Is scutting your students good for them?

[Gotti]

Hey guys,
I really get indignant about doing excessive scut work especially if its unnecessary and may not speed up the resident's work at all. I have sworn to always send my student home early so he/she can go home and read if there is nothing more to learn at clinic that day. I would say there's only about 2-3 hours worth of learning at the hospital per day, maybe morning rounds and watching one procedure or two. The student's paying a huge price for education and should read while they can before the hectic resident's schedule.

My classmate made the argument that scut work helps us learn how to more more efficient when we are residents. That's a fine argument and all, but my counterpoint is that any hospital we go to for residency will have different forms to learn and it will take no less than 2-4 weeks in residency to get them. We never get good enough at them as med students because we don't see enough of them anyway before going to a different service.

What do you guys think?

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[Blade28]

You've made some good points.

I agree that there's a limit to how much scut the med students should be exposed to. On the other hand, it can take quite a few weeks to get used to doing all the floor work as an intern, and those interns that had more experience dictating/discharging/dealing with consults/calling radiology/lab/path/etc. seem to catch on a little quicker.

I agree that if there's no educational value to be had for the students on any given day, just let them go home and study!

 

[Anka]

Just to give a (not necessarily universal) medical student perspective. While constantly being scutted out sucks, being on a service where you aren't part of the team sucks even more. Some of the most satisfying experiences I've had in medical school were when, as the junior medical student on the service, my intern would let me preround on everyone, write all the notes, get my orders in... and then show up 10 minutes before rounds to deal with any problems I came up with. I learned a lot doing it, although I was at the hospital about 2 hours before rounds (because I hadn't gotten efficient). Was it scut? Sure. Could you have argued the intern was taking advantage? I'm sure you could if you wanted to. But it was a great experience, and I learned more doing that then I could have reading in a corner. It also built up my confidence that he was willing to trust me to do that.

Most disatisfying experiences were ones where every two second the resident was like "Hey, we're not really doing anything, why don't you go read?" "Oh, that's just scut, you shouldn't do that." And pretty soon, I'm totally marginalized sitting in the corner reading.

Anka

 

[sunlioness]

Yeah, I always hated being told to "go home and read." It felt like a brush off. And I never learned primarily through reading anyway. I think some level of "scut" is reasonable to expect because it's work that needs to be done by someone and it helps to learn how to do it. I think doing stuff like that as a medical student at least helped me feel not so overwhelmed with it as an intern. But there are degrees, of course.

 

[AmoryBlaine]

Just to give a (not necessarily universal) medical student perspective. While constantly being scutted out sucks, being on a service where you aren't part of the team sucks even more. Some of the most satisfying experiences I've had in medical school were when, as the junior medical student on the service, my intern would let me preround on everyone, write all the notes, get my orders in... and then show up 10 minutes before rounds to deal with any problems I came up with. I learned a lot doing it, although I was at the hospital about 2 hours before rounds (because I hadn't gotten efficient). Was it scut? Sure. Could you have argued the intern was taking advantage? I'm sure you could if you wanted to. But it was a great experience, and I learned more doing that then I could have reading in a corner. It also built up my confidence that he was willing to trust me to do that.

Most disatisfying experiences were ones where every two second the resident was like "Hey, we're not really doing anything, why don't you go read?" "Oh, that's just scut, you shouldn't do that." And pretty soon, I'm totally marginalized sitting in the corner reading.

Anka

Good post. I agree that the worst thing is to see a resident overwhelmed with med-student level jobs who refuses to let us help out because it's "scut."

Sometimes "scut" is patient care.

 

[Faebinder]

I'm with the "Send your student home" crowd. I can sit and teach a student but there are so many things you wont learn on the floor. Sides, some people really look at scut work as a non-learning experience and refuse to learn from it.

Just send them home unless they want to hang around and help, after which you are obligated to make their day useful.

 

[Gotti]

I agree rounding on patients, charting how their labs progress, and writing orders is great learning so that's fair to do. But what do you learn from administrative paperwork that will vary department to department anyway. Some hospitals are more strict on some forms than others and the med student might fill it out wrong. One student spent an afternoon filling out an entire PT/OT form line by line with practically an essay on the patient's history and pathophysiology probably to impress his resident, but because he didn't fill out one line with exactly what the PT/OT people wanted, this kept the patient another day or two on the ward and probably increased his chances of DVT/PE. Another student was asked to walk a patient he had never met or rounded on around the nurse's station which is fine and nice for the patient, but the student is not a trained rehab person or even a nurse; he nearly tripped over the patient's numerous lines and probably dislodged his chest tube a little. What if the patient fell? Who's liable? And what does an intern do when med students are on vacation anyway? So I think interns have to just suck it up for a year and do their own work.

Talking to my classmates, they've decided they will now scut their students "hard" because of how they were treated. I've taken it on as my personal mission to stop the cycle of abuse no matter how bad I get it as a student. I will also ridicule any colleagues as lazy bullies when they scut their student. Med students should go home and study so that when they become residents, they know a lot of medical science to help the patient and make good suggestions to the attending. They can then focus on the paperwork without having to worry about trying to read up on Takyusu's arteritis that would have saved the patient. So if I do nothing else as a doctor, even if I don't save a single life, or even help a nurse, I will stop scut!

Well, that's my soap-box for the day. Thanks to all those still paying attention throughout my little tirade up there.

 

[DrDawg]

Good post. I agree that the worst thing is to see a resident overwhelmed with med-student level jobs who refuses to let us help out because it's "scut."

Sometimes "scut" is patient care.

