Failing Medical Student

[Scutpuppy007]

Has anyone had an experience of working with a medical student who is doing so poorly on their clinical rotation that they are in danger of failing? I am dealing with this situation now. As an intern, I don't have much say as to how someone is going to be evaluated, but both my resident and attending are threatening to fail this girl if she doesn't straighten her act up.

She argues and gets defensive when she is wrong. She interrupts the attending to give the patients misinformation (and did so once when we were discussing Code Status). She pulls the disappearing act and can't be found for hours at a time. She comes in late and is totally unprepared. She doesn't know her patients. She doesn't have their labs or studies available in the morning when it is time for rounds and she can't handle more one or two patients. I have tried talking to her when she asks for feedback, but she doesn't listen when she is given suggestions as to how to improve her performance. I told her that she needed to be more organized and to have all of her information ready when it comes time to round in the morning. She told me that she was good at that. She isn't. She hasn't looked at an xray, EKG strip, or labs. Once, it took her two hours to see a patient in the ER and she "forgot" to write a History and Physical.

By the way, she is a 4th year and is supposed to be a subintern this month.

I am really frustrated. I want to see this girl succeed, but I feel like I am getting nowhere with her. I told the attending that she needed to talk to the student directly when the attending was asking me about what I thought of this girl's performance. It is still early in the rotation and I am hoping that with some negative feedback from someone in authority, she will straighten up. Does anyone have any suggestions as to how I can help her? Keep in mind that I am in a very busy academic medical center where the patients have very high acuity. My patient load is generally 10-12 patients so I don't have a lot of spare time to really work with her closely.

---

Members don't see this ad.

 

[fineline]

If everything you say is true, then do us all a favor and just fail her rather than passing her along. But you know that's going to happen because she clearly already made it past third year acting like that. Let's hear it for the medical education system!! I love it! Also: wimmen Am I right, guys?

 

[lumbering]

Just link her to this thread.

 

[Top Gun]

Has anyone had an experience of working with a medical student who is doing so poorly on their clinical rotation that they are in danger of failing? I am dealing with this situation now. As an intern, I don't have much say as to how someone is going to be evaluated, but both my resident and attending are threatening to fail this girl if she doesn't straighten her act up.

She argues and gets defensive when she is wrong. She interrupts the attending to give the patients misinformation (and did so once when we were discussing Code Status). She pulls the disappearing act and can't be found for hours at a time. She comes in late and is totally unprepared. She doesn't know her patients. She doesn't have their labs or studies available in the morning when it is time for rounds and she can't handle more one or two patients. I have tried talking to her when she asks for feedback, but she doesn't listen when she is given suggestions as to how to improve her performance. I told her that she needed to be more organized and to have all of her information ready when it comes time to round in the morning. She told me that she was good at that. She isn't. She hasn't looked at an xray, EKG strip, or labs. Once, it took her two hours to see a patient in the ER and she "forgot" to write a History and Physical.

By the way, she is a 4th year and is supposed to be a subintern this month.

I am really frustrated. I want to see this girl succeed, but I feel like I am getting nowhere with her. I told the attending that she needed to talk to the student directly when the attending was asking me about what I thought of this girl's performance. It is still early in the rotation and I am hoping that with some negative feedback from someone in authority, she will straighten up. Does anyone have any suggestions as to how I can help her? Keep in mind that I am in a very busy academic medical center where the patients have very high acuity. My patient load is generally 10-12 patients so I don't have a lot of spare time to really work with her closely.

Okay, I know that 4th year med students can be prone to senioritis, but this is beyond that. How did this girl make it all the way through third year? In my opinion, you've done all you can do to help her. Whether she succeeds or not is entirely up to her.

 

[Scutpuppy007]

Okay, I know that 4th year med students can be prone to senioritis, but this is beyond that. How did this girl make it all the way through third year? In my opinion, you've done all you can do to help her. Whether she succeeds or not is entirely up to her.

