Med school self-reflections - Pearls of wisdom for clinical rotations, by Phloston

[Phloston]

It seems you're getting quite worked up over this discussion. Have you thought of maybe taking a break? You sound like someone who shouldn't be allowed anywhere near the medical sphere.

---

Members don't see this ad.

 

[lymphocyte]

It seems you're getting quite worked up over this discussion. Have you thought of maybe taking a break? You sound like someone who shouldn't be allowed anywhere near the medical sphere.

Uh huh. Well, I already matched JMO in Australia with ERAS good to go as well, so maybe I'll be your resident when you return from Japan or wherever. I like my coffee black and bitter.

 

[Phloston]

Uh huh. Well, I already matched JMO in Australia with ERAS good to go as well, so maybe I'll be your resident when you return from Japan or wherever. I like my coffee black and bitter.

So you advocate people buying you coffee! Nice

 

[lymphocyte]

So you advocate people buying you coffee! Nice

 

[DocWinter]

.

 

[Hangry]

It seems you're getting quite worked up over this discussion. Have you thought of maybe taking a break? You sound like someone who shouldn't be allowed anywhere near the medical sphere.

And we've made it to Burnett's law on page 2. Look Phloston, you give a lot of good advice, but you aren't perfect. Some of your advice is strange, some of it is flat out wrong. A large part of your PDF seems to be trying to teach human interaction, which shouldn't need to be taught, especially at this stage of someone's career. You can teach someone some basic rules to follow (wear a tie, cut your hair, be nice to all parts of the hospital team), but scripting conversation is a bit ridiculous. At some point, the way you interact with people is just who you are, and trying so incredibly hard to act different from yourself comes across as insincere and disingenuous. There are other parts of your PDF I disagree with as well (I agree with most of the disagreements posted in this thread for a start), but I have neither the time nor inclination to go through it piece by piece and break it down for you (realistically not for you, per se, but for other readers of this website). I simply want to add another dissenting opinion to the pile for future readers who may otherwise get caught up in the Phloston aura to their disadvantage.

New third years: I absolutely guarantee that if you follow 100% of Phloston's advice you will be "that guy" on rotations. The guy who's trying really hard and just wants to be nice and accepted but is making it weird for everyone. No one will call you on it because your intentions will be good, but it will leave a negative impression. Phloston, as far as I can tell over the internet, is a nice guy who really wants to help people and is articulate and verbose, but for some reason gives out a lot of bad advice with the good and has a hard time acknowledging that he might be wrong. I remember reading his step 1 studying advice and seeing how preclinical students would just slobber over it and deify it like it was the best thing ever written. Much of it was good, but on the whole it was overkill, and IMO detrimental if followed to a T. However it was a huge, well written guide and involved insanely intensive study which appealed to the anxious and neurotic tendencies of SDN (because more is always better to a med student) to the point where it got almost a cult following.

I don't want this to go that same route. I think that advice on the whole probably did more harm than good, just like I think this advice can. Preclinicals students and new third years, this is NOT your comprehensive bible to third year and the wards. Read it, take from it what is useful, but heed the criticisms in this thread and gather data from the many other excellent threads on SDN before planning your steps through the clinical rotations.

Phloston, I'm sorry I felt like I had to write this. Please don't take this as an a personal attack on you or your character. I believe you want to help, and I believe you think your advice is the best you can give. I think you deserve a great deal of credit for being willing to dedicate the sort of time it takes to write out a manifesto of this nature and give back to the website and the community. However, some of your advice is flat out wrong, and it would be wrong for our community not to point that out for the benefit of upcoming students. The coffee thing is a great example, come on Phloston that's not a 50/50 thing its 99/1 and you're the one. Just give it up.

 

[lymphocyte]

Phloston, as far as I can tell over the internet, is a nice guy who really wants to help people and is articulate and verbose, but for some reason gives out a lot of bad advice with the good and has a hard time acknowledging that he might be wrong.

He certainly hasn't been nice to me.

He's now digging up my old posts and leaving derogatory remarks: http://forums.studentdoctor.net/threads/img-with-a-medical-leave-of-absence-red-flag.1180277/

@Phloston, I'm not "gleeful." That implies I'm happy. I'm not. I think you could have a really bright future in medicine (or anything really), but perhaps your outright hostility in responding to honest criticism might hold you back (and to be fair, I have no idea what you're actually like in person).

Almost everybody who has disagreed with you has expressed gratitude for your help to others on SDN. But some of that help has been misguided, and there's an obligation to try and offer differing opinions for the benefit of our junior colleagues. That has nothing to do with you personally.

And you make a very fair point. None of us have offered a "manifesto" of our own. You took a crack at it and put yourself out there. That takes guts. But that also takes (hopefully graceful) receptivity to feedback on an open forum of your peers.

Yes, I know I've edited this post a million times. I'm trying to be as collegial and charitable as I can despite the outrage I feel at the personal remarks you made about me on other subforums.

@Hangry said things more eloquently than I ever could. Everyone can come to their own conclusion. I'm 100% done with this thread. Unwatched.

 

[Phloston]

Lymphocyte what you're referring to is being called out on your prevarications, which I wouldn't suggest bragging about. I think it's a good idea you're finally giving it a rest.

 

[Phloston]

He certainly hasn't been nice to me.

He's now digging up my old posts and leaving personally derogatory remarks: http://forums.studentdoctor.net/threads/img-with-a-medical-leave-of-absence-red-flag.1180277/

@Phloston, I'm not "gleeful." That implies I'm happy. I'm not. I think you could have a really bright future in medicine (or anything really), but perhaps your outright hostility in responding to honest criticism might hold you back (and to be fair, I have no idea what you're actually like in person).

Almost everybody who has disagreed with you has expressed gratitude for your help to others on SDN. But some of that help has been misguided, and there's an obligation to try and offer differing opinions for the benefit of our junior colleagues. That has nothing to do with you personally.

And you make a very fair point. None of us have offered a "manifesto" of our own. You took a crack at it and put yourself out there. That takes guts. But that also takes (hopefully graceful) receptivity to feedback on an open forum of your peers.