I agree with Anka and Amoryblaine. There is no scutwork, only work. Students had two years to sit and read. They should be involved with all aspects of patient care for the few patients they follow. This gives ample time to read while in the hospital. It is annoying to get students in the spring of their MS3 year who can't write a consult note, write admission orders, formulate an assessment and plan, or read a film. Part of this is the students fault, but more of it is the resident who allowed the student to sit there while he/she did all the work. I really can think of very little that goes on in the hospital that a student can't learn from, so long as you don't have them do something you wouldn't otherwise do yourself. Okay a coffee run would be scut.

 

[RTrain]

I agree with Anka and Amoryblaine. There is no scutwork, only work. Students had two years to sit and read. They should be involved with all aspects of patient care for the few patients they follow. This gives ample time to read while in the hospital. It is annoying to get students in the spring of their MS3 year who can't write a consult note, write admission orders, formulate an assessment and plan, or read a film. Part of this is the students fault, but more of it is the resident who allowed the student to sit there while he/she did all the work. I really can think of very little that goes on in the hospital that a student can't learn from, so long as you don't have them do something you wouldn't otherwise do yourself. Okay a coffee run would be scut.

I completely agree with every word of this. "Go home and read" defies the entire purpose of the 3rd and 4th years of med school, and to expect that to be the substance of the clinical years reveals a profound lack of foresight on the part of a student. It is not possible to learn to function as a member of a medical team, nor is it possible to make an educated choice about a future career if you spend only "2 or 3 hours" in the hospital each day. A large portion of the choice of career involves "fit," IMHO, and you can't get a sense for how your personality fits with the real, day-to-day work of a field if you are spending 8 to 10 of the 12 (or more) working hours per day at home reading about esoteric pathologies that you can look up in 30 seconds if faced with them in the future.

And I'm sorry, but the OP's namecalling is insulting. Residents are not "lazy bullies" for relying on a model of medical education that has been a foundation for the teaching of junior and senior medical students for over a hundred years, or for expecting the beginning development of the work ethic that will be necessary in the years to come.

 

[herbalgarden]

I had a really good experiences in a few of my rotations, particularly IM core clerkship, where where the interns/residents basically gave me complete independence (with oversight and inputs of course) on my patients - of course, I had to ask. This include admission, writing orders, f/u labs, writing notes, calling and f/u with consults, leading family meetings, and dealing with nurses questions. I would admit 1-2 patients/call night, and generally carry 2-4 pts at a time. When I'm done with my work, unless everyone is buried in work requiring help, I go home and read/study. This may seem like a lot of work, but from a med student perspective, it makes it soooo much easier and efficient since I know my patients better than following a few patients where the intern/residents took charge (and I always end up playing "catch-up" or trying to figure out why certain orders are made). Certain days, it can be draining especially if I have >2 fairly complex/demanding patients (especially the ones in the ICU), but for the most part, I get to go home with enough time to wind down and study.

I really think this is the best balance between student learning and helping the interns/residents workload. I totally felt like a huge part of the team. The consults, nurses, and attending come to me regarding questions about my patient. It's fun to play Sub-I before the rotation is over. Of course, this only works if the intern/resident allow the me to be be independent (usually take 1-2 wk to gain their trust) couple with a rotation of decent length 6 wks+.

For the new interns out there, it would be tremendously helpful to give your med student the independence if you feel confident in them. Can start slow by offering them to follow just 1 pt first. Be a guide/consult for them, but don't take over. When you do take over for things that can't wait, please keep them up to date when you have a moment about their patients. Make it clear that once they're done with their work, they can go (unless there's some interesting procedure they can do or case to see of course). One of the more difficult experience for me was when I work with interns who want to have complete control over the patient's care. As a result, my involvement in the pt I'm following is fragmented and makes it really difficult to keep track of.


Sorry this is a little long, but something that I have to deal with this whole year.

 

[smq123]

I really can think of very little that goes on in the hospital that a student can't learn from, so long as you don't have them do something you wouldn't otherwise do yourself.

And this is a really important point. I don't want to be sent home just to read.

(One of my interns on medicine said, "I know you want to be helpful, but don't volunteer to do a lot of stuff like fill out paperwork and do discharges. Your job is to just read up on the patients as much as possible."

It was sooooo tempting to ask, "Oh...so...does that mean I don't have round on anybody tomorrow? Can I come in at 11?"

I mean, come on.)

But please, don't make me do things just because you don't want to do them. (The intern above ended up doing that - if he didn't want to deal with an irate family member, he'd send me in there "'cause it's educational!" ) I can tell when you are just shoving off unwanted chores, or when you're making me do your work because you want to have an extra 10 minutes to flirt with the respiratory therapist.

 

[Tired]

But please, don't make me do things just because you don't want to do them. (The intern above ended up doing that - if he didn't want to deal with an irate family member, he'd send me in there "'cause it's educational!" ) I can tell when you are just shoving off unwanted chores, or when you're making me do your work because you want to have an extra 10 minutes to flirt with the respiratory therapist.

I wouldn't tell you to do it because it's educational. I'd tell you to do it because I didn't want to do it, and I wanted to go flirt with the RT instead.

Welcome to medicine.

 

[smq123]

I wouldn't tell you to do it because it's educational. I'd tell you to do it because I didn't want to do it, and I wanted to go flirt with the RT instead.

Well, you might not, because we all know that ortho interns lack the creativity needed to say anything other than what they're thinking at that moment.

Interns in other fields are able to get a little more creative.

 

[Faebinder]

I wouldn't tell you to do it because it's educational. I'd tell you to do it because I didn't want to do it, and I wanted to go flirt with the RT instead.

Welcome to medicine.

Tired, you are a mean $^#$@! because you know very well that you should do what's best for the student.... meaning if you are gonna show a student how to flirt then it better be the best looking chicks in the hospital and those are usually drug reps.