Oh.....I just found out that she repeated her 3rd year medicine clerkship earlier this year. I am so glad that I am changing to another hospital in 2 weeks!

 

[fineline]

Question: does she at least have big breasts? That could make me more interested in her education. Think about it.

 

[Top Gun]

Question: does she at least have big breasts? That could make me more interested in her education. Think about it.

Yes, is she hot? Then I'd probably be more interested in helping her too.

 

[fineline]

I never said anything about helping her, just educating her. LOL.

 

[Winged Scapula]

Well, I don't really care about her breast size.

Spend 5 minutes with her and tell her point blank:

1) you have been asked to speak with her by the more senior members of the team
2) that she is in danger of failing the rotation
3) since the rotation is a Sub-I, it is very important that she do well in order to maximize her chances of matching and in addition, to offset the poor performance in 3rd year medicine (a rotation that almost all specialties see as key to do well in)
4) that you have been frustrated in trying to discuss with her ways of improving her performance
5) it is not too late to turn things around

Then tell her that you will give her time to think about what she wants to do and that her options are:

1) ignore your offer of information and help to pass the rotation
2) agree to meet with you at a later date and time (to be specified by you) for no more than X number of minutes to listen earnestly to your suggestions

Many people will tell you that she's not your responsibility and you could reasonably say you've already tried to help her. But posting here signifies to me that you are concerned about helping her and I would venture that many on your team, including the attending, consider interns as being at least partially responsible for the students.

Generally students take instruction better from interns, but some do not...if that is the case, you have tried and refer her to the attending. You cannot make someone accept help if they are unwilling to.

In surgery we see a lot of unhappy students, but I've never seen someone willfully do as poorly as you describe.

 

[fineline]

Well, I don't really care about her breast size.

Note: nothing important was stated after that sentence.

 

[Tired]

Many people will tell you that she's not your responsibility and you could reasonably say you've already tried to help her. But posting here signifies to me that you are concerned about helping her and I would venture that many on your team, including the attending, consider interns as being at least partially responsible for the students.

My question is: why the interest in helping this person? I've only been an intern for like 3 months, but I've had two students who wanted to do well, worked hard, but just weren't quite up to snuff. Like most people would do, I prepped them, I complimented them on rounds, I helped them identify important points to bring up and had them present my plans as if they came up with them on their own.

I did this because they were hard workers who needed a hand.

What is described by the OP is completely different. Argues? Interrupts? Refuses to prepare and carry out even basic duties? The question isn't how can you help this person, it's how can you impress on the residents and attendings that this person needs to be failed.

. . . unless she's breast feeding; then go ahead and give her the pass . . .

 

[fineline]

...only if you're the one feeding on her breast.

 

[teri78]

Fineline,
You are extremely unprofesional! Do you realize that even though this forum is for medical profesionals, that non-profesionals also do bypass this forum? Your comments make the medical profession look very very bad! Imagine if you were a woman. Would you really want someone as imature as yourself doing a breast exam on you?

Moderator: Why don't you do your job, and get rid of posts like that! Although, my guess is you'll get rid of this one instead.

Before you even say it, no I am not a woman. I am a male.

 

[Tired]

Before you even say it, no I am not a woman. I am a male.

But certainly not a man . . .


[that's gonna be an infraction, but it was so worth it]

 

[fineline]

Imagine if you were a woman. Would you really want someone as imature as yourself doing a breast exam on you?

That depends: if I was a wimmen, exactly how hot would I be? Also, when you got your degree did they castrate you?

 

[teri78]

I've survived metastatic CNS cancer, 12 major operations, 8 minor ones and radiation and chemotherapy to beome a physician. Being a physcian means alot to me, so I probably became a physcian for more substantial reasons than you(money/prestige) I say that, because anyone who makes remarks like you clearly doesn't have the right priorities in mind(the patient, or even helping the OP with their problem) You generalize, why can't I.