Yes, I know I've edited this post a million times. I'm trying to be as collegial and charitable as I can despite the outrage I feel at the personal remarks you made about me on other subforums.

@Hangry said things more eloquently than I ever could. Everyone can come to their own conclusion. I'm 100% done with this thread. Unwatched.

Yes, you've edited your post a million times. Sometimes apologetic. Then erasing your apologies and expressing anger instead. At least you've acknowledged that. Let's be civil here.

 

[pd1112]

Nobody disagrees with the obvious and commonsensical points... and it's always worth affirming what should be obvious and commonsensical... but some of it is excessively self-effacing.

Did you read the document? There are 5+ graded examples for introductory, mid-point, and concluding statements (that's 5+ for each) with timing and tone of voice to ask for an observation chart. Here's the suggested template:

Opening: “I’m sorry to bother you, I know you’re busy. Do you know where the chart is for bed 21?”
Midpoint: "Yeah, I really appreciate it."
Closing: “You’re a champion. Thanks. I really appreciate your time. Sorry to bother you.”

Have you ever been busy on the wards (as lots of nurses are)? Could you imagine if a medical student went through this rigamarole to ask for an obs chart? And "You're a champion"? For getting an obs chart? How condescending does that sound? Especially from a medical student.

A pleasant 5 minute coffee break does 1000x more for you in terms of building good-will and conveying kindness.

Seriously, if you and a nurse are both doing scut work, just ask them if they did anything fun last weekend. Shoot the **** for a few minutes. It's fun; it's light; it's other-centered; and it's being a normal human being. That's true respect. Then ask away for whatever whenever: "Sorry, do you know where X is? Got it. Thank you." Get on with it.

Lol yeah I agree, I wasn't advocating using scripted dialogue from some document found on an Internet forum (although that's probably a good idea for the seemingly large % of med students whose only face-to-face human interaction before M3 was their med school interview, but that's none of my business). It seemed like you were saying it's weak to open a conversation with an apology. I was pointing out that it's a pretty standard interaction, or should be at least IMO, but I suppose that also depends on regional/colloquial standards.

 

[SilverCat]

This is a well-written reflection on third year, but I would definitely take it with a grain of salt ( like most other things found on the web).

1.) I have never seen a med student offer to buy coffee for the residents or attendings, much less correct the intern's coffee order (that actually came across as somewhat arrogant to me). Sure, people bring food every now and then, but it's shared with everyone. If I saw an M3 bringing coffee twice a week to the residents, I would think that they were a serious brown-noser.

2.) saying sorry all of the time--you really can overdo this. I'm one of those people who does this a lot--not on purpose, but because I am often in the way and feel guilty about it--and I've actually a scrub nurse get ticked off by it and pull me aside to tell me that I needed to be more assertive in the OR. So no, it does not endear you to all and sundry to to be overly obsequious. Being polite, saying thank you and excuse me are sufficient; there's no need to be theatrical about it.

 

[SilverCat]

It's also pretty much given in third year that students are expected to pre-round before the team; I've never heard of a student showing up just in time for rounds--they would most likely fail by default. That's somewhat common sense.

I agree with the points about enthusiasm and willingness to go the extra mile-- these things are expected of students, and are considered the bare miminum expected. But don't expect to get honors by just being an over-eager, grinning scut monkey. I went into third year thinking that this was the most important factor in evals, and was slammed by my family rotation grades. The most important thing in third year grades is the ability to give a focused patient presentation. When I started, I would have a patient coming in for a HTN checkup, and would be doing a full ROS. Surprisingly, my attending was annoyed when I uncovered knee pain in the patient and mentioned it in the presentation, because that's not what the patient was there for. Conversely, I would have a patient with a cough and sore throat, and somehow forget to ask about fever. Yeah, I was--and probably still am--a pretty stupid med student. These are the things that cost you in the evals, though, not whether or not you were willing to buy coffee for your residents.

Apologies if this comes off as an angry rant-- it's just that I found myself in trouble following some of the things you are recommending.

 

[pd1112]

This is a well-written reflection on third year, but I would definitely take it with a grain of salt ( like most other things found on the web).

1.) I have never seen a med student offer to buy coffee for the residents or attendings, much less correct the intern's coffee order (that actually came across as somewhat arrogant to me). Sure, people bring food every now and then, but it's shared with everyone. If I saw an M3 bringing coffee twice a week to the residents, I would think that they were a serious brown-noser.

2.) saying sorry all of the time--you really can overdo this. I'm one of those people who does this a lot--not on purpose, but because I am often in the way and feel guilty about it--and I've actually a scrub nurse get ticked off by it and pull me aside to tell me that I needed to be more assertive in the OR. So no, it does not endear you to all and sundry to to be overly obsequious. Being polite, saying thank you and excuse me are sufficient; there's no need to be theatrical about it.

Yeah things are different in the OR for sure, I don't think anyone was questioning that.

It's also pretty much given in third year that students are expected to pre-round before the team; I've never heard of a student showing up just in time for rounds--they would most likely fail by default. That's somewhat common sense.

I agree with the points about enthusiasm and willingness to go the extra mile-- these things are expected of students, and are considered the bare miminum expected. But don't expect to get honors by just being an over-eager, grinning scut monkey. I went into third year thinking that this was the most important factor in evals, and was slammed by my family rotation grades. The most important thing in third year grades is the ability to give a focused patient presentation. When I started, I would have a patient coming in for a HTN checkup, and would be doing a full ROS. Surprisingly, my attending was annoyed when I uncovered knee pain in the patient and mentioned it in the presentation, because that's not what the patient was there for. Conversely, I would have a patient with a cough and sore throat, and somehow forget to ask about fever. Yeah, I was--and probably still am--a pretty stupid med student. These are the things that cost you in the evals, though, not whether or not you were willing to buy coffee for your residents.

Apologies if this comes off as an angry rant-- it's just that I found myself in trouble following some of the things you are recommending.