 

[Tired]

Interns in other fields are able to get a little more creative.

No, interns in other fields are just a bunch of p***ies.

Being a med student sucks. Being an intern sucks. I assume that being a resident also sucks. Part of this large cycle of suckage is that you are often asked to do unpleasant things simply because the person about you doesn't want to. Most of the time these things are educational (and I would definitely include talking to an irate family member on the "educational" list), some times they are not.

If I'm going to ask a med student to do something because I don't want to do it, I'm going to man up and be honest about it. I'm not devaluing you by asking you to do something crappy, I'm asking you to help me out. So I'm not going to lie to your face about my motivation.

 

[Tired]

Tired, you are a mean $^#$@! because you know very well that you should do what's best for the student.... meaning if you are gonna show a student how to flirt then it better be the best looking chicks in the hospital and those are usually drug reps.

The drug reps aren't around long enough during the day to make it worth my time. Then there's the problem of the attendings already putting the moves on them, which dilutes your chances of success. Plus, most of my interaction is with the device reps, and all of ours are male.

I've been preaching my targeting order for years, although I can no longer practice this because apparently being married means no more flirting: Travelers and student nurses. That's where your money is.

 

[Dr Jboo]

I was just thinking about this topic the other day as I was driving 30min away to pick up sushi for all the residents and the attending on call that night :/

 

[smq123]

Being a med student sucks. Being an intern sucks. I assume that being a resident also sucks. Part of this large cycle of suckage is that you are often asked to do unpleasant things simply because the person about you doesn't want to. Most of the time these things are educational (and I would definitely include talking to an irate family member on the "educational" list), some times they are not.

If I'm going to ask a med student to do something because I don't want to do it, I'm going to man up and be honest about it. I'm not devaluing you by asking you to do something crappy, I'm asking you to help me out. So I'm not going to lie to your face about my motivation.

If talking to the irate family member is so "educational," then shouldn't the intern at least tag along to make sure that what you're saying is correct? Shouldn't there be an element of moral support?

I don't mind talking to the irate family member if the intern is in the background, ready to correct anything that I say (and I'll probably say something that's wrong). But do you really want to send your med student, alone, to talk to a family member of a cancer patient? What if the family member starts asking questions that even you can't answer? Do you really want to risk having a third year med student tell them something incorrect - which will require damage control from you (or the attending) later?

And, like I said, YOU might be willing to be honest about why you're asking a med student to do something for you. And that's fine - be honest with me and don't lie. (Isn't "don't lie" one of the cardinal rules of rotations? Why shouldn't it go both ways?) Sadly, not all of us have had interns that lived by that rule.

 

[exPCM]

If the student wants to get into psychiatry or family practice, then scut work is typically not worthwhile for them since they can usually get into a psych or FP residency with ease without needing to do much scut work.
However for students going into highly competitive residencies, the abiity to do scut work efficiently and without complaining can impress residents and attendings leading to better evaluations and recommendations and giving them an edge in getting into their chosen residency.

 

[Tired]

Do you really want to risk having a third year med student tell them something incorrect - which will require damage control from you (or the attending) later?

Eh, I don't farm out conversations with family, although I know many do.

But with regards to your underlying point (having to clean up after med student mistakes) I'm all for it. The time for shadowing needs to taper off as 3rd year goes on, and independent action begins. Mistakes happen, errors are made, and these all need to happen for education to truly occur.

I hear that in the European programs, "residency" is one long shadowing experience. I think that's crap. Mistakes that can be fixed is a small price to pay for good student training. I had a lot of sutures torn out as a med student, but I was sewing like a pro by the first day of internship. And really, how much more "watching" do you really want to do these days?

 

[SoCuteMD]

I can tell when you are just shoving off unwanted chores, or when you're making me do your work because you want to have an extra 10 minutes to flirt with the respiratory therapist.

Even interns need to get some SOMETIME!

As far as scutwork, I actually like the opportunity to be helpful to my team. When I draw blood on my patients and run it to the lab, it's doing what is expected. When I offer to draw blood on another patient that belongs to our team, I look like a team player. Plus, I kinda like drawing blood anyways. I also like the fact that if I'm willing to do a few extra things that aren't necessarily expected of medical students, I can help my team get home earlier and keep everybody happy.

 

[rowan]

For the new interns out there, it would be tremendously helpful to give your med student the independence if you feel confident in them.

I too understand that there are few better experiences in med school than actually feeling like you matter to the team, because so often, we don't. However, also consider the following...(I am not an intern for another couple of months, so I suppose I am talking about something that I know little about at this point).

I once heard a discussion amongst surgical residents regarding how much certain attendings would let them do in the OR. The junior resident argued that the attendings that didn't have much confidence in their own skills would let the resident do most of the case, because they didn't feel comfortable doing it themselves. The chief pointed out that, actually, the ones with the MOST confidence in their own skills would let the resident do the most because they were confident enough in their operative skills to get out of any mess the resident created. This long-winded story brings me to my point that, because interns are new and clinically inexperienced, their unwillingness to let you take complete control of your patients may have more to do with a lack of confidence in their own abilities than a lack of confidence in yours.

For the past two years, I have tried to take mental notes of the types of residents/interns I have enjoyed working with, and those I haven't, as I hope to be the type of resident that provides a positive student experience. Certainly, I can say I enjoyed most those that made me feel that I was part of the team. However, I am not certain that, as an intern, I will be willing to let students take full responsibility of their patients. As I said earlier, this represents mostly a lack of comfort with my own clinical abilities, and I will probably feel it necessary to be intimately involved in the care of every patient for which I am ultimately responsible.