 

[fineline]

LOL, when they operated on you, did they excise your sense of humor too? Or do you just spend all your time working on your personal statement?

 

[Terpskins99]

I just wanted to point out how this thread reminded me how much I appreciate having a wonderful intern to guide me on the floors.

Before I went into rotations, all I read about were horror stories of abusive interns that did nothing for their students and would force them to engage in meaningless scut (e.g. picking up dry cleaning). That has totally not been the case at my hospital. All the members of my team (attending, resident, intern) have been extremely patient with me, very supportive and have repeatedly reminded me how well I'm doing.

I don't know what the problem is with that girl, but seeing how much my intern went out of his way to help me only made me that much more determined to do my best. I'm pretty sure that all the other students rotating here have likewise had a similar experience.

You guys rock!

 

[fineline]

You guys rock!

Thanks. Did you finish washing my car yet?

 

[fineline]

LOL, teri edited out the part about being able to predict what race I was based on my post before he reported me to KentW. What a man!! (Not that I care because I'm not a liberal and don't get all erect over stuff like that.)

 

[deleted87716]

Discuss the topic, not each other, please. Thank you.

 

[fineline]

I just want to point out that I wasn't the one who derailed the thread. I will gladly discuss the cup size of the medical student in question as it relates to improving her performance on her clinical rotation.

 

[PeepshowJohnny]

So...still waiting on the boob size then?

Just kidding.

My advice is similar to above. Go up to this girl and say point blank "Currently, if I were to grade you, I would have no choice but to give you a failing grade. I am 100% serious." This does two things:

A) Finally gets through to the idiot that she's NOT doing well and needs to turn her act around.

B) She turns her nose up at you for being "mean" and continues to screw around and you can fail her in good conscious.

Honestly, I can't see how she made it through her M3 rotations.

 

[fineline]

So...still waiting on the boob size then?

And how!

 

[ruggerdoc123]

Moderator: Why don't you do your job, and get rid of posts like that!

Because he doesn't have a backbone.

Fineline is just trolling, trying to start a fight. Don't take the bait.

 

[ruggerdoc123]

You might want to consider giving her a mid-rotation written evaluation. If she wants to play the system, she can say that she never got feedback about her performance.

Or, email her after the meeting with the points that you discussed.

Med students like this turn into dangerous interns.

 

[deleted87716]

Moderator: Why don't you do your job, and get rid of posts like that!

We do not edit or delete posts on SDN unless they contain offensive language of an extreme nature.

We do, however, discipline users for violating SDN's Terms of Service, which includes personal attacks. Typically, this happens behind the scenes.

Furthermore, continued unprofessional commentary in this thread about female breasts will result in disciplinary action. That crap belongs in the Lounge.

 

[ruggerdoc123]

We do not edit or delete posts on SDN unless they contain offensive language of an extreme nature.

Kent W just deleted my post that asked if disciplinary action had been taken already. But I guess that question was far more offensive than the others posted. This is the same mod who closed the intern call story thread, but allows 25 posts on a medical student's breast size. Weak.

 

[deleted87716]

I have restored your post. It was deleted because it had already been addressed via PM, which is the more appropriate avenue through which to inquire about moderation issues.

I am trying to keep the discussion here on-topic, and frankly, you aren't helping one bit. If you have any further concerns about moderation in this or any other thread, I suggest you contact one of the Admins.

Thank you.

 

[fineline]

Furthermore, continued unprofessional commentary in this thread about female breasts will result in disciplinary action.

Actually, there's nothing unprofessional about it. We ALL know that there are certain wimmen medical students who will use their physical attributes to get better subjective clinical grades, including flirting with male residents/attendings. Most people will just call this "getting ahead," or at the most will just silently grimace. If you feel so strongly about this being unprofessional, then it would be incumbent on you to pull aside this person and lecture them on the limits of professionalism, ruggerdoc. Instead, you just come on an anonymous Internet forum and go on and on about how this type of discussion is "unacceptable" for physicians to engage in. By the way, I hope you also don't talk dirty to your girlfriend because I'm sure your patients would not appreciate that, either.

