Anyone ever...

[LucidSplash]

Just not come in to work as a medical student? Has anyone ever had a medical student call and say they couldn't come in because of being "really tired?" Told the intern he wasn't sick but told me when I called that he had "severe malaise and fatigue but nothing infectious" after his 24-call on Friday. Other than talk to the clerkship director and let them handle it, any recommendations? This is sudden onset, low suspicion of mono. I already asked him if he'd ever had a real job before...

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[ProfMD]

So he had a 24 hour call on Friday, had Saturday off and now has "severe malaise and fatigue?" Sounds fishy. I suppose he might legitimately be tired, still, and felt too tired to work. In this case, I suspect the dean's office will back up the student (you know, recognition of fatigue and all), but I do worry for his future patients and fellow residents. I would give equal chances that he either overslept, is hung over, or has some other excuse he doesn't want to share.

However, I think all you can do at this point is talk to the clerkship director.

 

[Winged Scapula]

Beyond discussing it with the clerkship director, I would take this student aside and talk with him about it and implications for the future. At least in surgery, its expected that you show up, even if you aren't feeling well. There are differences of opinion about working when really ill (i.e., when febrile) but he needs to understand that this is a job when there is work to be done even when ill or fatigued.

 

[Trauma Surgeon]

Haha! He made a stupid mistake calling… Do you really miss a student, I would be surprised if you did. At my service they come and go as they wish, and have always some excuse to leave early or come in late: lecture, meeting with advisor or someone else, other student activity… and to be honest I don't have the time to look it up… The funny thing is that many of them put on their evals that the rotation was not what they expected with more OR time or hands on procedures

 

[LucidSplash]

Out interns/juniors typically know. Truthfully I didn't know until they told me. I'm the in-house senior so my responsibility to take care of this stuff.

Ours get plenty of hands-on time. This one wants to do FM but seems not to realize that while we do work long hours on surgery, he will still have long hours on other rotations. He told one of our interns on Friday he was looking forward to other rotations where he could be "with his own kind of people."

Haha! He made a stupid mistake calling… Do you really miss a student, I would be surprised if you did. At my service they come and go as they wish, and have always some excuse to leave early or come in late: lecture, meeting with advisor or someone else, other student activity… and to be honest I don't have the time to look it up… The funny thing is that many of them put on their evals that the rotation was not what they expected with more OR time or hands on procedures

 

[LucidSplash]

I did this on the phone call at 1030. Asked him how he was feeling after m sleeping in and he said "still pretty terrible." Told him he would have to find a way to meet his responsibilities or he would have difficulty not just on surgery but with all of 3rd year encouraged him to come in today once he was rested and made clear would speak with clerkship director.

Beyond discussing it with the clerkship director, I would take this student aside and talk with him about it and implications for the future. At least in surgery, its expected that you show up, even if you aren't feeling well. There are differences of opinion about working when really ill (i.e., when febrile) but he needs to understand that this is a job when there is work to be done even when ill or fatigued.

 

[Vandalia]

Perhaps he read the institution's policy on "Alertness Management and Fatigue Mitigation" and thought that it actually meant what it said.

I agree with Winged Scapula that a brief, private conversation on the real expectations is in order. No matter what specialty, things will only get worse before they get better. (Assuming, of course, that it does get better. 3/4th year remain for me halcyon* days. Of course, the decades tend to erase all the bad parts.)

*For those with a limited background in Greek mythology/literature, "halcyon" is not a drug.

 

[LucidSplash]

Thanks for the input everyone. I think we are all on the same page. I was just flabbergasted by the whole conversation. He says he's made a doctors appt for tomorrow morning (which I guess means he won't be here then either) to rule out anything serious.

Also confided that up to this point in life he felt he needed 10 hours of sleep a night to function. Since this is the first rotation of his 3rd year and the 3rd week of that rotation and first weekend call I guess this is reality sinking in that that isn't going to work as a medical student.

