Here’s a different angle...what to do with a difficult Med student (as an attending)

[SLC]

I’m a new attending, taking students into my practice for clinical rotation preceptorship. They’re mostly great but I have one that’s very “tough”

Big mouth, no filter, too overconfident, doesn’t respect professional boundaries etc. I’m honestly afraid to have the student alone with my patients for fear of what might get said or done.

How would you as a student prefer I address these types of issues if you were the student in question.

I know how I’d handle it as an attending, but what say ye? What gives the best opportunity for learning and improvement from a current student perspective.

---

Members don't see this ad.

 

[Naruhodo]

Something that drives me a bit nuts, but which probably works, is a preceptor starting off a feedback conversation with, "Tell me what you think went well today? What do you think could have gone better?" It makes a student reflect on their own strengths and weaknesses. Maybe you find something they say about their strengths that you can agree with, and something about what could have gone better might give you an inroad to give some constructive criticism. It may feel like an inauthentic way to do things, but in my experience at least many students can be at times pretty neurotic, emotional, on-edge, etc. so a gentle approach might be good to feel out the situation at first.
You can also try something like, "What is your preferred communication style?" but I think most people say they like others to be direct when them, but then aren't happy when they are. Therefore, see above.

 

[Medic741]

Private frank feedback is extremely helpful especially when it includes constructive / clear actions that we can take for the rest of our time in the rotation

 

[holdthemayo]

I'll echo what has been said above. Give feedback, and give it early. It's better to let them know your concerns at the beginning of a rotation and provide a window to show improvement than to spring it on them at the end on their evaluation.

 

[ciestar]

I'll echo what has been said above. Give feedback, and give it early. It's better to let them know your concerns at the beginning of a rotation and provide a window to show improvement than to spring it on them at the end on their evaluation.

THIS. Yes please.

 

[mistafab]

Give them mid rotation feedback, and be specific as possible with your concerns.

If there is not drastic improvement by the end, slam them in their evals. Again, just be specific with what behaviors need to change. Hopefully they are mature enough to learn from their mistakes and are receptive to feedback. If not, slam them for that too.

 

[SLC]

So my thought were in line with everyone here: be blunt, say what’s going well and what has to change. This was accepted with some reservation by the student; and promptly followed up with some even worse behavior.

I’ve handled it already in the way I felt was appropriate. But what do students think would be the most reasonable next step?

 

[Ludwig2000]

Have you talked with them about the “even worse behavior” yet? Sounds like the next step to me. Bring up whatever it was, and ask if they think that was the appropriate thing to do.

Because I guess the first question is: do they actually understand what the problem is?

If no- I suppose repeat conversation you had before... but try to determine whether they understand the broader pattern you’re concerned about rather than one specific instance.

If they do understand but they keep doing it- what’s that about? Do they disagree/ think they know better? If this is the case it may require talking to one of their leadership - dean of students or whoever.

I will say as a student albeit an older one, I am much more often concerned by students seeming unwilling to take personal responsibility / respond to criticism than I am about preceptors being “mean” or “unfair”

 

[Ho0v-man]

So my thought were in line with everyone here: be blunt, say what’s going well and what has to change. This was accepted with some reservation by the student; and promptly followed up with some even worse behavior.

I’ve handled it already in the way I felt was appropriate. But what do students think would be the most reasonable next step?

Dang that really sucks. Sadly the best option there is to deliver a poor eval. Super sucks bc of how damning that is but it sounds like they’re acting out like a rebellious teenager. I personally would avoid comments if possible as those could end up on the MSPE. I doubt anyone who cared enough to make such a thread would be demanding anything unreasonable. Not doing anyone any favors by letting this guy/gal get honors.

 

[SLC]

I don’t think avoiding comments on an evaluation is on anyone’s interest. Student needs real impetus to address the issue permanently. Potential residencies deserve to know about the issue (believe me it was almost disqualifying lack of professionalism IMO) so they can take any and all precautions when considering hiring student. After second event, which was on same day as my feedback session, the school was made aware and student is going to be pulled off rotation starting Monday.

 

[deleted480308]

I don’t think avoiding comments on an evaluation is on anyone’s interest. Student needs real impetus to address the issue permanently. Potential residencies deserve to know about the issue (believe me it was almost disqualifying lack of professionalism IMO) so they can take any and all precautions when considering hiring student. After second event, school was made aware and student is going to be pulled off rotation starting Monday.

you gave clear feedback and they blew it. You did your job by reporting it and you don't owe any apologies for it

 

[jurassicpark]

I don’t think avoiding comments on an evaluation is on anyone’s interest. after second event, school was made aware and student is pulled off rotation and subject to school discipline.

Good that you contacted the school. I have not yet had to go there, but I would've done exactly that. Talked to the student privately, if they continued to worsened immediately contact the school and quite frankly tell them not to come in the next day. You're doing the school a favor, you don't want or NEED a disruptive student in your practice.

 

[SLC]

Good that you contacted the school. I have not yet had to go there, but I would've done exactly that. Talked to the student privately, if they continued to worsened immediately contact the school and quite frankly tell them not to come in the next day. You're doing the school a favor, you don't want or NEED a disruptive student in your practice.

Yep, and at the end of the day that’s exactly what the student was...disruptive. Also: Rude, Closed minded, judgemental. I was worried the student would offend and chase patients from my practice. I gave pointed feedback, an opportunity to reign it in, and when that wasn’t done I did what I think was the necessary next step.

 

[Ho0v-man]

I don’t think avoiding comments on an evaluation is on anyone’s interest. Student needs real impetus to address the issue permanently. Potential residencies deserve to know about the issue (believe me it was almost disqualifying lack of professionalism IMO) so they can take any and all precautions when considering hiring student. After second event, which was on same day as my feedback session, the school was made aware and student is going to be pulled off rotation starting Monday.

Wow didn’t realize it was quite that bad. Better to learn there’s consequences for ones actions now instead of figuring it out in residency.

 

[ArteryStudyPainting]

I'm curious to what the student was doing! Sounds like they needed a wake-up call (and hopefully aren't dense enough to get it now).

 

[SLC]

I'm curious to what the student was doing! Sounds like they needed a wake-up call (and hopefully aren't dense enough to get it now).

I can’t elaborate, unfortunately.

But I think a wake-up call will be delivered; or the student will be dismissed from school. At least that would be my guess. I submitted my account of the issue to the powers that be as requested, and I’m no longer involved with the situation, as it should be.

 

[Goro]

So my thought were in line with everyone here: be blunt, say what’s going well and what has to change. This was accepted with some reservation by the student; and promptly followed up with some even worse behavior.

I’ve handled it already in the way I felt was appropriate. But what do students think would be the most reasonable next step?

Report back to his clinical Dean, and fail him. Kick him off rotation if needed .

We call these types of students "site Killers", because they are so bad they ruined a rotation site for the school.

This is the type of person who will get kicked out of residency if they don't mend their ways