Again, I don't think anyone was recommending being eager & grinning in place of history taking & presentation skills. It actually is given that third year students have to learn how to do & present focused vs. full H&P, which I'm guessing is why it wasn't a Pearl of Wisdom for Clinical Rotations by Phloston. It's near impossible to generalize "most important factor(s) for evals" across even different clerkships for 2 students at the same medical school, let alone all medical students everywhere.

 

[TheDBird90]

Think of clinical propriety like every day propriety on overdrive. Things you do on the street that are normal can be considered rude in the hospital. If you're asking someone for directions and wave him or her down and say, "Excuse me, do you know where x is?" There's no issue. But the baseline is a lot higher in a healthcare setting, and saying sorry before and after shows you're unquestionably putting the person in front of you first.

If you do end up attending a medical school, you'll interact with a lot of staff just fine and won't ever know something comes off rude until you look back and see your own behavior changing. And if you asked me before I started med school I certainly would have said I got on well with people. The character you expect out of your doctor though doesn't have wiggle room to be borderline, which is why a lot of these interactive mechanisms can seem excessive.

Hope that helps,

Wow. Now I really don't want to go to med school (just decided it's not for me; this doesn't really have anything to do with it). I have Asperger's, so I suck at interacting with people sometimes. If I work as a Medical Laboratory Technologist, will these rules apply to me as well? I mean, I really want to work in healthcare but I'm just completely shocked by this. I had no idea these things existed.

 

[dozitgetchahi]

Where in the US does this scenario happen routinely? Why is the medical student idle after rounds? Aren't there notes to write? Patients to admit (or at least H&P)? Investigations to chase? Consults to see? Didactics to attend? Team-scut to help with? Seeing a medical student stand idle is probably more concerning, if only because they didn't at least have the decency or common sense to help or learn from their assigned team.

Maybe you've only worked in an Australian context, where medical students "float" a bit more? (And nurses don't do cannulas.) Or maybe my only experience in America is from Sub-I's where everybody was really freakin' busy (me and the 3rd years under me included)?

But fair enough, I generally believe that you should do whatever it takes for your team. So if my team needed bloods, cannulas, IDCs, patients transported, whatever; hell yeah. Let's do it. That's what it means to work in a team. But leaving my team? Unthinkable. (Unless the random intern were desperate, and I let my senior resident know.)

Buying my intern coffee twice a week? Very odd. (And no @Phloston, the consensus above is that it's not even close to 50/50.) Volunteering my colleagues for extra work as a sign of collegiality? That merits a 12-gauge cannula shanking. Answering a patient-related question with "Well you know I’m not allowed to answer up the hierarchy." Really bizarre.

None of this is meant personally. No ad hominems. It's only directed at your self-proclaimed "Pearls of Wisdom." You're the one offering advice. And a few of your colleagues (and seniors) are pushing back, because some of it is really bad advice. Preclinicals should know what constitutes inappropriate behaviour, and some of the behaviour you're endorsing is inappropriate.

I agree with some of what you wrote. Never answer somebody else's pimp question. Keep your cool. Be helpful. Don't rely on others for validation. This advice is so general and amiable that it would be hard for anybody to disagree with it, though I suppose some forget the obvious.

This has only happened in med school in my case (and that hospital was a bit of a rodeo where the 'rules of enagagement' were very vague and people just did whatever). When I was a resident at a big ACGME IM program, I was never asked by other residents to scut out my students to their teams, and if anyone had asked I would have told them to stuff it.

I don't want other services scutting out my teammates. I made team unity and espirit d' corps a big priority as a resident. We all worked hard to get our entire team's work done so we could get out early. When it came to getting stuff done, nobody was above anyone else for even the lowest tasks (I would go run scut at the same time as a med student was putting in a line with staff etc if it made the most sense for the team that way). I would enter the fray and start writing notes for interns if it meant we all would get out earlier. Nobody is going to abscond with some of my students after we all got our crap done for the day and are ready to go.

 

[VisionaryTics]

"Med school self-reflections - Pearls of wisdom for clinical rotations, by Phloston"

Dear lord...

You can be a memorable med student for two reasons:
1. Being well-prepared, hard-working, and capable of doing a good history and physical and then presenting it
2. Being an obsequious jackass who tries to game rotations

Don't be #2.

Other thoughts:
I would never let a med student buy me anything. I get paid, you don't. I buy you coffee. Pay it forward when you're a resident. If a med student bought me coffee repeatedly, I would tell him it is inappropriate and internally think he's an obsequious jackass.

Why the **** is the other service pulling you for scut work? That's horse ****. If a senior or an attending found out a resident was so incompetent they couldn't handle their work without the help of medical students on other rotations, that resident would get his ass dragged before the chairman and program director to explain himself.

 

[BlueArc]

After finishing med school I randomly started writing about my experiences. I was doing it at first as just a self-reflective/-therapy exercise, and then found myself writing for many days at a time. In the end, I developed this document.

Colloquially, you could think of this as a version of a 'Dos and Don'ts of clinical rotations" PDF. But I haven't formally organized it that way.

I hope you find this even minimally helpful,

~Phloston

Thank you so much for these valuable guidelines. I have been accepted as a research trainee and start end of this month. I am a FMG, any advise related to to working as a research trainee?

 

[kpop]

After finishing med school I randomly started writing about my experiences. I was doing it at first as just a self-reflective/-therapy exercise, and then found myself writing for many days at a time. In the end, I developed this document.

Colloquially, you could think of this as a version of a 'Dos and Don'ts of clinical rotations" PDF. But I haven't formally organized it that way.

I hope you find this even minimally helpful,

~Phloston

Just wanted to say this was a very fun read! I was skimming SDN after I got home from work to learn a bit about clinical rotations but somehow it ended up with me and my little brother reading through this whole thing together. He's not even close to the premed track, he's still in high school but we were glued to the screen because your personal experience was so interesting and well written.

Thank you for sharing this with us !

 

[Kalydeco]

Just wanted to say this was a very fun read! I was skimming SDN after I got home from work to learn a bit about clinical rotations but somehow it ended up with me and my little brother reading through this whole thing together. He's not even close to the premed track, he's still in high school but we were glued to the screen because your personal experience was so interesting and well written.