I think maybe this kid has made a really poor life choice w/r/t medicine.

 

[deleted547339]

Wow. That is all.

 

[mimelim]

Heh, just wait until you have a resident...

Tell you that they can't stay to sign out because they have a hair appointment at 6pm and when you given them **** for it, they say, "But, this was made 3 months ago and I can't cancel it!"

or...

Ask if they can leave at 4:30 to make sure they can make it to a massage appointment on time. Then hear them bitch later to one of their friends that the mean senior wouldn't let them go even though they "asked ahead of time".

or...

Show up at 7am because, "the first case isn't until 9:30"


Never mind the whole, "I'll violate work hours." I am a strong proponent of protecting residents. I also think that with a well run and well funded (key part) program, it can easily be done. But, to scrub out of an aortobifem at 7pm (despite ACGME having exceptions to their hours rules for exactly this) is just plain stupid. The number of times that I have had to deal with, "I'll violate work hours." with a resident not proposing a solution and expecting someone else (usually me) to do their work and violate hours is staggering.

Residents mind you... not medical students. Thankfully, we have a pretty grueling selection process and we only have to recruit 3 people a year so we can pretty much handpick.

I am not going to blame millennials or an entitlement generation, because I personally don't have the experience to say it. But, people are really ****ing clueless sometimes.

 

[Goro]

we call students like this" site killers"

Just not come in to work as a medical student? Has anyone ever had a medical student call and say they couldn't come in because of being "really tired?" Told the intern he wasn't sick but told me when I called that he had "severe malaise and fatigue but nothing infectious" after his 24-call on Friday. Other than talk to the clerkship director and let them handle it, any recommendations? This is sudden onset, low suspicion of mono. I already asked him if he'd ever had a real job before...

 

[ThoracicGuy]

Yup I'd bet the most likely outcome of taking this up the ladder would be the school citing a fatigue management policy and probably moving to eliminate overnight call for students

We had that happen. Though they did change it so you took one night of call at each of the trauma hospitals. They at least got some semblance of a clue of what a surgery residency would be like if they wished to go through with it... I think they even had one student write a letter to JAMA or something complaining about it. I have no respect for that sort of thing.

 

[cpants]

I would tell this kid you are going to give him a second chance. If any BS like this occurs again, he can expect a comment on his dean's letter about his attitude and work ethic (as he should). It's the only thing that will scare most of them as grades are increasingly shelf-based and this is something that will truly sink your chances at residency of choice. At our place we disregard most grades as long as they aren't fails. Board scores, evaluations, and letters are pretty much all we look at. 10 years ago an honors on surgery and medicine meant something. Today...not so much.

 

[WedgeDawg]

Yup I'd bet the most likely outcome of taking this up the ladder would be the school citing a fatigue management policy and probably moving to eliminate overnight call for students

Totally unqualified to be posting here, but at a recent NSGY grand rounds that I went to that was focused on challenges in resident education (actually a very interesting talk), I found that apparently our institution has eliminated overnight call for medical students (which I thought was supposed to be a cool thing experience for a medical student).

 

[bannie22]

Lets be honest. Its inappropriate for a MS3 going into FM to be working a 24hr shift.
I'm peeved at times when my MS tries too hard to leave early daily. But its the end of the year, they are checked out, and have decided on their specialties - not surgery.
But man, a 24hr shift for a FM MS3 I have some empathy for.

I have no doubt that the school will have to take his/her side because he surely is violating work hours seriously.
We be fortunate if the MS works 12hrs in this era.

 

[pacman2018]

I have no doubt that the school will have to take his/her side because he surely is violating work hours seriously.

But there are no work hour restrictions for students... unless the school has set their own restrictions

 

[LucidSplash]

So just to be clear, it isn't the end of the year here. This is the start of MS3 for our students. But I don't think that's the point...