 

[ruggerdoc123]

I am trying to keep the discussion here on-topic.
Thank you.

By allowing 12 off-topic posts about breast size?

 

[fineline]

By allowing 12 off-topic posts about breast size?

Are you cutting your wrists while you type this?

 

[ruggerdoc123]

Classic.

 

[fineline]

The problem was that you got what you wanted -- a public statement that no more boobie talk was going to occur -- and you kept going because you weren't satisfied for some reason. At least when I get banned, I have a gripe because I don't get the action I want; what you did only demonstrated that you were being irrational. Like I said, if you care THIS STRONGLY about THIS SUBJECT, you should be the professionalism police at your medical school and lecture everyone on professionalism because it hurts you when your profession is "brought down" by people like me.

 

[Top Gun]

Okay, to get back on topic...

If this girl actually showed interest in doing better, talking to her again might work. She's not showing any, based on the fact that she argues with attendings and residents and didn't listen the first time you provided feedback on her performance. If you really care that much about her succeeding, try talking to her again with the explanation that she is in danger of failing and needs to get her as$ in gear. And tell her specifically what she needs to do to improve. If she listens and shapes up, great. If not, well, you did the best you could. If she fails, she has no one to blame but herself.

 

[Tired]

I've survived metastatic CNS cancer, 12 major operations, 8 minor ones and radiation and chemotherapy to beome a physician. Being a physcian means alot to me, so I probably became a physcian for more substantial reasons than you(money/prestige) . . .

On a completely unrelated note, I love this little smilie.

 

[teri78]

Tired I have never said anything against you, so I really don't know why you continue to attack me.

I will no longer post on this topic, because it is taking away from the original poster's problem. So you two immature little boys can attack away and I really don't care, and I'm sure you will.

I apologize to the OP and the MOD that my post turned into this mess.

 

[fineline]

Why is it immature? You deliberately used your illness -- and to be clear, nobody wishes illness upon you, OK -- as a "trump card." Wow, medicine helped you and as a result you take it "more seriously" because you don't post about breasts on an Internet forum. What if I then was like, "you lose, I'm a quadriplegic and confined to a wheelchair and I type like Stephen Hawking!" Would you then go, "oh, I'm owned, this guy clearly has it worse than me and therefore cares more about medicine than I do and I also feel bad now for making someone like that feel bad"? If so, then I'm in the wheelchair.

 

[teri78]

You win, you got me to respond

I never said I thought I was better or more mature than you because of my health problems. I said I was more mature than you because of your previous posts. For the record, I do not think I am better or more motivated than any other person on this site because of my medical conditions. I simply objected to the way you make physcians look to others.
If we were in person I would add some other stereotypical comments, but I won't since this is a public forum. I wouldn't want to insult the rest of that group by including you in it. I may have some medical illness, but I wouldn't any of them for your obvious mental illness.

 

[fineline]

Ah ah ah, not so fast. You said that because of your medical condition, medicine means a lot to you and because of that you say you probably became a physician for more substantial reasons than me. Note, you don't say anything about my posting habits, just the fact that you have an illness and that makes you a more worthwhile and committed individual. Gotta work on that logic. Also, I'd rip you a new one in the same fashion but since I've already been told that I can't make fun of you "because of your illness," I'll save it for later.

 

[Winged Scapula]

Good idea guys...take it outside or to PMs or whatever.

This is the last warning for BOTH of you...anymore discussions of each others failings, etc. will result in the thread being closed and possible further administrative action.

 

[fineline]

I agree, he can PM me and then I can respond as I'd prefer. Oh, and administrative action isn't taken for PMs, right? If so, then I'M ALL IN. Actually, even if it is taken, I'm still all in.