Thank you for sharing this with us !

This guide has lots of good, useful information, particularly with respect to clinical medicine (as opposed to interpersonal interactions). But with all due respect to the author, having now wasted way too many minutes of my life reading this guide, and as someone who earned honors for the clinical component of every rotation during my clinical year, I feel obliged to point out that much of the advice contained herein is NUTS. BONKERS. DERANGED. I intermittently had to stop myself, stare off into space, and ponder whether it was satire.

A few examples, in no particular order, of what I mean:

1. If your resident asks you to leave not once, but twice, it might be out of respect for your time but it's probably because they have a lot to do and they want to get rid of you. Insisting upon staying isn't going to ingratiate you with them. It's just annoying.

2. If you apologize at the beginning and end of each interaction, people will think you're being sarcastic, because no well-adjusted person does that. Apologize if you're interrupting someone, or if your request might take a few minutes of their time. In other words, apologize if you actually have something to be sorry about. Accordingly, don't apologize if you need to excuse yourself from rounds for an academic commitment -- just state where you're going and why, and then leave.

3. The coffee stuff has been litigated above and goes without saying.

4. One ridiculous idea that permeates this guide is that you are not entitled to any teaching from attendings and residents, and you have to grovel, apologize, and admit you're stupid to get your attending to teach you. No. If you're in a teaching hospital, teaching medical students is literally an expectation of your attending's job. And you are paying $60,000 a year for them to perform that aspect of their job.

Just had to vent, because interspersed with the quality advice in this document is quite a bit of garbage.

 

[Beezlebub]

3. The coffee stuff has been litigated above and goes without saying.

Free coffee... you're crazy man. I would never turn that down.

On a serious note, I don't think he wrote the guide w/ bad intentions. Phloston is a good guy. You may disagree w/ some of his approaches, and are entitled to your opinion, and we appreciate your feedback.

 

[kpop]

This guide has lots of good, useful information, particularly with respect to clinical medicine (as opposed to interpersonal interactions). But with all due respect to the author, having now wasted way too many minutes of my life reading this guide, and as someone who earned honors for the clinical component of every rotation during my clinical year, I feel obliged to point out that much of the advice contained herein is NUTS. BONKERS. DERANGED. I intermittently had to stop myself, stare off into space, and ponder whether it was satire.

A few examples, in no particular order, of what I mean:

1. If your resident asks you to leave not once, but twice, it might be out of respect for your time but it's probably because they have a lot to do and they want to get rid of you. Insisting upon staying isn't going to ingratiate you with them. It's just annoying.

2. If you apologize at the beginning and end of each interaction, people will think you're being sarcastic, because no well-adjusted person does that. Apologize if you're interrupting someone, or if your request might take a few minutes of their time. In other words, apologize if you actually have something to be sorry about. Accordingly, don't apologize if you need to excuse yourself from rounds for an academic commitment -- just state where you're going and why, and then leave.

3. The coffee stuff has been litigated above and goes without saying.

4. One ridiculous idea that permeates this guide is that you are not entitled to any teaching from attendings and residents, and you have to grovel, apologize, and admit you're stupid to get your attending to teach you. No. If you're in a teaching hospital, teaching medical students is literally an expectation of your attending's job. And you are paying $60,000 a year for them to perform that aspect of their job.

Just had to vent, because interspersed with the quality advice in this document is quite a bit of garbage.

Hey @Kalydeco, thank you for your post! I will make it clear that I did not plan to use this as a literal step by step guide on how to honor my clinical rotations. My comment to OP was more because I found their notes of their personal experiences really interesting, especially with how they read into/interpreted interactions that they believed helped them perform better on these rotations. I doubt there's a perfect step by step guide out there on how to do well at every rotation but I really liked OP's post because it walked me through their thought process on how they made themselves as useful as possible in their hospital team setting and the sheer absurd dedication it took for OP to do well. I think anybody who reads OP's post should process the advice given and decide for themselves what to use, if any at all. However, it was imho well written with great flow and fun to read so I enjoyed every page of it.

 

[Kalydeco]

@kpop I hear you, but I also want to emphasize that "sheer absurd dedication" and constant self-flagellation are not required for success clinically and will often lead to the opposite of the desired outcome. You need to be four things to succeed on rotations: knowledgeable, confident, respectful and friendly. Add (sometimes more than) a dash of luck and that's really it.

 

[Phloston]

Hey @Kalydeco, thank you for your post! I will make it clear that I did not plan to use this as a literal step by step guide on how to honor my clinical rotations. My comment to OP was more because I found their notes of their personal experiences really interesting, especially with how they read into/interpreted interactions that they believed helped them perform better on these rotations. I doubt there's a perfect step by step guide out there on how to do well at every rotation but I really liked OP's post because it walked me through their thought process on how they made themselves as useful as possible in their hospital team setting and the sheer absurd dedication it took for OP to do well. I think anybody who reads OP's post should process the advice given and decide for themselves what to use, if any at all. However, it was imho well written with great flow and fun to read so I enjoyed every page of it.

Thank you!

 

[Domperidone]

.

 

[lymphocyte]

This caught my attention.
JMO - you mean Australian internship?
Australian internships and any residency terms start in January. Have you started working?
So, what are you going to do when you match in the US?

Feel free to PM me with questions (as anybody else is always welcome to).

 

[Domperidone]

.

 

[Domperidone]

.

 

[lymphocyte]

You think I'm looking for advice?

Or you prefer not to answer the question, despite kinda volunteering the information already.

have you matched or not in the US, oh Australian JMO?

What is it that you think I'm asking?

My apologies. I thought you were asking for advice. I did start working in January, and it's generally been a kick in the pants. I feel less comfortable sharing personal details publically than I used to, but I'm always happy to chat.

 

[Domperidone]

.

 

[lymphocyte]

You've done what i'm assuming you have already done.

Wow. I actually have a two year contract with zero intention of breaking it after having already started.