 

[Ypo.]

Like a previous poster said, I prefer scutwork (even if there is little educational value) to being completely divorced from patient care. However, I feel like my goal while at the hospital is to learn how to function like an intern. So, if the scutwork is what the intern has to do and I can help out, fine. Or, if I can see an advantage for said scutwork to patient care, and there is little chance that anyone else is going to do it, I'll be on it in a heart beat.


It's been GLORIOUS the past several days. The resident didn't show up, so I have been working on my own. I go see the patients, write H & P, report back to the attending. Soooo much better than shadowing.

P.S. I would also add, that "go home and read" is perfectly acceptable if there isn't much else going on. I think third and fourth year should be a mix of clinical and studying on your own. We shouldn't have to be there as much as a resident because too much clinical can impede your reading time. Likewise, too much reading and not enough hospital time can impede your clinical skills.

 

[Ypo.]

This may seem like a lot of work, but from a med student perspective, it makes it soooo much easier and efficient since I know my patients better than following a few patients where the intern/residents took charge (and I always end up playing "catch-up" or trying to figure out why certain orders are made).

You know the feeling when someone expresses a thought that has been lingering on the edge of your conscious for quite awhile? Well, you took the words right out of my mouth! This is so true...

 

[Coastie]

No.

You're job as an intern is to educate your med students, and minimize their scut as much as possible. Optimize their rotation towards learning and allowing them to have the opportunity to earn the highest grade possible. Present something to them daily, and encourage them to have daily readings outside of work based on interesting cases or weak points you see in your mentoring of them. Unless they give you a good reason, always rate them high.

This sort of idea that scut "helps them as residents" is asinine. Having medical knowledge and exposure to pathology helps them as residents. Honoring the rotation helps them as residents. Doing scutwork detracts from these goals..

If a student wants more, it's there. If they want a taste of scutwork, I've got plenty. I find the best clinical teaching cases, hands on learning (procedures, situations, etc), and bring them along PRN.

Hey guys,
I really get indignant about doing excessive scut work especially if its unnecessary and may not speed up the resident's work at all. I have sworn to always send my student home early so he/she can go home and read if there is nothing more to learn at clinic that day. I would say there's only about 2-3 hours worth of learning at the hospital per day, maybe morning rounds and watching one procedure or two. The student's paying a huge price for education and should read while they can before the hectic resident's schedule.

My classmate made the argument that scut work helps us learn how to more more efficient when we are residents. That's a fine argument and all, but my counterpoint is that any hospital we go to for residency will have different forms to learn and it will take no less than 2-4 weeks in residency to get them. We never get good enough at them as med students because we don't see enough of them anyway before going to a different service.

What do you guys think?

 

[herbalgarden]

As I said earlier, this represents mostly a lack of comfort with my own clinical abilities, and I will probably feel it necessary to be intimately involved in the care of every patient for which I am ultimately responsible.

You made a good point, and this is probably more true around July or so, when the med student is new to the ward and the intern just started. The experiences I described is probably more 2-3 mos into the academic year.

 

[DarthNeurology]

Residents are not "lazy bullies" for relying on a model of medical education that has been a foundation for the teaching of junior and senior medical students for over a hundred years, . . .

LOL, I sometimes think that the "foundation for the teaching of junior and senior medical students for over a hundred years" relies a lot on bullying subordinates. I don't mind doing H and P, progress notes, running stuff to lab, filling out forms, but the worse thing is when you are new to a service and the resident says, "Fill out the WFDW-909 (or whatever form) and you basically" you ask them to help, and they say "Get the patient info and put it in" you do this, but then you need to enter information that is hospital specific like this or that code, or "On Wednesday we have to send the CBC in a special pink-stripped tube, and send it to the secret auxillary lab . . . etc." and look at you like you should know this when it really is just at that hospital, and then you go back and they have "fix" the form that you "screwed up" all the while joking and eating food with the other residents, so basically I don't like poor orders, i.e. not training somebody to do something and then wasting our times because I have to track down the resident just to get the "help" to fill out a form I've never seen, which takes 45 minutes, but would take the residents 2 minutes if they did it and I watched and did it next time . . . if your not really deligent letting students do this leads to errors in patient care (things attendings care about, but residents have blind spots as long as the "work is done") I have seen it happen a lot patient x stays an extra couple days or a lab test is never done as another student was obviously clueless and I tell them to "better check with the resident about this form." So, a lot of the time residents make poor commanders in the field, i.e. given troops orders but not instructions and really not caring or confirming if the orders were carried out. Other times residents feel that as "commanders" they can order you to do things unrelated to education like staple the list and make 30 copies and hurry because the attending is coming and my *** is on the line. . . residents don't care to even ask nicely anymore at some places. And as the poster said the justification is that is has been done for a hundred years, however, I do notes that often a mean resident gets chewed out for being irresponsible when they yell at me 10 times a day to work harder even though I am running around frantically and get good evals etc. . . and these are usually the residents who yell the most at students because they are getting their share

 

[Anka]

Just to add, I'm more than happy to do truly scutty and unpleasant tasks for interns and residents who teach me. That's just paying your tuition. And I am willing to to truly scutty and unpleasant tasks for even for residents who don't teach me. Why? Because I've found that most residents who don't teach don't because they've been abused my med students (far more common at my med school than the other way around, usually in the form of completely inappropriate evaluations which are relentlessly pursued by my school regardless of the source of the complaint).

Look, the primary job of the intern and resident is patient care. Teaching med students is at most a secondary responsibility. If you want your resident to go above and beyond the most rudimentary teaching requirements, stop acting like entitled a$$es and help out.