 

[Winged Scapula]

I agree, he can PM me and then I can respond as I'd prefer. Oh, and administrative action isn't taken for PMs, right? If so, then I'M ALL IN. Actually, even if it is taken, I'm still all in.

Administrative action is taken in regards to PMs if:

- one of the users is feeling harassed by the other; usually we just give a warning to the "harasser" unless it is crazy stalker kind of stuff they are sending. We also tell the person who is feeling harassed to block their InBox from the other.

- if private PMs are posted in a public forum without permission from all parties involved.

 

[Tn Family MD]

Why is it immature? You deliberately used your illness -- and to be clear, nobody wishes illness upon you, OK -- as a "trump card." Wow, medicine helped you and as a result you take it "more seriously" because you don't post about breasts on an Internet forum. What if I then was like, "you lose, I'm a quadriplegic and confined to a wheelchair and I type like Stephen Hawking!" Would you then go, "oh, I'm owned, this guy clearly has it worse than me and therefore cares more about medicine than I do and I also feel bad now for making someone like that feel bad"? If so, then I'm in the wheelchair.

Man, that's the funniest post on SDN in quite some time! I almost shot beer out my nose!

 

[lumbering]

We ALL know that there are certain wimmen medical students who will use their physical attributes to get better subjective clinical grades, including flirting with male residents/attendings. Most people will just call this "getting ahead"...

Even attactive women who don't do this intentionally probably have some advantage in subjective evaluations because everyone subconsciously judges everyone in part based on looks. Even patients judge their physicians on looks, so perhaps attractive medical students DO deserve better evaluations. Mabye looks should be a seperate section on the evaluation forms where attendings can write things like "needs to drop ten pounds" or "Looks like a $4 ho with that eyeliner."

 

[Winged Scapula]

Even attactive women who don't do this intentionally probably have some advantage in subjective evaluations because everyone subconsciously judges everyone in part based on looks. Even patients judge their physicians on looks, so perhaps attractive medical students DO deserve better evaluations. Mabye looks should be a seperate section on the evaluation forms where attendings can write things like "needs to drop ten pounds" or "Looks like a $4 ho with that eyeliner."

Interestingly enough, my fellowship program actually included that on the interview evaluation forms for candidates. I believe the actual terminology was "appearance" and was meant to evaluate things like hygiene, professional dress, comportment, etc. but you could certainly assume that it might have included things like you suggest.

 

[lumbering]

Interestingly enough, my fellowship program actually included that on the interview evaluation forms for candidates. I believe the actual terminology was "appearance" and was meant to evaluate things like hygiene, professional dress, comportment, etc. but you could certainly assume that it might have included things like you suggest.

Pretty much everyone is primped up for the interview, so I don't see the point of an "appearance" section other than to give an advantage to conservative-looking comely candidates.

Who would get a higher ranking for appearance?

or

 

[Miami_med]

Even attactive women who don't do this intentionally probably have some advantage in subjective evaluations because everyone subconsciously judges everyone in part based on looks. Even patients judge their physicians on looks, so perhaps attractive medical students DO deserve better evaluations. Mabye looks should be a seperate section on the evaluation forms where attendings can write things like "needs to drop ten pounds" or "Looks like a $4 ho with that eyeliner."

Man,

I'm gonna fail for sure

 

[Winged Scapula]

Pretty much everyone is primped up for the interview, so I don't see the point of an "appearance" section other than to give an advantage to conservative-looking comely candidates.

Who would get a higher ranking for appearance?

or

You would be suprised at what people show up in for interviews. Its usually not horrible by this level, but there are some suspect judgements made. At any rate, as I noted, the 'appearance' rating was not based soley on what you wore or your physical appeal, but other factors as well including professional demeanor, comportment, etc.

At any rate, I didn't design the form so I cannot comment on whether it was designed to give the better looking applicants an advantage.

 

[fineline]

Both of those wimmen are hideously ugly and un-doable, so they're both qualified to be female residents.