. I strongly recommend this if you are rotating at a residency choice. Thtat resident will not remember your skill set he/she will just remember you as the cocky ******* who corrected them in front of a patient. GL getting in there.

2. I wore shirt and tie every day to every rotation including Surg and ICU and changed into scrubs once I was there. That is just standard professionalism. You are soon-to-be doctors, not grocery clerks. Dress appropriately.

3. I detest FM. Hate outpt medicine in general. just not for me. However, I never ever ever conveyed that on any FM rotation either verbally or via body language. I made it seem as if I was there and ready to learn whatever knowledge you could teach me, regardless of how I truly felt about it.

4. I had fantastic medical student rotations. Was never berated by an attending nor a resident. However, I never did any of the above mentioned things to warrant such actions. And nothing made me hate life more than standing around doing nothing all day, it is good punishment for those who obviously do not care about their rotation. we had a student who I asked to go see a pt to listen to a murmur, not even do an H and P or note, just listen. He says, 'well i was gonna hit the road as the attending already signed my eval so I really dont need to bother doing anything for the last 2 days..' Not only did we fail him, my PD sent a letter to his dean formally saying he was not welcome to do any more rotations at our hospital. We know you just want to get out the door and get to your next rotation, I was the same way. But do not ever verbalise those feelings. Finish it out like your supposed to and dont burn any bridges.

medical students are there to learn. they are not paid, in fact they are paying to be there. So i totally agree they should not be overworked, not be berated and not made to do things they are not comfortable doing. that said, as a resident, we are not paid to take medical students, hell some of my attendings are not paid. And med students invariably slow you down. I realsied this as a med student. I knew that if i asked questions frequently or took excessive time examining pts i slowed down my resident who just wants to finish their endless amount of work so they can get home to their spouse and kids. Medical students need to know their place. And not dressing professionally, not showing interest, not reading when told to read about something, half-assing their way through a rotation they do not otherwise care about but need to pass to graduate, is not, and should not, be allowed nor condoned. put in your time like we all did and make it atleast seem like you care.

 

[DoctwoB]

1. I never corrected a resident or attending in front of a pt or other resident/attending. Even if I knew they were 100% wrong I kept my mouth shut. I strongly recommend this if you are rotating at a residency choice. Thtat resident will not remember your skill set he/she will just remember you as the cocky ******* who corrected them in front of a patient. GL getting in there.

2. I wore shirt and tie every day to every rotation including Surg and ICU and changed into scrubs once I was there. That is just standard professionalism. You are soon-to-be doctors, not grocery clerks. Dress appropriately.

3. I detest FM. Hate outpt medicine in general. just not for me. However, I never ever ever conveyed that on any FM rotation either verbally or via body language. I made it seem as if I was there and ready to learn whatever knowledge you could teach me, regardless of how I truly felt about it.

4. I had fantastic medical student rotations. Was never berated by an attending nor a resident. However, I never did any of the above mentioned things to warrant such actions. And nothing made me hate life more than standing around doing nothing all day, it is good punishment for those who obviously do not care about their rotation. we had a student who I asked to go see a pt to listen to a murmur, not even do an H and P or note, just listen. He says, 'well i was gonna hit the road as the attending already signed my eval so I really dont need to bother doing anything for the last 2 days..' Not only did we fail him, my PD sent a letter to his dean formally saying he was not welcome to do any more rotations at our hospital. We know you just want to get out the door and get to your next rotation, I was the same way. But do not ever verbalise those feelings. Finish it out like your supposed to and dont burn any bridges.

medical students are there to learn. they are not paid, in fact they are paying to be there. So i totally agree they should not be overworked, not be berated and not made to do things they are not comfortable doing. that said, as a resident, we are not paid to take medical students, hell some of my attendings are not paid. And med students invariably slow you down. I realsied this as a med student. I knew that if i asked questions frequently or took excessive time examining pts i slowed down my resident who just wants to finish their endless amount of work so they can get home to their spouse and kids. Medical students need to know their place. And not dressing professionally, not showing interest, not reading when told to read about something, half-assing their way through a rotation they do not otherwise care about but need to pass to graduate, is not, and should not, be allowed nor condoned. put in your time like we all did and make it atleast seem like you care.

I agree with your assessment of how med students should act on a rotation, but disagree with the severity of punishments you offer for failing to meet expectations. Give them a worse grade, sure, but failing grades should be reserved for (1) people who don't show up (2) people whose knowledge is so appalling it is unsafe for them to work with patients.

 

[bigkahunaburger]

hahaha bostonredsox you've got to be kidding me?