I also disagree that it is inappropriate for an MS to "work" a 24-hour shift. They need to be exposed to what these specialties are, both the ones they ultimately choose to pursue and those they might not. There is value is seeing what a surgeon/surgery resident does in a 24-hour period, regardless of what specialty they ultimately go into, just as there was value for me to rotate on medicine or FM or anesthesia etc as a student.

There are no work hour restrictions for students. And even if there were, they aren't violating. They go home postcall right after conference and they don't get near 80 hours.

And the FM residents here take call for inpatient months. Not as much as surgery obviously but they do take it. Not at all inappropriate for a student planning to go into FM to experience it.

Lets be honest. Its inappropriate for a MS3 going into FM to be working a 24hr shift.
I'm peeved at times when my MS tries too hard to leave early daily. But its the end of the year, they are checked out, and have decided on their specialties - not surgery.
But man, a 24hr shift for a FM MS3 I have some empathy for.

I have no doubt that the school will have to take his/her side because he surely is violating work hours seriously.
We be fortunate if the MS works 12hrs in this era.

 

[vhawk]

I guess I don't really even understand what fatigue or work hours has anything to do with med students. At least for residents you can pretend it is a patient safety issue or whatever. But what fatigue related errors are med studs going to be making? Too exhausted to know the blood supply to the colon? Too fatigued to sew up port sites?

 

[bannie22]

Your intern has a 16 hour restriction and your third year med student does not?

I emphatize for the medical school they attended.

Also OP's student is going into family Medicine. Errr. What sort of exposure are they getting from a 24hr shift that they cannot get in two 14 hour shifts?

I can only think of empathy when they call surgery residents at 3am for bs consults. They can learn tht when they are fm intern on surgery rotation.

 

[thedrjojo]

Your intern has a 16 hour restriction and your third year med student does not?

I emphatize for the medical school they attended.

Also OP's student is going into family Medicine. Errr. What sort of exposure are they getting from a 24hr shift that they cannot get in two 14 hour shifts?

I can only think of empathy when they call surgery residents at 3am for bs consults. They can learn tht when they are fm intern on surgery rotation.

Our interns don't have 16hr limits. In the first trial, interns get to be real doctors too. Im has a trial going on right now themselves, and maybe both those specialty trials can undo the mistake that was the 16hr limit

 

[Moose A Moose]

Out interns/juniors typically know. Truthfully I didn't know until they told me. I'm the in-house senior so my responsibility to take care of this stuff.

Ours get plenty of hands-on time. This one wants to do FM but seems not to realize that while we do work long hours on surgery, he will still have long hours on other rotations. He told one of our interns on Friday he was looking forward to other rotations where he could be "with his own kind of people."

Yet to learn to keep his/her mouth shut.

Soon.

 

[LucidSplash]

As others have noted, many of us do not agree with the 16-hour limit for interns. Including our interns. Having done both (intern year was 2010 and we adopted night float for junior residents once the 2011 rules came to pass) I can tell you night float sucks 100x more (arbitrary random measure of suckage quantity) than overnight call for surgery residents. Our juniors hate it; typically means less time in the OR, not feeling like part of the team, and totally jacked up sleep cycles. They have every weekend off but they don't feel they get the benefit of that due to crazy day/night cycle and covering services you only see every other weekend when they are not on night float is awful. Prior to night float we would be able to leave the hospital around 430 or so at times if everything was tucked in and the on call person agreed to take the page early we gladly did this for one another because it means we'd get the same benefit when it was our turn. Now they have to wait until change of shift at 6 or 630 even if there isn't anything going on. Terribly inefficient and poor use of manpower. I have pictures of myself from intern year reading Greenfield's on a blanket in the park in the afternoon on precall days. Not an option for our juniors these days.

I get that you think we are doing Med students a disservice but the real disservice is 1) at programs that don't expose students to the realities this specialty, risking them choosing it and finding out later that it isn't what they wan for themselves and 2) to the interns who have to suffer through the 16-hour rule which adversely affects their surgical education and lifestyle.

