If only all residents had your mindset lol.
Also, I thought only residents were able to dismiss students. At least that's the excuse my interns gave me lol.
Interns should run everything by their residents. Even when I was dismissing the students as an intern, it was always after checking with my senior. Don't want to send someone home and have them be like "where's felicia? this is a good learning experience!"
I've always felt empowered to dismiss the medical students and I think this must just depend on the culture of your program. I'm a psych intern and on my psych rotations this year, there has been no resident and I just work directly with an attending. Generally the attending rounds in the morning and has gone to clinic by noon, doesn't come back, and I run the list by phone at the end of the day. In this situation I definitely have the authority to tell med students to go home because well . . . if not, then who does?
On medicine, generally we're all in the same team room and I try to involve the other intern and the resident in these decisions casually. About 80% of the time the way this goes is I ask to everyone in the room "Is there any reason the med students still need to be here?" and usually nobody has an objection so I tell them to go home. If the other people are gone and it will be more than like half an hour before they'll be back and the med students are not working on any active tasks, I tell them to go home and let the resident know I did this when they get back.
It's never happened because generally people don't really care that much but if anyone was upset that the med student I sent home wasn't there, I'd take the flack for it. Besides, on the medicine rotations where I'm not effectively the acting resident to my med students, there's a realistic limit to how far anyone is going to try to discipline the intern who's not even part of their department. I guess people could try to create a problem for me but if they tell the psych administrators about such a small thing, the complaint will come off as petty and they'd just laugh. I also don't have to work directly with these medicine people after this year, so whatever. I truly do not care if some uptight resident gets his feathers ruffled over me sending a med student home too early one day.
Generally true, although at my school at least, as the year comes to an end (as is the case in this scenario) some attendings and residents will start to "upgrade" people in anticipation of the transition - e.g. on medicine: PGY-2 or 3 runs rounds instead of the attending, medicine intern asked what they think of prelim intern's/MS4's plan, MS3 expected to behave closer to sub-I. I could see a scenario where a rough day in April or May results in an MS3 staying late managing 1 or 2 patients.
Speaking as a psychiatry intern who spends a lot of time on medicine, any attending who explicitly asks the medicine intern I'm working with to critique my plan is a ****ing dick, and the medicine intern in such a situation should be very political about the way they answer that question. When I am acting as the intern on a medicine team, I am doing the same work as the categorical intern. The majority of my year is identical to that of a medicine intern and I do ICU, nights and long days of wards just like them. This would be even worse if, as you said, he was doing this to prelims who, at least at my program, truly have identical schedules. This would really piss me off and I don't think I'd be alone in that.
MS-3s aren't going to be performing like a Sub-I unless their rotation has been structured to let them do so, which never happens because it makes no sense for them to be operating as a sub-I when they haven't finished their clerkship. Unless you are carrying patients that I as the intern don't have to see, you're not a sub-I. 3rd years have all sorts of educational **** that drags them away from the wards for hours on any given day and often they can't even enter orders for cosign in the EMR. You can't really act as a sub-I under these conditions and this means that most likely I'd still have to be seeing your patients as a late 3rd year clerkship student.
This seems pedantic but the important thing here is that it's different for a true Sub-I to go home compared to a clerkship student. For one, the sub-I should be signing out his patients to the night team and thus would have to stay until signout, whereas if you're a 3rd year and you have one of my patients, I will be signing out and you can go home. Also, a sub-I is actually managing patients and has to stay until the work is done, whereas if you're a third year and you have one of my patients, as long as I'm okay doing whatever tasks you were doing on the patient, you can go home (from my perspective at least, and you would have to check with any other staff you might share a patient with).