"2. I wore shirt and tie every day to every rotation including Surg and ICU and changed into scrubs once I was there. Afterwards I would change out of my "human" costume and revert back into my natural robot form, to which I subsequently proceeded to oil all of my rusty parts as to prevent me from being late the next day. bleep bop bleep bop bop...Laser engage, TARDY MED STUDENT, DETROY!!!!"

 

[kjamess]

If you truly think some do not want to be there, make them come in to every pt you see and stand next to you. Do not allow them to sit, nor speak. Do not let them examine the pt. Make them stand there and listen while you go through your visit and ask if they have questions, they wont, and then go onto the next pt. It is absolute torture to have to stand and do absolutely nothing for 8-9 consecutive hours. After a few hours they will probably ask why you are making them stand there at which point you can tell them they clearly do not care about this rotation and have shown no interest so you see no reason to waste your time. If they do not promptly apologize and request a second go round, take that response to the PD and request they make a phone call to their school and ask for them to be taken off your schedule.

If they correct you in front of a patient take them aside outside the room and tell them if they ever discredit your integrity in front of a patient again you will fail them. If they disagree with what you are telling the patient they can ask you about your thought process in a learning manner AFTER you have finished seeing the pt and left their room. Medical students are easy to crush and the thought of failing their rotation will make even the most pompous, unprofessional ones shape up fast.

If they do not respond and/or your PD does not seem inclined to make them improve than request no residents on your service. If they still make you take them then again, just make them stand there with instructions to not speak to the pt. They will probably request another resident or atleast if they realllly dont care, wil lstand there silently and no longer slow you down.

strong work, but I would've failed them after the first time, no warning.

 

[aterry]

Hahahahah

Being a medical student who did not commit any of these horrible acts, I have still been mistreated by attendings. You have to have a thick skin for medical education for sure but I think we all have to remember that we all make mistakes and try our best to remember how we felt in their shoes. Everyone deserves compassion and should be treated with respect. Give them a chance. Ask them why they are behaving a way that is offensive to you. You may be surprised by the answer and you may make a bigger impact that way.

 

[CardioPlus]

"2. I wore shirt and tie every day to every rotation including Surg and ICU and changed into scrubs once I was there. Afterwards I would change out of my "human" costume and revert back into my natural robot form, to which I subsequently proceeded to oil all of my rusty parts as to prevent me from being late the next day. bleep bop bleep bop bop...Laser engage, TARDY MED STUDENT, DETROY!!!!"

hahahahaha funniest thing I've read in a while

 

[JustPlainBill]

Also, some of the female students push the edge of clinical attire with the latest fashions -- seems that spandex tights and long shirts are now the rage in women's fashion....some of our medical students don't realize that it doesn't become professional attire when you throw a white coat and ankle boots on --- how would you address that one?

And finally, we've had a few that obviously didn't want to be there and would attempt to "correct" the resident in front of the patient and/or in front of the attending or to attempt to address the laundry list of problems rather than top 2-3 with frequent RTC -- suggestions on that one -- slap 'em down hard or try to be subtle?

I figured an update was in order -- I started letting the students see 1 or 2 patients per 4 hour shift, do a good note and present. If I had time between patients being roomed, I did what teaching I could in an instructional, non-pimping manner....time still sucks but that's more of a clinic staff/flow thing than the students.

I did notice the female student in question dressed differently depending on whether she was working with a male or female resident. The tights/shirt/ankle boots were when she worked with a married male colleague of mine, for me it was 4" spike heels, form fitting sweater/shirt and capri slacks, for the female resident it was flats, fashionable and respectable top with standard tan khakis......kinda humorous and once you pick up on it, rather shallow.

The corrector/interruptor is getting a bad rep around with the residents....don't know if he's been counseled yet but it's probably in the works.

I'm just working hard to make their experience better than mine...I had some really good attendings/residents that did what they could in the time allotted and I try to emulate them without the more odious parts of other residents/attendings who treated me like a child and expected me to learn by osmosis i.e. never said a word to me, literally.

 

[lowbudget]

If you truly think some do not want to be there, make them come in to every pt you see and stand next to you. Do not allow them to sit, nor speak. Do not let them examine the pt. Make them stand there and listen while you go through your visit and ask if they have questions, they wont, and then go onto the next pt. It is absolute torture to have to stand and do absolutely nothing for 8-9 consecutive hours. After a few hours they will probably ask why you are making them stand there at which point you can tell them they clearly do not care about this rotation and have shown no interest so you see no reason to waste your time. If they do not promptly apologize and request a second go round, take that response to the PD and request they make a phone call to their school and ask for them to be taken off your schedule.