Your intern has a 16 hour restriction and your third year med student does not?

I emphatize for the medical school they attended.

Also OP's student is going into family Medicine. Errr. What sort of exposure are they getting from a 24hr shift that they cannot get in two 14 hour shifts?

I can only think of empathy when they call surgery residents at 3am for bs consults. They can learn tht when they are fm intern on surgery rotation.

 

[adenocard]

But there are no work hour restrictions for students... unless the school has set their own restrictions

Can confirm med students do not have work hour restrictions, only 80 hour work week limits enforced by the school and possibly the LCME.

We still take q4 24 hour call with the residents and leave after sign-out through the 8 weeks of general surgery. A lot of people in my class didn't care for it, but at least they knew it ahead of time before submitting their apps.

 

[mimelim]

Can confirm med students do not have work hour restrictions, only 80 hour work week limits enforced by the school and possibly the LCME.

We still take q4 24 hour call with the residents and leave after sign-out through the 8 weeks of general surgery. A lot of people in my class didn't care for it, but at least they knew it ahead of time before submitting their apps.

LCME does not restrict work hours, even on a weekly basis, they simply say, "Student duty hours should be set taking into account the effects of fatigue and sleep deprivation on learning and patient care. In general, medical students should not be required to work longer hours than residents. " Most restrictions on hours come from the medical schools themselves.

We have done away with our night float system and gone back to the old standard call system. Nobody is shedding a tear.

 

[LucidSplash]

As an update, the student has communicated to the clerkship coordinator that he is "unwell" and is withdrawing from the rotation and returning to the main campus (another city), presumably for workup/tx. So I suppose it is possible he has something serious going on.

 

[LucidSplash]

Now don't you feel like a jerk??

Yes.

 

[ThoracicGuy]

As an update, the student has communicated to the clerkship coordinator that he is "unwell" and is withdrawing from the rotation and returning to the main campus (another city), presumably for workup/tx. So I suppose it is possible he has something serious going on.

Or he's trying to take a "W" rather than a "F" on the rotation...

 

[Winged Scapula]

Or he's trying to take a "W" rather than a "F" on the rotation...

Yeah I call "BS" on his reason.

I think he got called out by the "mean"surgery resident for missing work and somehow thinks that the nicer people in family medicine won't call him out on the same BS.


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[LucidSplash]

Well he'll still have to complete his rotation at some point. Will see if we get anymore info. He had a doc appt Monday so i suppose they could have gotten some lab work back today or something. If he isn't sick, He won't have an easier time with the residency at the main campus. They're known to be malignant while we are the kinder gentler surgery residents

And I'm not sure he realizes yet that FM interns are required to rotate on surgery.

I can't decide yet if I hope he is faking or if he is really sick. Either option is not good for him.

Yeah I call "BS" on his reason.

I think he got called out by the "mean"surgery resident for missing work and somehow thinks that the nicer people in family medicine won't call him out on the same BS.


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[bannie22]

Falling on deaf ears, once again MS3 is FM bound and
1) at programs that don't expose students to the realities this specialty, risking them choosing it and finding out later that it isn't what they wan for themselves
is not applicable.

also,
2) to the interns who have to suffer through the 16-hour rule which adversely affects their surgical education and lifestyle.
is speaking to your personal preference and belief.

You're a med student. A broad based education including not just adequate but exceptional clinical exposure is the backbone of our training.

General Surgeons can come across as very arrogant and short-sighted and consistently fail to recognize that having a medical student work 14 hours 16 hours 24 hours 28 hours has no relationship to a "broad based education or exceptional clinical exposure"

And yes, many schools do take better care of their students and have duty hours of which the student can sometimes electively/illegally break if they were interested in a specific specialty. Definitely not applicable to this kid who wasnt feeling well but was jumped on needlessly by his resident. He could have been down with the flu, had viral gastro, nothing of which would have demonstrated significant lab abnormalities.