Anka

 

[RTrain]

LOL, I sometimes think that the "foundation for the teaching of junior and senior medical students for over a hundred years" relies a lot on bullying subordinates. I don't mind doing H and P, progress notes, running stuff to lab, filling out forms, but the worse thing is when you are new to a service and the resident says, "Fill out the WFDW-909 (or whatever form) and you basically" you ask them to help, and they say "Get the patient info and put it in" you do this, but then you need to enter information that is hospital specific like this or that code, or "On Wednesday we have to send the CBC in a special pink-stripped tube, and send it to the secret auxillary lab . . . etc." and look at you like you should know this when it really is just at that hospital, and then you go back and they have "fix" the form that you "screwed up" all the while joking and eating food with the other residents, so basically I don't like poor orders, i.e. not training somebody to do something and then wasting our times because I have to track down the resident just to get the "help" to fill out a form I've never seen, which takes 45 minutes, but would take the residents 2 minutes if they did it and I watched and did it next time . . . if your not really deligent letting students do this leads to errors in patient care (things attendings care about, but residents have blind spots as long as the "work is done") I have seen it happen a lot patient x stays an extra couple days or a lab test is never done as another student was obviously clueless and I tell them to "better check with the resident about this form." So, a lot of the time residents make poor commanders in the field, i.e. given troops orders but not instructions and really not caring or confirming if the orders were carried out. Other times residents feel that as "commanders" they can order you to do things unrelated to education like staple the list and make 30 copies and hurry because the attending is coming and my *** is on the line. . . residents don't care to even ask nicely anymore at some places. And as the poster said the justification is that is has been done for a hundred years, however, I do notes that often a mean resident gets chewed out for being irresponsible when they yell at me 10 times a day to work harder even though I am running around frantically and get good evals etc. . . and these are usually the residents who yell the most at students because they are getting their share

From what I can gather from your post, you seem to misunderstand what I mean. I am not saying it is a time-honored tradition to abuse or bully, but expecting medical students to take some responsibility for clinical duties on their patients is part of the structure of medical school. The first two years are for reading and reflective study. The second two years are a practical immersion experience in which you begin to think and work like a doctor instead of a graduate student.

Medical education is not built on "yelling" but it is built on teaching and growing the people below you, and part of that is giving them graded responsibility. Residents learn by being given responsibility for patient care, why would it be any different for medical students? Look ahead, and see how the experiences you are having now will equip you for the rest of your life. You spent the first 18 years of your education getting all the time to read and study that you could possibly wring out of a 24 hour day, now it is time for a different kind of learning. Quit complaining about it and embrace it for the opportunity it is.

 

[Mayhem]

This long-winded story brings me to my point that, because interns are new and clinically inexperienced, their unwillingness to let you take complete control of your patients may have more to do with a lack of confidence in their own abilities than a lack of confidence in yours.

I agree. In 3rd year I had an intern like that on surgery who was pretty inexperienced with even the simple procedures so she wouldn't let us do anything. It was annoying but I suppose it was more urgent for her to learn it than for me. Usually though we got shut out because the Doctors wanted things done a specific way and the interns were afraid to let us do anything because they might get chewed out for it. This is the norm at our University hospital (especially for IM) and I hated it because we have OSCE's. You can't expect us to do something in an exam that we don't get to practice on the ward.

 

[dmitrinyr]

First, I want to say that at this point with less than 2 months left, I really don't want to do much on the 2 rotation that I have left. I'm just tired and want to relax a little bit. Still, if a fellow asks me to go down to ED and do a GI consult on a pt, I'll do it and do it to the best of my ability. The main thing that I want from that fellow is to TEACH me afterwards. All I need is a few minutes after I finished with my consult to sit down with me and discuss the case and all the appropriate differentials and his/her approach towards the treatment of this pt and etc. I really hate it when you have fellows just give you consults to do (which in the end don't really matter because they come down and fill in the actual consult itself) and then don't even discuss the case with me. With this type of fellow or resident I get disenfranchised very quickly and feel like "why bother?". As a student, regardless whether you're a 3rd or 4th year, you're main job on any rotation and basically the reason why you're there is TO LEARN. That's what you're paying $$$ for. So if a intern/resident/attending/fellow will not take the time to teach me something, then that just makes me care less. I hated those rotations in which I would round for hours with attendings that would not explain anything, would not ask anything and would just tell the residents what has to be done while completely not acknowledging that the student was even there. I also hated when I would do call and would follow an intern and then intern would not even say one word to me about the pt we just admitted. My hospital was really strict about students writting in charts and so we were not allowed to write any orders, notes, H&Ps, consults, etc. We would occasionally do some of this stuff but most of the time the interns would not spend any time talking to us about "what orders would you write for this pt?" "what is your A/P?" This made me really annoyed because I actually wanted to learn how to write certain orders and just learn what the intern is thinking at specific points so that I will be a better intern and I didn't get that chance. Yes I tried to write my own orders and then compare it to the actual ones but you can only do this so long without actual constructive criticism from intern.

I know this post is just running on and on but I have not had a good clinicals experience in terms of learning on the wards and I'm just venting.

 

[ineedsleep]

I'm just a MS4, but I guess I have mixed feelings about scut. I like being part of the team, so I don't mind most stuff like putting away notes after rounds (learned my way around the hospital and good ways to search for charts), pre-noting for residents on pt.s other than my own(gotta learn a little about a lot of pts), attempting to track down labs/exams/bothering radiology (good to learn how things work in the place) and such. I'll grab food for my resident if I'm free to run to the cafeteria and he/she isn't just to help out. I don't mind helpful stuff like learning how to discharge a patient and that sort of stuff especially when someone shows me how.