I withdrew from the Match because I liked the programme so much, had family in the area, and would feel crummy about abandoning a rural hospital that's desperate for doctors. I posted about this decision months ago in the Lounge, which is access-restricted, but you're welcome to search for the post if you have access.

I do agree with your general sentiment, and I think loyalty and commitment mean something in life. I don't like how people have abandoned programmes--or how programmes sometimes turn their back on people--but I also don't think I'm really in a position to judge anyone for their professional decisions, especially without knowing their personal circumstances.

 

[Domperidone]

Okay, cool. Phew. I wasn't sure. It just sounded so fishy.
That would be the right thing to do - withdrawing, which is hard.
I've access to the Lounge, lol I just don't necessarily stalk everyone I find sus. (maybe i should?)

It's not justified what they're doing, it's not even about whether i like or not.
It's how the hospitals and governments respond to actions like that. We're talking a public health system and resource. This is has very real consequences on futures generations of international students.

In very seldom cases are people leaving for family reasons. if it was for family reasons, the hospitals are understanding of this, what they do not stand for is someone leaving internship for jobs overseas when it is in such high demand, to an almost desperate degree for many grads. I get that students are troubled by loans and would like to return home. then again, i also get that the hospitals here have their own interests to protect too. hell the government responds, it's actually not easy for AMSA to talk about the CMI with the health department (as in Australian student reps arguing for their international peers to stay in Australia), when the response is that international students are voluntarily leaving Australia - I mean why justify spending 10s of millions on additional internships for non-citizens?

Anyway, now I feel super bad for kicking you in the arse!

Yes, first rotation to internship is rough. Rural is arguably harder than tertiary too!
I tried to block out as much of first rotation as I could, didn't really work.
because now I get to relive the experience through the first rotation interns right now.
'yes, movicol is two sachets.. and the dose of endone is 5 mg."
It got really fun after about second or third rotation though.

G'luck!

 

[JB50]

Might I just point out that you entitled your personal experiences as a 3.5 year medical student as Pearls of Wisdom?

Again, I appreciate your Joel Osteen-like aphorisms, but some of them really do come across as quite odd, as your other colleagues have mentioned above. I'm only highlighting this because any medical student who followed all of this advice would probably appear odd as well.

Holy crap you had me rolling

 

[Anicetus]

I don't know why more people haven't mentioned the cringey responses to "you can go home, it's 10pm". Most residents really aren't testing you and really care about you having time to study for the shelf.

I can't even begin to talk about the tragedies of students offering to stay later who bomb the shelf. This isn't 1980 where your third year grade only comes down to being on the floors. Grades now have all this other crap attached + a shelf/osce grade.

 

[SpikesnSpookes]

When I'm a resident in 1 year and you are buying me coffee and/or staying late when other students are leaving when they are told, your evals will be reflective of your kiss-a$$ behavior. Just work hard, show interest, don't try to out-do anyone (unless your classmates are complete slackers), and don't speak out of turn and be disruptive either.

 

[ortnakas]

I don't know why more people haven't mentioned the cringey responses to "you can go home, it's 10pm". Most residents really aren't testing you and really care about you having time to study for the shelf.

I can't even begin to talk about the tragedies of students offering to stay later who bomb the shelf. This isn't 1980 where your third year grade only comes down to being on the floors. Grades now have all this other crap attached + a shelf/osce grade.

This. I'm just a third year student, but there's clearly a difference between "you can go home if you're bored" (this is a trap) and "there's nothing else for you to do here, go home and study" (this is legit and you should take them up on it).

 

[Misterioso.]

I don't know why more people haven't mentioned the cringey responses to "you can go home, it's 10pm". Most residents really aren't testing you and really care about you having time to study for the shelf.

I can't even begin to talk about the tragedies of students offering to stay later who bomb the shelf. This isn't 1980 where your third year grade only comes down to being on the floors. Grades now have all this other crap attached + a shelf/osce grade.

Look, if I tell a student to go home, it's probably because they are starting to get on my nerves. I really don't care about getting them study time; I don't micromanage their day and expect them to look stuff up and study during down time. This whole "late students fail the shelf" stuff is garbage. I've never seen a student who stayed late and worked hard fail the rotation, but I have seen the ones who are obsessed with studying to the point of barely being present or memorable fail. Being around to see and examine patients gives them knowledge, but if they aren't paying attention and are just thinking about how they have to study, they've missed out on the point of being there in the first place.

 

[Anicetus]

Look, if I tell a student to go home, it's probably because they are starting to get on my nerves. I really don't care about getting them study time; I don't micromanage their day and expect them to look stuff up and study during down time. This whole "late students fail the shelf" stuff is garbage. I've never seen a student who stayed late and worked hard fail the rotation, but I have seen the ones who are obsessed with studying to the point of barely being present or memorable fail. Being around to see and examine patients gives them knowledge, but if they aren't paying attention and are just thinking about how they have to study, they've missed out on the point of being there in the first place.

Really? That's not the trend at my school. The 10% who get honors are the ones who skimp out of clinic/the floors to study and rock the shelf exam.

It's your thought process that being on the floors with patients somehow helps for the shelf exam. In 2017 where the shelf exam is a make or break for honors or high pass/pass, the culture of third year has become a disjointed process. Staying to do more ED admissions for gastroenteritis isnt going to help a whole lot if evals are barely half the grade in the end, not to mention if the evaluator just gives everyone a similar eval. It comes down the shelf now to make or break your honors. Whether you residents/attendings believe that or not isn't your problem, it's ours and we do what we have to do to get the grade. I say this as an MS3 who has learned how to do well throughout this year instead of getting stuck with people like you.

 

[AirplaneFruit]

many other excellent threads on SDN

Any links?

 

[Hemorrage]

Look, if I tell a student to go home, it's probably because they are starting to get on my nerves. I really don't care about getting them study time; I don't micromanage their day and expect them to look stuff up and study during down time. This whole "late students fail the shelf" stuff is garbage. I've never seen a student who stayed late and worked hard fail the rotation, but I have seen the ones who are obsessed with studying to the point of barely being present or memorable fail. Being around to see and examine patients gives them knowledge, but if they aren't paying attention and are just thinking about how they have to study, they've missed out on the point of being there in the first place.