Perhaps it is time to remind ourselves of the value of empathy.

 

[pacman2018]

Falling on deaf ears, once again MS3 is FM bound

Just out of curiosity, what does this have to do with anything? Nothing in 3rd year matters what you plan on going into. Still a lowly medical student, so I know my opinion isn't worth much in this forum, but I fail to see why it matters that he plans on going to FM. If I have no interest in OB, should I tell them that and tell them I shouldn't work long hours because I'm not going into that specialty?

 

[deleted547339]

As others have noted, many of us do not agree with the 16-hour limit for interns. Including our interns. Having done both (intern year was 2010 and we adopted night float for junior residents once the 2011 rules came to pass) I can tell you night float sucks 100x more (arbitrary random measure of suckage quantity) than overnight call for surgery residents. Our juniors hate it; typically means less time in the OR, not feeling like part of the team, and totally jacked up sleep cycles. They have every weekend off but they don't feel they get the benefit of that due to crazy day/night cycle and covering services you only see every other weekend when they are not on night float is awful. Prior to night float we would be able to leave the hospital around 430 or so at times if everything was tucked in and the on call person agreed to take the page early we gladly did this for one another because it means we'd get the same benefit when it was our turn. Now they have to wait until change of shift at 6 or 630 even if there isn't anything going on. Terribly inefficient and poor use of manpower. I have pictures of myself from intern year reading Greenfield's on a blanket in the park in the afternoon on precall days. Not an option for our juniors these days.

I get that you think we are doing Med students a disservice but the real disservice is 1) at programs that don't expose students to the realities this specialty, risking them choosing it and finding out later that it isn't what they wan for themselves and 2) to the interns who have to suffer through the 16-hour rule which adversely affects their surgical education and lifestyle.

I'm a PGY3 in EM now. My schedule was infinitely better as a med stud without work restrictions than as a PGY-1 with the 16h work week. My med school embraced the fact that med studs didn't have work hour restrictions. I worked a ton more hours on medicine and surgery rotations as a med stud, but had a much better life at the time (it's amazing how quickly you can get to 100 hours/week when you stay in the hospital for 36 hours at a time). We took q3-q4 in-house call for both medicine and surgery. In the MICU, CCU and on trauma as an intern I worked a lot fewer hours but life was phenomenally worse. Some of that is probably the fact that I'm married now, but I think most of it was simply the schedule.

 

[LucidSplash]

I contemplated not responding to this because you clearly don't appreciate the importance of taking call but I think there are a couple salient points here:

He wasn't needlessly jumped on by his resident. I didn't yell or belittle him. And he clearly stated to me that it was "nothing infectious or anything beyond severe fatigue."

Also, he tried to call in again yesterday due to "being tired." Not after a call day, not after being in the hospital late. He was directed to call the clerkship director and explain it to him directly and the result of that conversation was that he withdrew from the rotation until he thought he would be able to complete his responsibilities (i.e. coming to work) like all the other students.

The fact that lifestyle is better with overnight call than with 16-hour workdays isn't just my personal opinion and belief. It's the perspective of everyone in my residency. And it was also the outcome of the prelim results from the FIRST trial. Maybe for nonsurgery residents it works, but for us it keeps us from the thing we love most (the OR) and forces us to be less efficient with our work hours.

Also, you realize that FM interns are required to rotate on surgery right?

You think we're being arrogant, I think you're being obtuse. Let's just call it even.

Falling on deaf ears, once again MS3 is FM bound and
1) at programs that don't expose students to the realities this specialty, risking them choosing it and finding out later that it isn't what they wan for themselves
is not applicable.

also,
2) to the interns who have to suffer through the 16-hour rule which adversely affects their surgical education and lifestyle.
is speaking to your personal preference and belief.

You're a med student. A broad based education including not just adequate but exceptional clinical exposure is the backbone of our training.