If they correct you in front of a patient take them aside outside the room and tell them if they ever discredit your integrity in front of a patient again you will fail them. If they disagree with what you are telling the patient they can ask you about your thought process in a learning manner AFTER you have finished seeing the pt and left their room. Medical students are easy to crush and the thought of failing their rotation will make even the most pompous, unprofessional ones shape up fast.

If they do not respond and/or your PD does not seem inclined to make them improve than request no residents on your service. If they still make you take them then again, just make them stand there with instructions to not speak to the pt. They will probably request another resident or atleast if they realllly dont care, wil lstand there silently and no longer slow you down.

Stupidest advice. Accomplishes nothing.

Be a leader. Communicate with your med student with your expectations like a normal human being and an adult.

Medicine is as much about learning and following as much as it is about teaching, supervising, and leading. People who've worked a real job before have a leg up on this concept. In the real world, you get promoted into a supervisory position because you've earned those stripes. In medicine, you get promoted de facto showing up and not screwing up.

If medical students and residents realized that they've been blessed with talent and opportunity to be a doctor, a manager, and a leader, they would definitely make the most out of the time they've been given and survive the real world when it hits them soon enough.

 

[lowbudget]

medical students are there to learn. they are not paid, in fact they are paying to be there. So i totally agree they should not be overworked, not be berated and not made to do things they are not comfortable doing. that said, as a resident, we are not paid to take medical students, hell some of my attendings are not paid. And med students invariably slow you down. I realsied this as a med student. I knew that if i asked questions frequently or took excessive time examining pts i slowed down my resident who just wants to finish their endless amount of work so they can get home to their spouse and kids. Medical students need to know their place. And not dressing professionally, not showing interest, not reading when told to read about something, half-assing their way through a rotation they do not otherwise care about but need to pass to graduate, is not, and should not, be allowed nor condoned. put in your time like we all did and make it atleast seem like you care.

This, however, I agree with.

I don't care that you don't care about the rotation. Just don't start caring after you've failed it.

 

[Bostonredsox]

Stupidest advice. Accomplishes nothing.

Be a leader. Communicate with your med student with your expectations like a normal human being and an adult.

Medicine is as much about learning and following as much as it is about teaching, supervising, and leading. People who've worked a real job before have a leg up on this concept. In the real world, you get promoted into a supervisory position because you've earned those stripes. In medicine, you get promoted de facto showing up and not screwing up.

If medical students and residents realized that they've been blessed with talent and opportunity to be a doctor, a manager, and a leader, they would definitely make the most out of the time they've been given and survive the real world when it hits them soon enough.

stupidest? is this a word?

this is not about medicine, it is about being professional and acting like an adult.

And as for the above comment "give them a worse grade but do not fail them", where I went to med school rotations were Pass-Fail. Your exams determined Honors vs pass as well as fail if you bombed them. And even if it was not that way, who would care about a 3/7 on FP vs a 6/7 if you hated the rotation and were just skating by because your not applying to FP? the 3/7 wil have no bearing on you getting a residency slot and will not make you change your ways at all. A failure however, you will think twice about acting like an immature teenager and start acting like a doctor real quick. Can be career altering.

Med students who are having trouble learning, I love to help them. But those that just act like immature brats who do not care about taking their role in patient care seriously nor dressing as they should nor showing up on time, I have no time for that. That is not my job to correct. This is a cruel world and people never learn nor act any differently if the punishments have no signciant level of severity.

IE: man jailed and tried for manslaughter after killing family of 4 while driving drunk....this was his 4th offense. He paid large fines and went to AA briefly for the previous 3 offenses... In other countries that dont have the lawyer problems we do, that man loses license forever after second and may even be in jail for a year after the second. Slaps on the wrists do not make people change. Don't baby the med students or they will be ****ty residents and then ****ty attendings.

And for the poster who thinks the robot post is hilarious and true.......oms3 from NY.....hope you are not at NYCOM..because if you show up late and improperly dressed for MICU or surg hell even medicine at LIJ-NS, Maimonedes, Lutheran as several of my friends/roomates did initially, your residents will tear you apart.

 

[bigkahunaburger]

"Professionalism", definitely chills my bones when I hear this enigmatic word thrown around like the f-bomb should be .

 

[bigkahunaburger]

Also, you're really saying "ooohhhh I dare you to come to these big bad hospitals late without a tie". Man I'd be terrified now, I wonder what they'd do!!!??????