I wonder what delusion you're living in

 

[cellsaver]

After finishing med school I randomly started writing about my experiences.

Thanks for sharing. Your command of the English language is impressive. English is my second language and I noticed immediately that your utilization was not that of an American. Additionally your interpersonal skills are, by today's USA standards, foreign and threatening to Americans. Of course you would receive negative reactions to your suggestions on this forum - you are asking Americans to act civil, deferential and focus on the ultimate goal of getting ahead. Instead we continually read from Americans how "unfair" life is in their medical education. Ever since social media was launched, empathy has plummeted in our culture. We are the poorer for it and you offer a more authentic way for a greater good: your goals and harmony in the work place.

The section entitled "why of course you do" was breathtaking. It was brilliant and completely in synch with my own culture (Latin American). I have found having that type of "go get 'em" disposition invaluable in the workplace especially when you are junior and need to learn from those above you. Excellent points in this section.

Buying coffee for superiors or collaterals? Absolutely. If done correctly it will get you far. Coffee is a staple in my culture and people use coffee as an excuse to gather, share and bond. You essentially used a cultural device to disarm your peers, earn face time and gather much fruit. It worked. Your suggestions make some Americans uncomfortable because it would entail their letting go of their "connecting" with others online and focus on others. Shedding a bright light on darkness will always cause the demons to howl. keep doing it.

I found your section "Begin and end every interaction with an apology" striking. It reminded me of a DON in a small hospital where I worked as a teenager back in the 1970s. Though she had the title and the experience, she apologized a great deal. Everyone loved her. It was so disarming and self-effacing, it was difficult to not feel comfortable around her. Though I was the immigrant in her hospital, she made me feel relaxed and went out of her way to teach me sterile technique, CPR, basic ER protocols, how to set a cast and encouraged me to jump in the fray of things in the ER precisely because I could translate Spanish - English conversations between Hispanic patients and White Anglo physicians and nurses. In short, your/her approach opens doors. Americans aren't interested in hustling to open doors. As mentioned by others on this forum, they expect offers to be given to them by virtue of just being.

America Magazine, an intellectual Jesuit publication by the Jesuits of the USA, recently published an article that applies

On Google, we become like gods—and act like animals​

I have to completely agree with the summary you provided in the recapitulation.

“I’m a really tough grader and have failed students and residents before. Everything you’ve been doing, just keep doing exactly that. Having you on board was like having an extra member of faculty. If you ever want to work here as an intern I will write you a top evaluation.”​

Touché. It is not the MD Degree that opens the doors or the Step 1/2 CK Scores, nor the ERAS matching, but rather going out of your way to sell yourself face to face to decision makers, and let them know you are different. As your "consultant" stated, you earned high marks and a vote of confidence from someone who rarely provides such glowing reviews.

Your interpersonal skills are golden. keep writing. And please feel free to share more of them regardless of the arrows that will be shot your way. You're turning heads in the clinical setting while they....just do the minimal and know everything by virtue of just taking up space.

I read your document after I crashed in bed. It was a special gift or grace that I relished. Thank you for that.
keep at it.

Happy trails

 

[sunealoneal]

Thanks for sharing. Your command of the English language is impressive. English is my second language and I noticed immediately that your utilization was not that of an American. Additionally your interpersonal skills are, by today's USA standards, foreign and threatening to Americans. Of course you would receive negative reactions to your suggestions on this forum - you are asking Americans to act civil, deferential and focus on the ultimate goal of getting ahead. Instead we continually read from Americans how "unfair" life is in their medical education. Ever since social media was launched, empathy has plummeted in our culture. We are the poorer for it and you offer a more authentic way for a greater good: your goals and harmony in the work place.

The section entitled "why of course you do" was breathtaking. It was brilliant and completely in synch with my own culture (Latin American). I have found having that type of "go get 'em" disposition invaluable in the workplace especially when you are junior and need to learn from those above you. Excellent points in this section.

Buying coffee for superiors or collaterals? Absolutely. If done correctly it will get you far. Coffee is a staple in my culture and people use coffee as an excuse to gather, share and bond. You essentially used a cultural device to disarm your peers, earn face time and gather much fruit. It worked. Your suggestions make some Americans uncomfortable because it would entail their letting go of their "connecting" with others online and focus on others. Shedding a bright light on darkness will always cause the demons to howl. keep doing it.

I found your section "Begin and end every interaction with an apology" striking. It reminded me of a DON in a small hospital where I worked as a teenager back in the 1970s. Though she had the title and the experience, she apologized a great deal. Everyone loved her. It was so disarming and self-effacing, it was difficult to not feel comfortable around her. Though I was the immigrant in her hospital, she made me feel relaxed and went out of her way to teach me sterile technique, CPR, basic ER protocols, how to set a cast and encouraged me to jump in the fray of things in the ER precisely because I could translate Spanish - English conversations between Hispanic patients and White Anglo physicians and nurses. In short, your/her approach opens doors. Americans aren't interested in hustling to open doors. As mentioned by others on this forum, they expect offers to be given to them by virtue of just being.

America Magazine, an intellectual Jesuit publication by the Jesuits of the USA, recently published an article that applies

On Google, we become like gods—and act like animals​

I have to completely agree with the summary you provided in the recapitulation.

“I’m a really tough grader and have failed students and residents before. Everything you’ve been doing, just keep doing exactly that. Having you on board was like having an extra member of faculty. If you ever want to work here as an intern I will write you a top evaluation.”​

Touché. It is not the MD Degree that opens the doors or the Step 1/2 CK Scores, nor the ERAS matching, but rather going out of your way to sell yourself face to face to decision makers, and let them know you are different. As your "consultant" stated, you earned high marks and a vote of confidence from someone who rarely provides such glowing reviews.