General Surgeons can come across as very arrogant and short-sighted and consistently fail to recognize that having a medical student work 14 hours 16 hours 24 hours 28 hours has no relationship to a "broad based education or exceptional clinical exposure"

And yes, many schools do take better care of their students and have duty hours of which the student can sometimes electively/illegally break if they were interested in a specific specialty. Definitely not applicable to this kid who wasnt feeling well but was jumped on needlessly by his resident. He could have been down with the flu, had viral gastro, nothing of which would have demonstrated significant lab abnormalities.

Perhaps it is time to remind ourselves of the value of empathy.

 

[Mr Cookie Pants]

We have medical students from a few different universities, including one that is 100 miles away and receives lake effect snow. Well during the winter their home city got pounded, so the university cancelled for non-essential personnel. Despite the fact that we had a light dusting and they were being housed 1/4 mile from the hospital, the med students didnt show up because they had a snow day. That one took the cake for me.

We've caught other 'sick' medical students posting on social media.

 

[masaraksh]

Show up at 7am because, "the first case isn't until 9:30"

nah bro, that seems legit. really don't see the point in showing up before 9:15. It shouldn't take more than 15mins to check that the first case still has a pulse, still has insurance, and scrub in.

 

[bannie22]

I absolutely do not see the importance in a FM bound MS3 taking in house surgery 24 hour call. That is something a MS3 interested in surgery can voluntary/electively participate in.

Anyway, I am happy for you that you are at a program that practices your call/shift preferences.

 

[ThoracicGuy]

I absolutely do not see the importance in a FM bound MS3 taking in house surgery 24 hour call. That is something a MS3 interested in surgery can voluntary/electively participate in.

Anyway, I am happy for you that you are at a program that practices your call/shift preferences.

Interests change. Medical school is for a broad range of experiences, most of which will NOT be in the specialty you end up picking. You don't sign anything that says "I'm FM" or "I'm Surgery" when you start your third year. Part of your experience includes what happens at night. The FM-bound student can learn from an overnight call just like a Surgery-bound student can learn from overnight FM call. For me, in med school, call was not voluntary/elective. It was part of the rotation. If you didn't like it? Tough luck. The rotation is only 4-6 weeks long. You can get through it. You might even find you liked something you never thought you would...

 

[bannie22]

Part of your experience includes what happens at night. The FM-bound student can learn from an overnight call just like a Surgery-bound student can learn from overnight FM call.

Nights and Weekend Calls can be a different and valuable experience just from patient population and OR opportunities alone. 24 hour call adds nothing of value.

For me, in med school, call was not voluntary/elective. It was part of the rotation. If you didn't like it? Tough luck. The rotation is only 12 weeks long. You can get through it. You might even find you liked something you never thought you would...

 

[ThoracicGuy]

Part of your experience includes what happens at night. The FM-bound student can learn from an overnight call just like a Surgery-bound student can learn from overnight FM call.

Nights and Weekend Calls can be a different and valuable experience just from patient population and OR opportunities alone. 24 hour call adds nothing of value.

For me, in med school, call was not voluntary/elective. It was part of the rotation. If you didn't like it? Tough luck. The rotation is only 12 weeks long. You can get through it. You might even find you liked something you never thought you would...

EDIT:

Your response seemed like you were just copying what I said and your line in the middle did not stand out. Proper quoting would help this. I retract my prior posting.

 

[VA Hopeful Dr]

Part of your experience includes what happens at night. The FM-bound student can learn from an overnight call just like a Surgery-bound student can learn from overnight FM call.

Nights and Weekend Calls can be a different and valuable experience just from patient population and OR opportunities alone. 24 hour call adds nothing of value.

For me, in med school, call was not voluntary/elective. It was part of the rotation. If you didn't like it? Tough luck. The rotation is only 12 weeks long. You can get through it. You might even find you liked something you never thought you would...