 

[Lys Ile Glu Leu]

http://theoatmeal.com/comics/ie

 

[Bostonredsox]

http://theoatmeal.com/comics/ie

Too much bright orange, strained my eyes.

 

[surrender903]

stupidest? is this a word?

stupidest is the superlative of stupid.

example:

He is the *stupidest* oreo eater ever. He thinks the cream is better than the cookie!

 

[Lys Ile Glu Leu]

Alright, sorry to have contributed to directing this thread in a grammarish direction. Seriously though, good info, though it largely goes without saying. It's good to hear from people in your position what will be expected of me in just under 3 years.

 

[brianmartin]

Remember that there are many who seem nice and shiny on the outside but it's hiding something underneath. I've seen many of these types in medicine, and I've seen just as many great, compassionate doctors who dress pretty casually. Who are you to say that a suit and tie = professionalism. I say evaluate the medical students based on their compassion and commitment to caring for patients. I have been on rotations where I am very interested in the field and the patients, but I'm working for some jerk who obviously has a problem that I can't fix--so I become distant and then it appears to him that I "don't care about the rotation" when in fact its just that he is difficult to work with. These people very often have no idea they are having this affect on the people around them. Often, it is not just medical students, but other staff will have a problem with this person too. The key thing is that these people usually do not know they have this effect on people. I would say if you "keep on getting med students who don't care" you should probably do a reality check on your own attitude.

 

[VA Hopeful Dr]

Remember that there are many who seem nice and shiny on the outside but it's hiding something underneath. I've seen many of these types in medicine, and I've seen just as many great, compassionate doctors who dress pretty casually. Who are you to say that a suit and tie = professionalism. I say evaluate the medical students based on their compassion and commitment to caring for patients. I have been on rotations where I am very interested in the field and the patients, but I'm working for some jerk who obviously has a problem that I can't fix--so I become distant and then it appears to him that I "don't care about the rotation" when in fact its just that he is difficult to work with. These people very often have no idea they are having this affect on the people around them. Often, it is not just medical students, but other staff will have a problem with this person too. The key thing is that these people usually do not know they have this effect on people. I would say if you "keep on getting med students who don't care" you should probably do a reality check on your own attitude.

While there is truth in what you say, you're forgetting something - I don't get graded on how I am with med students. You, on the other hand, very much get graded on how you are with me.

We've all had crappy residents/attendings. You learn to smile, fake enthusiasm, and hold all the negativity in until you leave the hospital.

 

[vistaril]

While there is truth in what you say, you're forgetting something - I don't get graded on how I am with med students. You, on the other hand, very much get graded on how you are with me.

We've all had crappy residents/attendings. You learn to smile, fake enthusiasm, and hold all the negativity in until you leave the hospital.

as a pgy-4 in psych, I know what it's like to be working with students who are not really taking your field/rotation seriously. I'm sure many of the future amgs rotating through family medicine view it the same way they do psych(as in 'I would never do this'). A lot of these students are very very smart....heading off to radonc, neurosurgery, IM at top places, derm, etc.....

For starters, yes, a certain level of professional from the students is required. If they are dressed in a completely ridiculous manner, you have to address that(or your attending). But once they meet basic professional obligations, I view it as more of a 'what can I do for them' sort of thing. These people arent going into family medicine(or psychiatry), so as long as they are ok to work with, I just let them do their own thing and throw in a few teaching points here and there....big picture teaching points that may affect how they would approach patients in their chosen field in the future(from the perspective of our specialties).....

the reality is that we don't have a lot of power to 'punish' them(and why would you want to?)....clerkship grads in field like family medicine(and psychiatry in my case) are not super important, and quote frankly if one is a usmle 250+ rock star in things like medicine and surgery and then has a mediocre grade in family medicine or psychiatry, it casts more doubt on us than them....

you have to keep in mind- they're paying to learn and we're getting paid. Let's teach them something(if they are willing) and as long as basic professionalism guidelines are met we should make it a fun relaxing service for them.

 

[lowbudget]

"To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others." -- Hippocratic Oath

Teaching medical students is not a matter of getting paid or getting graded. It's a fundamental matter of being a physician, of who we are. One day, these people will be our colleagues and will be one amongst us. In return for the government to not regulate the practice of medicine, we as a profession agree to regulate ourselves (thus, the board and the license). If we don't take control of our profession, we risk allowing other people who know nothing about medicine to regulate us.

It's our job to set medical students on the right path when they're veering off on the wrong path.