I get annoyed when I'm asked to do things they don't want to or know how. As a poster said above it's hard to do stuff with bad instruction. Or like making consult calls to certain services that either will not talk to me once they find out I'm a med student or on a patient that I don't know and the resident won't give me time/info to figure out why we need this consult, so I basically am set up to sound like a bumbling idiot.

Plus if I get a resident who want to teach me, heck makes everything seem even better. I basically know what kind of residents I would like to emulate and which one I hope to never become.

 

[Tired]

This sort of idea that scut "helps them as residents" is asinine. Having medical knowledge and exposure to pathology helps them as residents. Honoring the rotation helps them as residents. Doing scutwork detracts from these goals..

So what's scut work in anesthesia? Finding another crossword puzzle for the resident to do during the case?

 

[DarthNeurology]

The first two years are for reading and reflective study. The second two years are a practical immersion experience in which you begin to think and work like a doctor instead of a graduate student.

Medical education is not built on "yelling" but it is built on teaching and growing the people below you, and part of that is giving them graded responsibility. Residents learn by being given responsibility for patient care, why would it be any different for medical students? Look ahead, and see how the experiences you are having now will equip you for the rest of your life. You spent the first 18 years of your education getting all the time to read and study that you could possibly wring out of a 24 hour day, now it is time for a different kind of learning. Quit complaining about it and embrace it for the opportunity it is.

If you are going for a high-powered specialty like neurosurgery, opthalmology you need to do a lot more reading and reflection than you thought because the reading don't end after the first two years . . . it is just a begining (these specialties ARE like grad school.) I have seen some folks who just want to 'learn by 'doing, and mostly these are general medicine types who think that they can pick up most of what they need to learn on the wards, . . . bad move in my opinion though. It is more than a little scary to think you are learning medicine just by being given responsibility, if someone let me be responsible for general surgery operations and I was stupid enough to accept it then there would be a lot of dead patients, although I bet the percentage would drop each month.

I would argue that there is a lot of reading left to do in the clinical years, I read constantly during rotations and electives because it is interesting as the reading gets more clinical and as a good side effect lets you spank step 1 and step 2 (96/99 for me after heavy reading) but I digress . . . I think that learning clinical medicne is a little different from just learning how to adapt to a new role in the hospital, i.e. being a student, . . . it is a big transition from resident to attending as well. While I work hard on rotations and get generally excellent evaluations, I am not deluded enough to think that an intern 1 year ahead of me has some magical power to "grow me" into medicine (although it is laughable when an intern or resident tries to teach you something and it is obvious they don't know what they are talking about) and they will most certainly not be my primary source of learning clinical medicine (this is a combination of reading and experience gain by observing patients, reactions to treatments, and treatment decisions, most of which is decided by attendings NOT interns.) Before you become an experience attending realize that residents have A LOT to learn as well, and just magically making students "responsible" for patient care does not an excellent medical student make. I can be responsible for all the WBCs, radiology reports and cultures and more possible but at the end of the day I learn anything? I like how you summarily "order" me to "stop complaining" LOL, I don't think medical students responsibility is "graded" when comparing different electives in 3rd and 4th year, i.e. I had more responsibility on my surgical core than anywhere else. Most of what I have learned have been little things I piece together from the chart on my own, not from residents. I really think that the different type of learning you are talk about is learning how the 'play the game in a military type culture, . . . LOL I love hearing residents and interns talk about what medical students don't get, how they are supposed to learn it, how a wonderful transformative process it is blah blah blah

 

[smq123]

Even interns need to get some SOMETIME!

Sure, I can understand that. But be honest about it. Don't say something like, "Oh, just fill out that d/c paperwork...it'll be good for you," when I can see you trying desperately to exchange phone numbers with a member of the ancillary staff. Even if you just said, "There's someone that I need to talk to...so...could you...?" Fine, that's not a problem. It IS a good learning opportunity, and I certainly don't mind doing it.

For instance, one of my chief residents on surgery made me take the patient to the PACU with only the intern - he went to go get lunch. He said beforehand that he was going to do this, because he hated, hated the circulating nurse in that particular room. (I thoroughly believe him, by the way - that particular circ has gotten written up for abusing med students and interns.) And that's fine. He was honest with me, and was upfront for his motivation in making me do this for him.

I just hate being lied to. I don't lie to my residents - why should they lie to me?

But with regards to your underlying point (having to clean up after med student mistakes) I'm all for it. The time for shadowing needs to taper off as 3rd year goes on, and independent action begins. Mistakes happen, errors are made, and these all need to happen for education to truly occur.

I had a lot of sutures torn out as a med student, but I was sewing like a pro by the first day of internship. And really, how much more "watching" do you really want to do these days?

I wish you were my intern. The surgery and OB interns let me be very "hands on," but it wasn't always the case in other specialties.

 

[Tired]

I wish you were my intern. The surgery and OB interns let me be very "hands on," but it wasn't always the case in other specialties.

I hated the crap you described when I was med student too. It's so damn patronizing and fake. "Oh, do this, it will be good for you." F*** you, you phoney p****.

The funny thing is that, even when I was doing B.S. for a resident because they didn't want to, it still made me feel useful and like part of the team. The only thing I hated more than residents who brushed me off with a "Why don't you go read?" were the fakers you describe.

And unfortunately it doesn't stop even after you match. My first rotation in July, the Chief Resident once yelled at me, "Don't you ever let a f***ing social worker talk to me ever again. I hate those b****es, and I don't care if they're bleeding to death in front of me, I will not ackowledge they even exist. YOUR JOB is to keep them the f*** away from me."

For whatever reason, it made me feel important to hear that.

"No, I won't give you the Chief Resident's pager number. You need to talk to me about this issue." It was awesome.