As an FM attending, your attitude troubles me. Our patients expect us to, if not actually know almost everything, at least know enough to tell them what to expect and help guide them through the whole healthcare system. I spend a surprising amount of time reassuring patients before surgery and I couldn't do that as well if I didn't know what was going to happen once they get to the hospital and post operatively. Plus, you will have patients that end up as trauma patients or who have complications after surgery. The more you know about everything involved in their care the better care you can provide. Period.

But don't believe me, after all what could I possibly know that an MS3 doesn't?

 

[MediCane2006]

I absolutely do not see the importance in a FM bound MS3 taking in house surgery 24 hour call. That is something a MS3 interested in surgery can voluntary/electively participate in.

Anyway, I am happy for you that you are at a program that practices your call/shift preferences.

I know everyone is already jumping on you but still....

...I was "FM-bound" in MS-3 too. One of the big things that changed my mind was my surgery rotation when I was up all night seeing ER consults, snatching a nap in the nurses lounge during down time, then scrubbing cases with the residents. As opposed to my overnight calls in peds and OB, I realized that I was actually looking forward to surgery call because I really bonded with the team, was interested in the pathology, and enjoyed the adrenaline of overnight call (vs OB when I seriously contemplated jumping off the helipad). Not to mention I learned that I could physically handle the fatigue of being on call overnight and then powering through rounds the next day (and actually even enjoyed the physical challenge). I think that for specialties that take care of sick patients in the hospital, overnight call provides a benefit to med students that you don't get by just showing up 9-5.

You don't get some special exemption to call just because you've picked a specialty in the preclinical years....

 

[MediCane2006]

In answer to the OP question, yes I have seen this. As background, our med students usually come in at 6:30-6:45, round with the team, and then either scrub in or in some cases just observe surgery and are done by 3pm. It's literally surgery lite. We definitely had a med student no-show, then when we finally tracked him down, he said he was "emotionally exhausted" and so chose to take a mental health day (without letting anyone know).

Still to this day remains the only med student I have ever failed.

 

[SXMMD]

.

 

[vhawk]

In answer to the OP question, yes I have seen this. As background, our med students usually come in at 6:30-6:45, round with the team, and then either scrub in or in some cases just observe surgery and are done by 3pm. It's literally surgery lite. We definitely had a med student no-show, then when we finally tracked him down, he said he was "emotionally exhausted" and so chose to take a mental health day (without letting anyone know).

Still to this day remains the only med student I have ever failed.

Honestly if one of our med studs no showed I'm not sure I'd even notice and I certainly wouldn't track them down haha. I'd be more afraid to find out the answer why they weren't there. And this is at an "old school" supposedly hardcore top shelf surgery program.

 

[Trauma Surgeon]

You poor souls in US, you think your students are lazy and arrogant. You can at least fail them or not recommend them for a surgical residency.
You should come and visit us here in Europe… This is what happened this friday:
The colorectal section did early rounding on all their in-patients, canceled all surgeries and clinic since they were attending one of their colleague's dissertation. I did take on to cover for them for the day after rounds, and the med-student on their service was assigned to my service. I told him early to prepare for the round by only reading on patients on our service, 11 for that particular day (not to take any test, do any notes or anything beside just knowing why they were admitted, their labs, and so on). I meet up with my team on the floor (one intern, one resident, and the med-student), seeing the med-student surfing on the web. I asked him if he had read on all patients and the answer he gave me was most of them!!! on further questioning the correct number were 3!!! And the piece of work continues that they have half day, finishing after lunch… So I asked him nicely but firmly that he could just pack his stuff and go home.
The same day I received an email from the surgical rotation director that I could have had handled the situation more professional!? Lets say I was not happy with that email, called him and the end result was he hung-up on me…
Had a talk to my chief of surgery about what it takes to fail a student, and his answer was basically it is impossible since they generate income for the university...