Your interpersonal skills are golden. keep writing. And please feel free to share more of them regardless of the arrows that will be shot your way. You're turning heads in the clinical setting while they....just do the minimal and know everything by virtue of just taking up space.

I read your document after I crashed in bed. It was a special gift or grace that I relished. Thank you for that.
keep at it.

Happy trails

I don't know if you had a string of negative experiences with Americans, but you've expressed a silly sentiment or two here.

Nobody here is going to disagree that a good personality and working well as part of the broader team is one of the most important considerations. It's interesting that you mentioned authenticity, because my criticism of a lot of the above advice is that someone following it to the letter runs the risk of seeming insincere.

"Reading the room" is important. I would never regularly buy coffee for an inpatient team because if I were to do it, it would frankly come off as bizarre. I did regularly offer to pick up a drink from Starbucks for someone on one rotation because I would always stop by there for myself during lunch anyway. It didn't come off as an attempt to curry favor because, well, it wasn't an attempt to curry favor.

All that other stuff about apologizing before and after, "you're a champion", etc, may have come naturally to OP and the person you knew, but it's certainly not necessary and maybe a little annoying depending on who is following the advice. We all interact with others in general just a little bit differently. What makes a student stand out as part of team isn't anything fancy. It's just a matter of knowing your patients well (because the student has the luxury of spending much more time on individual patients) anticipating needs of the team if it is within your wheelhouse to help with those needs, and generally being an agreeable and pleasant person to work with.

I'll end by saying that if you ever rotate in a US hospital assuming that you will blow your American peers (who are merely "taking up space") out of the water, you might be in for a rude awakening.

 

[Phloston]

Thanks for sharing. Your command of the English language is impressive. English is my second language and I noticed immediately that your utilization was not that of an American. Additionally your interpersonal skills are, by today's USA standards, foreign and threatening to Americans. Of course you would receive negative reactions to your suggestions on this forum - you are asking Americans to act civil, deferential and focus on the ultimate goal of getting ahead. Instead we continually read from Americans how "unfair" life is in their medical education. Ever since social media was launched, empathy has plummeted in our culture. We are the poorer for it and you offer a more authentic way for a greater good: your goals and harmony in the work place.

The section entitled "why of course you do" was breathtaking. It was brilliant and completely in synch with my own culture (Latin American). I have found having that type of "go get 'em" disposition invaluable in the workplace especially when you are junior and need to learn from those above you. Excellent points in this section.

Buying coffee for superiors or collaterals? Absolutely. If done correctly it will get you far. Coffee is a staple in my culture and people use coffee as an excuse to gather, share and bond. You essentially used a cultural device to disarm your peers, earn face time and gather much fruit. It worked. Your suggestions make some Americans uncomfortable because it would entail their letting go of their "connecting" with others online and focus on others. Shedding a bright light on darkness will always cause the demons to howl. keep doing it.

I found your section "Begin and end every interaction with an apology" striking. It reminded me of a DON in a small hospital where I worked as a teenager back in the 1970s. Though she had the title and the experience, she apologized a great deal. Everyone loved her. It was so disarming and self-effacing, it was difficult to not feel comfortable around her. Though I was the immigrant in her hospital, she made me feel relaxed and went out of her way to teach me sterile technique, CPR, basic ER protocols, how to set a cast and encouraged me to jump in the fray of things in the ER precisely because I could translate Spanish - English conversations between Hispanic patients and White Anglo physicians and nurses. In short, your/her approach opens doors. Americans aren't interested in hustling to open doors. As mentioned by others on this forum, they expect offers to be given to them by virtue of just being.

America Magazine, an intellectual Jesuit publication by the Jesuits of the USA, recently published an article that applies

On Google, we become like gods—and act like animals​

I have to completely agree with the summary you provided in the recapitulation.

“I’m a really tough grader and have failed students and residents before. Everything you’ve been doing, just keep doing exactly that. Having you on board was like having an extra member of faculty. If you ever want to work here as an intern I will write you a top evaluation.”​

Touché. It is not the MD Degree that opens the doors or the Step 1/2 CK Scores, nor the ERAS matching, but rather going out of your way to sell yourself face to face to decision makers, and let them know you are different. As your "consultant" stated, you earned high marks and a vote of confidence from someone who rarely provides such glowing reviews.

Your interpersonal skills are golden. keep writing. And please feel free to share more of them regardless of the arrows that will be shot your way. You're turning heads in the clinical setting while they....just do the minimal and know everything by virtue of just taking up space.

I read your document after I crashed in bed. It was a special gift or grace that I relished. Thank you for that.
keep at it.

Happy trails

Thank you!

What you've mentioned about the DON reminds me of the chief of trauma at one of the major hospitals in Australia I had worked under as a med student. He had originally been a surgeon for over 40 years and was probably one of the most highly 'decorated' people in the hospital, yet he was extremely humble, enthusiastically catered to students, and made an explicit effort to show he cared about how you felt on a day-to-day basis.

Anyway, during the mere week I rotated through his team, he had pulled me aside on his own time to teach me life support skills. Just him and me. Probably one-hour sessions. Did he have to do that? Nope. Did he have a lot of spare time? Nope. On wards, by the bedside, he would discuss the character elements of patient interaction and thoughtfulness behind team dynamics. I remember another junior doctor and I exchanged glances, thinking "this is actually going down right now (i.e., this is rare)."

My impression is that during/after his long career, he probably grew to internalize that the most fulfilling parts of medicine could be consolidated down to merely showing basic consideration for other people on a day-to-day basis.

 

[cellsaver]

Thank you!...
My impression is that during/after his long career, he probably grew to internalize that the most fulfilling parts of medicine could be consolidated down to merely showing basic consideration for other people on a day-to-day basis.