 

[MirkoCrocop]

Some of the most satisfying experiences I've had in medical school were when, as the junior medical student on the service, my intern would let me preround on everyone, write all the notes, get my orders in... and then show up 10 minutes before rounds to deal with any problems I came up with.

i can read no further in this thread.

 

[Coastie]

So what's scut work in anesthesia? Finding another crossword puzzle for the resident to do during the case?

ah ha.

Nice.

We have a clinical base year, you know..

 

[RTrain]

... I love hearing residents and interns talk about what medical students don't get, how they are supposed to learn it, how a wonderful transformative process it is blah blah blah

Look. I'm sorry you've obviously had some negative experiences with being scutted out, made to fill out useless forms, being taught by people that you think are not competent to teach you, and not been given enough time to study about your patients. I can't change that. You need better teachers (and by that I mean residents) on the wards and I'm sorry you haven't been getting them.

I agree wholeheartedly that medical school is a time to learn but I disagree that reading is the main route to that learning after the 2nd year. I am not advocating that you are supposed to stop reading and just adapt to a hierarchical culture, but med school would be lousy preparation for residency if you didn't start to learn to function in residency before you get there. To use your example of neurosurgery, there is no protected time to read while in that crazed residency, yet neurosurgical residents find a way to fit in the reading and study necessary, along with all their other responsibilities - and no matter how much they read during med school, they sure as **** don't know all they need to before they start. The "learning by doing" that you deride is the mainstay of ALL residencies, certainly not just IM.

 

[sunlioness]

if someone let me be responsible for general surgery operations and I was stupid enough to accept it then there would be a lot of dead patients, although I bet the percentage would drop each month.

There'd be just as many dead patients if I sent you home to read about the operation and then put you in complete charge of it.

 

[Ypo.]

There are as many different ways to learn as there are people. Remember how we all studied at least a little differently from each other in the first and second year of medical school? Nothing has changed since then.

That's why I get irritated when I hear people making hard and fast rules about how the third year med student should learn. Ultimately we are all responsible for our own education. We should be there for each other to help each other learn. Most students are going to do their best to honor or at least pass the rotation. So everyone should just relax a little.

What's also interesting is how undefined the role of a third year medical student is. Just look at the difference of opinion on this thread. This is why we get such a variable clinical experience from rotation to rotation, and hospital to hospital. Just yesterday I was functioning like a resident because the real resident had called in sick and I was the only one on the consult service. This morning she came back and wanted me to shadow her (didn't give me a choice). Luckily the attending called and told her what a great job I did yesterday and that I should be allowed to see the patients on my own and report back to the attending directly. But there was an hour and a half of misery where I wasn't allowed to do much but was still supposed to stand there looking grateful for the experience of shadowing her.

Overall I think people need to let (or push) students be more hands on. If anyone here learns best from "shadowing" let them raise their hand. So far I haven't met anyone who learns this way. Most people daze out when shadowing. I try to "fight" to be more hands on, to be more active, but truth is I'm just a peon and there is only so much resistance I can put up, especially when working with a constantly changing schedule and people who don't know me well. I've gotten better at not completely dazing out when shadowing, but some days it is hard. Like shadowing the extremely disorganized resident this morning who took an hour and a half on one patient. Every once in awhile I get a really cool attending or resident and then life is happy for a few glorious days. But overall I am so so so so SICK of being a third year. Kill me please.

 

[DarthNeurology]

I can't change that. You need better teachers (and by that I mean residents) on the wards and I'm sorry you haven't been getting them.

I agree wholeheartedly that medical school is a time to learn but I disagree that reading is the main route to that learning after the 2nd year. The "learning by doing" that you deride is the mainstay of ALL residencies, certainly not just IM.

First of all, I certainly learn by doing, of course we all do. I really make an effort to admit more patients than anyone, and you better believe I know ALL the patients during my subIs better than the residets. So you can see, I don't "deride" learning by doing, but I deride people who sort of feel that they have somehow gone "beyond books" and articles, when all they may have learned was how to move patients, i.e. basic admitting orders, uninspired differential diagnosis, and a treatment plan that needs tweaking, they talk to their attending who tells them how foolish they are to do it this way and Wow! they feel like they learned a lot.

If you read solidly NOTHING should surprise you in clinic or on the wards, the difference between your thinking and the attending should be details you sandout in fourth year and residency. I had a *terrible* resident who had to repeat a year of residency, ouch, and he always talked about how much he learned in clinic and on the wards, . . ."I really learn by doing!" 100% clinically inept, well yeah you learn a lot in clinic if you don't know anything at all. If you want honors and to excel in residency, you do at times have to tell attendings how you would do it differently and research the treatment yourself. If you feel that you are "learning by doing" I get the impression that attendings are holding your hand and "teaching" you a lot, where at that stage I would hope that I would basically manage the floors and clinics and *be the teacher* that is how you reall learn, when you teach yourself and others. . .

But if you don't do your reading then you fall somewhat behind I think, I have seen residents who really don't read, but who try to solely "learn by doing" and it seems to be a disaster. Nobody just learns by reading obviously, we all have almost the exactly same clinical hours after finishing medical school and very similar from program to program. Saying that reading is not the "main pathway" to reading is like saying that the jelly in a peanut butter and jelly sandwhich is the "main pathway" to the taste of the sandwhich, you need both.

I prescribe by a much different way of how I learned some medicine from the standard system, i.e. I would analyze what was done, what I would do differently and envision how I would admit the patient, you never should wait for anybody to "teach you", I think residents are good for the following things on a rotation:

1. What is the routine and what is the paperwork we need to do.
2. When do we round, what is my role (this actually I get from other students who previously rotated.
3. Where is the cafeteria

After I have this answered I am ready to work very hard, period.