 

[doc05]

You poor souls in US, you think your students are lazy and arrogant. You can at least fail them or not recommend them for a surgical residency.
You should come and visit us here in Europe… This is what happened this friday:
The colorectal section did early rounding on all their in-patients, canceled all surgeries and clinic since they were attending one of their colleague's dissertation. I did take on to cover for them for the day after rounds, and the med-student on their service was assigned to my service. I told him early to prepare for the round by only reading on patients on our service, 11 for that particular day (not to take any test, do any notes or anything beside just knowing why they were admitted, their labs, and so on). I meet up with my team on the floor (one intern, one resident, and the med-student), seeing the med-student surfing on the web. I asked him if he had read on all patients and the answer he gave me was most of them!!! on further questioning the correct number were 3!!! And the piece of work continues that they have half day, finishing after lunch… So I asked him nicely but firmly that he could just pack his stuff and go home.
The same day I received an email from the surgical rotation director that I could have had handled the situation more professional!? Lets say I was not happy with that email, called him and the end result was he hung-up on me…
Had a talk to my chief of surgery about what it takes to fail a student, and his answer was basically it is impossible since they generate income for the university...

actually, it's the same here. seems like med students are lazy everywhere. we CAN'T fail them. our evaluations don't count. and if you're too critical, YOU get written up.

 

[Wordead]

I don't know what kind of institutions you guys are at. I've met a couple subpar med students in terms of knowledge/ability, but nobody just straight up lazy and not coming in. They all try to be helpful and are generally not a huge detriment. They get there before me, have vitals ready, and are usually pretty well prepared for cases.

 

[deleted547339]

This is so insane. FM docs are supposed to be the jack of all trades, master of none. They will be having patients come to their office for lac repairs and abscess I&Ds and following up with their PCP after ER visits/surgeries and will need to be able to evaluate wounds. Obviously you don't become a surgeon on your MS3 surgery rotation, but you need to learn sterile technique, how to instrument tie, the different types of suture, etc. If a FM doc doesn't acquire these skills, (s)he's short-sold himself.

 

[dr zaius]

As an FM attending, your attitude troubles me. Our patients expect us to, if not actually know almost everything, at least know enough to tell them what to expect and help guide them through the whole healthcare system. I spend a surprising amount of time reassuring patients before surgery and I couldn't do that as well if I didn't know what was going to happen once they get to the hospital and post operatively. Plus, you will have patients that end up as trauma patients or who have complications after surgery. The more you know about everything involved in their care the better care you can provide. Period.

But don't believe me, after all what could I possibly know that an MS3 doesn't?

This. This right here. I had some phenomenal FM attendings in medical school, and the reason they were so good was that they never gave up an opportunity to learn something. 24 hour call as a medical student is your chance to learn about something. You have no real responsibility as a medical student. You're there to soak up knowledge and experience. This is your chance to see that mesenteric ischemia patient roll through the door and then to the OR, see how the operation is performed. You'll understand recovery much more when you see exactly what happened in the OR. It's not some waste of time because you think you'll be working 9-5 in a clinic on weekdays. You don't know that you won't be in the boondocks manning an ED as the solo physician, seeing these same types of patients roll through (this is the norm in my home town). For any physician, and almost doubly for family med, you should try to be the most well rounded doc possible. You know what's on all of these surgery patient's discharge info? Be sure to follow up with your primary care doctor (in addition to the usual post op appointment with the surgeon). You're going to see these patients, and you need to understand what they've been through.

This is your chance as a medical student to see, touch, and understand surgical disease processes, which are often picked up initially by primary care docs. You get to do this with no resident responsibilities- no pager, no duty hour restrictions. Some would say what can you see in 24 hours that you can't in 14-16. My answer is the other 8-10 hours. Medicine is a learn-on-the-job thing. There's only so much you can learn from a book. If you're not at the hospital, you're missing a key piece of the learning puzzle.

 

[Apollyon]

There's only so much you can learn from a book. If you're not at the hospital, you're missing a key piece of the learning puzzle.

Remember Sabiston Sr. - "Q2 call means you miss half of all the good cases."