I am older and have the classic Latina look. I make it a point to engage the "hired help" in the hospital: the techs, the nursing assistants, housekeeping, security officers, etc, most of who are minorities. Yet they have something to offer and many of the White American medical students dont get that. Just a simple exchange of pleasantries or recognizing their mere existence goes a long way. By the time the Attendings come around I have chatted with the staff on the unit, made the rounds with them first, asked them about them, and without fail to pays down the road, even if I am the lofty MD student and they are not. the day flows flawlessly with staff with this approach. The Residents and Fellows understand what I am doing, and most Attendings appreciate the "other directed" approach (to paraphrase Carl Rogers). But it can be difficult to break down a battered wall on a Dept Head Attending and so I just go with it. I am master of my moment and if it turns sour, I have the power to redirect and say, "I'm sorry, may I please...", "I dont want to make your day more difficult, could you tell me where I can get....", etc

Rock upon rock, stone upon stone, you will eventually get what you are seeking with people if you just remember that their favorite preoccupation is them. As long as I need something from them, it makes perfect sense to be other directed.

Works for me in spades. Its called people skills 101.

Saludos from USA!

 

[rjosh33]

I think I've learned about 10 new words from this thread.

 

[Coupd'Cat]

I am older and have the classic Latina look. I make it a point to engage the "hired help" in the hospital: the techs, the nursing assistants, housekeeping, security officers, etc, most of who are minorities. Yet they have something to offer and many of the White American medical students dont get that. Just a simple exchange of pleasantries or recognizing their mere existence goes a long way. By the time the Attendings come around I have chatted with the staff on the unit, made the rounds with them first, asked them about them, and without fail to pays down the road, even if I am the lofty MD student and they are not. the day flows flawlessly with staff with this approach. The Residents and Fellows understand what I am doing, and most Attendings appreciate the "other directed" approach (to paraphrase Carl Rogers). But it can be difficult to break down a battered wall on a Dept Head Attending and so I just go with it. I am master of my moment and if it turns sour, I have the power to redirect and say, "I'm sorry, may I please...", "I dont want to make your day more difficult, could you tell me where I can get....", etc

Rock upon rock, stone upon stone, you will eventually get what you are seeking with people if you just remember that their favorite preoccupation is them. As long as I need something from them, it makes perfect sense to be other directed.

Works for me in spades. Its called people skills 101.

Saludos from USA!

Would love to work with a person like you in the future.

I think I've learned about 10 new words from this thread.

hahaha.

 

[surprise me]

dear sir :
I am new here and am currently sifting my way through the previous years' forums (there is always some invaluable info lurking around ; just waiting for someone to come and utilize it ) . i wanted to show my appreciation for all that you have done . I admire your dedication and am hopeful to be just as outstanding . I do think that we were sculpted from the same stone . I am an IMG as well after all .

 

[TankTuck]

Love the post! Very good advice, nothing more important than continuously building character. However, I disagree with point 3. I know you said over and over that this should be "genuine," but what med student actually want to stay back with his resident at 10:50 pm after getting to the hospital at 7 am? Everything in moderation. Sure volunteer from grunt work and don't be that guy that just wants nothing more than to leave each day, but if you are consistently staying later than everyone else when a resident has told you that you can leave multiple times, just f**kn leave. No one is going to see that as genuine, unless you are doing something genuinely interesting. In fact, I would perceive that as clingy and annoying. Anyway, its great that you keep bringing up the all so important point that interactions in med school (and life) are more about how you convey and communicate than what you know. Thanks for sharing the pdf!

 

[lymphocyte]

Now that I've worked with about a dozen medical students, I have revised my views. I realise now that there's a certain subset of students for whom this kind of scripted approach to being a person might actually be helpful. These students simply don't grok interpersonal dynamics and have the social elan of a bowl of custard. It's like how some guys resort to "pick-up tactics" when it comes to dating. It's not their fault per se; they just need all the help they can get. I'd reckon that this subset is a solid 8% of medical students because I'm thinking of one student in particular out of the dozen. Maybe I'll revise my views again next year.

I've noticed the best medical students are just plain fun to teach. What does that mean? It means they're receptive to things. They ask good questions. They're fun to be around. They learn and get better over the rotation. They do what they're told (including going home when asked). They have common sense when given work to do. They only triple my workload, and it makes me want to kiss their feet.

If you simply want to honour a rotation, I think your best bet is to, as with most things in life, ask somebody who has already done what you want to do, and do what they suggest. If a bad evaluation ruins your sense of self, you probably have an unsustainably fragile ego to begin with, and the real lesson is develop resilience above all else.

Regarding "support staff." A lot of people say "be nice to the nurses." What they really mean is, "be nice to the nurses so that..." This instrumentalist view of relating to people is actually really hurtful and will lead to disappointment or a shallow sense of connection in the long run. Everybody knows the feeling. Fake smiles when you're really dying on the inside.

I hold open doors, I smile, I say thank you, I ask them about their weekend--I do these things regardless of whether or not somebody can or ever will be helpful to me in the future. Why? Because I'm an outgoing person. I would do that for anybody, attending, patient, or janitor. Who you are is what you do even when it doesn't matter--especially when it doesn't matter. So much of life for medical students is a tiring charade of projecting a certain kind of image. I think the real mark of maturity comes when you can comfortably drop the charade, forget about the image, and hopefully not be a psychopath. If you're introverted, then embrace your introversion and be a damn good doctor. The accolades will come eventually, and when they do, they won't even matter. The real accolade will be doing a job well done in the first place.

 

[Gorne]

I'm sorry, some of this is way, way over the top. Buying your interns coffee? Apologizing for speaking? Staying until 10pm when you're not on call? Looking at the floor when you answer questions? Don't out dress anyone? Acknowledge that your stupid for asking a question? I'm almost inclined to think you're trolling.

Absolutely none of that in any way makes you a better student or team player. For students actually struggling with the social dynamics on the wards, please take OP with a grain of salt.

 

[Chibucks15]

I'm sorry, some of this is way, way over the top. Buying your interns coffee? Apologizing for speaking? Staying until 10pm when you're not on call? Looking at the floor when you answer questions? Don't out dress anyone? Acknowledge that your stupid for asking a question? I'm almost inclined to think you're trolling.

Absolutely none of that in any way makes you a better student or team player. For students actually struggling with the social dynamics on the wards, please take OP with a grain of salt.

a few pounds of salt