 

[Bostonredsox]

"To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others." -- Hippocratic Oath

Teaching medical students is not a matter of getting paid or getting graded. It's a fundamental matter of being a physician, of who we are. One day, these people will be our colleagues and will be one amongst us. In return for the government to not regulate the practice of medicine, we as a profession agree to regulate ourselves (thus, the board and the license). If we don't take control of our profession, we risk allowing other people who know nothing about medicine to regulate us.

It's our job to set medical students on the right path when they're veering off on the wrong path.

They are regulating it. They are just doing it by controlling the reimbursement and the judicial system behind phyician lawsuits, Lack of tort reform, etc. They may be doing it in far more deceptive ways, but they are controlling it.

 

[Prncssbuttercup]

Since I'll be doing this in a little more than a year as a new student, can you guys give some solid tips on getting along with the difficult attendings or residents? I am generally a fun and amiable person who is also intelligent and professional. I try my best to get along with everyone, I'm not going to dress like a slut, and am a non-trad with a fair amount of prior medical experience.... I want to be able to show up, not get yelled at, get a good letter, and go home... I want to learn stuff, and not make it painful for the people who are being generous enough with their time to let me follow them...

 

[DCFamilyMed]

There are many styles in precepting. As a current preceptor to medical students in their family medicine rotation in the city the following are what I believe to be important as the role while they are with me. This, of course, varies from preceptor to preceptor but we have the common goal of introducing and planting seeds of interest in the field.

1. Ask questions. This is singularly the most important factor with students. It shows interest and also application of knowledge from basic sciences of what is learned from the classroom to the exam room.

2. Observe the physical exam and mimic the exam with the attending. If the student is not feeling comfortable repeat, explain. It is ok not to get it the first time. Repetition will help.

3. With a new pathology or disease in the exam room, read about it. I still do this as a preceptor to keep up to date. As a student I would expect this and even wait until the next session to present a brief report of the disease.

4. Consider writing patient education material for the office. All the students I precept "author" material that I eventually include in our homemade EMR. This is quite helpful n my office.

5. Receive a midpoint evaluation. I do this with all students. Review strengths and ways to improve. This will avoid surprises when I make my final evaluation.

6. Be on time, stay for the full duration, and dress professionally. Being on time is critical. Dress code is dependent on the preceptor but you should observe what the dress code is at the office and adapt. You will represent the office also and patients do keep an eye.

7. Show interest. Even if this may not be your chosen specialty, showing lack of interest is evident. Family medicine is a diagnostic specialty incorporating multiple fields. It is ok to ask me why I chose family medicine. Keep an open mind. You may be surprised and find that this is a great specialty as I have found. Notice the long lasting relationship I have with patients I care for.




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[aterry]

I am a 4th year medical student and have worked with the full spectrum of amazingly respectful and patient attendings to grumpy and rude ones. My evaluations have always been good to excellent (thankfully!) so here is how I approach it.

1. Always have an attitude that everyone (EVERYONE) can teach you something. I have not only learned from surgeons and diagnosticians, but from the MAs and RNs in their offices, the scrub techs in the OR and the nurses on the floor. Even the janatorial staff have helped me out when I have been lost in a hospital! I have been told on more than one occasion that this is an attitude that is lacking in medical students today.

2. Remember to be grateful. In my situation, the attendings I have worked with are not paid to have medical students on their service. They are doing it because they care about our education -- even the grumpy ones. They are opening up their practice and their patients to me and I am really grateful to be there. Of course there will be stressful and tiring days, but just try to remember that we are lucky to get to work with them in that capacity.

3. For the especially grumpy attendings I worked with, I learned their routine and did everything I could to make their work easier. Even if it was having all the necessary forms and labels ready for them when coming out of the OR -- I did it! It may seem mundane but I think it showed that I was willing to try.

4. Never underestimate a good work ethic. I will not be a surgeon nor do I get all hot and bothered about big surgeries. I did, however, show up very early every day on my surgery rotation, do my best pre-rounding, show respect for the patients during presentations, and offered to present a detailed report on a disease if I didn't know the answers during rounds. I didn't know much then, but I was gonna show that I at least could work as hard as the next person. It paid off.

For princessbuttercup -- if you have that kind of positive attitude -- it will get you far.

 

[Prncssbuttercup]

Having worked in healthcare I know first hand that a good relationship with the support staff can make or break your life as a student, resident, and attending. So considering I want to learn as much as I can, I agree with you and will work on that

Definitely know these docs are going out of their way to have us, so I will definitely NOT be treating them like they owe me the favor!!!

Thank you for the advice, and if anyone else has any, I'd certainly be willing to listen... I'd rather have an idea, than have to learn the hard way, I much prefer to learn by others' mistakes than my own whenever I can!