Everything else I run my own show, study my own topics. If I have a question, I have not found one I couldn't look up on the internet from reputable sources, which I trust more than any resident. Everything residents in medical school taught me I can type on 5 pages, and 90% is in any basic clinical book

 

[RTrain]

I think residents are good for the following things on a rotation:

1. What is the routine and what is the paperwork we need to do.
2. When do we round, what is my role (this actually I get from other students who previously rotated.
3. Where is the cafeteria

....
Everything residents in medical school taught me I can type on 5 pages, and 90% is in any basic clinical book

Well okay then. I have a much better understanding of where you are coming from. You are free to think that residents are useless to you and I know I won't change your thinking.

However, I can't tell if you're using "you" to mean "a person" or if you're specifically speaking to me when you say that "If you feel that you are "learning by doing" I get the impression that attendings are holding your hand and "teaching" you a lot, where at that stage I would hope that I would basically manage the floors and clinics and *be the teacher* that is how you reall [sic] learn, when you teach yourself and others." I can't figure out how you would deduce that about me, but I assure you that I personally am not having my hand held by anyone.

 

[swpm]

So what's scut work in anesthesia? Finding another crossword puzzle for the resident to do during the case?

There is no scut in anesthesia. That's reason #35 why we're all so happy.

Crossword puzzles are passe anyway. A couple days ago I saw a CRNA doing online sudoku on the computer charting system ... ****ing appalling.

 

[DarthNeurology]

Well okay then. I have a much better understanding of where you are coming from. You are free to think that residents are useless to you and I know I won't change your thinking.

However, I can't tell if you're using "you" to mean "a person" or if you're specifically speaking to me when you say that "If you feel that you are "learning by doing" I get the impression that attendings are holding your hand and "teaching" you a lot, where at that stage I would hope that I would basically manage the floors and clinics and *be the teacher* that is how you reall [sic] learn, when you teach yourself and others." I can't figure out how you would deduce that about me, but I assure you that I personally am not having my hand held by anyone.

No, not you personally, but have seen residents wrapped up in "learning by doing" and have told students how to do this or that without understanding why it is done that way . . . seriously had an intern who told me that we needed to order haptoglobin for an anemia workup, didn't know what haptoglobin was or why would be elevated, . . .just sort of following along, had no idea what definition of sirs, from sepsis, to Multi-organ failure, but really great clinical experience halfway into internship, LOL Best experience is watching surgical residents, pgy-2 manage sicu patients, totally clueless to why things are done, and attending smashes them for it, even stuff I know I need to order stuff that they miss, can't see big picture of our sickest patients, and then they us about how much they have "learned" in the SICU, . . . unacceptable, unacceptable (granted I have a lot more clinical experience than most residents, i.e. before med school) but still UNACCEPTABLE, UNACCEPTABLE

 

[yaah]

I don't know about the rest of you, but when I was elbow deep in abdominal fat holding a retractor for hour 2 of god knows how much longer this case is going to last I was begging to be let out so that I could go do some scutwork. When I was on rounds seeing a patient for the third time that morning and hearing the same stories over and over again, I was begging to be let out so that I could go do some scutwork. Scutwork was liberating at times. I think you all need to learn how to appreciate it more. I tell you what, one time I was on my IM rotation and I got out of rounds because I was the one picked to go down to Dunkin Donuts and pick up coffee and donuts for the teaching session we had later that day. One of the greatest half hours of my third year, right there. I saw the sun.

Of course, that time I showed up at the cafeteria and my buttwipe of a resident told me to drop everything and go draw a stat PT on a patient so he could sit and finish his coffee made me pine for the OR.

But then again, cases like that latter one are kind of the exception - some residents use their meager pathetic power to lord over the only people that they have any power over, medical students, and abuse the system. But scutwork is getting the job done and ultimately helping the patient. If everyone works together, I doubt anyone would complain. It's when the resident turns into lord and master and God forbid they ever have to put on gloves or write in a chart again that it becomes a problem.

 

[mlw03]

just wondering if anyone has stories where the student refused to be scutted? something like a resident says, "go down to radiology and pull the film on a patient who isn't yours," or something else truly non-educational. what happens if the med student simply says, "no, i'm not going to do that"? like yaah, i sometimes didn't mind scut, as it was a chance to get "lost" for a little while. but i remember a time on gyn onc (part of our surgery rotation) where the resident had me copying info from one chart to another. she was doing it too, but it was still about the closest i ever came to saying, "nope, not gonna do that." but i'll admit i didn't have the stones for it, however if anyone has stories where someone actually did, i think that'd be very interesting to read about.

 

[yaah]

I told the neurology resident I wasn't going to do the LP he wanted me to do. But then again, I consider procedures to be more scutwork than almost anything else except de-stooling a constipated patient.

 

[Blade28]

just wondering if anyone has stories where the student refused to be scutted?

I've had a couple med students pull the ol' "That's not part of my educational responsibilities/duties" before. We'd all look at him/her, incredulous, as the med student then proceeded to walk away and read somewhere. You can be sure they got it later on.

 

[Tired]

There is no scut in anesthesia. That's reason #35 why we're all so happy.

Crossword puzzles are passe anyway. A couple days ago I saw a CRNA doing online sudoku on the computer charting system ... ****ing appalling.

A little while back I had to do a 2 weeks Rads rotation. It was the most horrible rotation I had all year; nothing is worse than having to sit in the same place and basically do nothing for hours on end.

More power to you guys if you enjoy what you do. I've seen your intraop flow sheets. I would straight up kill myself. No wonder you're all addicted to Fentanyl.