med students

[fang]

Warning: this is a hypocritical post.

I can't stand our team's med student. I remember reading similar posts about this in the past and thinking "what a hypocrite, he/she was just a med sudent a few years ago." I know, but it's still incredibly annoying.

He is overly enthusiastic, all the time.
He asks "how am I doing" 3x a day.
He didn't do as well as he liked on the boards, and when I cracked and showed some sympathy he wanted to talk about it for like an hour.
He comes up to me 10 minutes before rounds to ask questions about his patient when I'm trying to get labs on 12 people and check telemetry.
He co-opts the resident's time discussing his plan for 1 1/2 hours so she forgets to tell me that the attending wanted xyz done, which I don't find out about till AM rounds.
He bugs me at 7 pm when I just want to finish and leave to talk about the bichemistry of statins and how "way cool" it is.
If I don't answer something in rounds right away, and he knows the answer, he'll pipe in before I can open my mouth (it's never a hard question, he just butts in).

I hate it, hate it, hate it. But when I brush him off it's like kicking a puppy and then I feel guilty. Beleive me, I remember the awkwardness of being a 3rd year, but I think I knew when to lie low and let people get their work done, my residents never spent more than 10-15 minutes going over the details of my plan with me, and I didn't wear my insecurity on my sleeve.

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[mlw03]

i just came off MS3, so i'll reply in that context. i would suggest pulling him aside and in a nice, non-threatening way, tell him to chill a bit. remind him MS3 is a marathon, not a 400m dash, and that he needs to find a little better balance. remind him that you're a fresh intern yourself and you need help from the resident and attending as well. i don't think you need to feel guilty if you do this, and if he's put off by it then he's in trouble because you sound a lot nicer than some of the residents/interns i worked with last year and i know a lot of them wouldn't have thought twice about putting me in my place.

as an aside, you've given me another thing to list in my "why i love pathology" mantra: no dealing with crazy third year med students.

 

[Tired]

I'll trade you, mine is completely the opposite.

He didn't see any patients before rounds until I suggested it.
After seeing one patient on the first day, he didn't do a note until I suggested it.
The following day he didn't see the patient again because I didn't tell him to.
He shows up 5-10min late to rounds every day.
He goes to his lectures at 2:00p and never comes back.
He never takes the initiative to go get things the team needs.
He constantly asks me the plans on patients instead of reading my notes.
It takes him more than an hour to gather labs on 5 patients.
He doesn't know anatomy.
He thinks he can get into Urology with a 195 on step 1.

Overly enthusiastic is easy to deal with. You tell them, "You're in good shape to do well on this rotation, but you have to dial it back because you're driving me crazy." But how do you tell a low quality student that they need to improve their performance in every way, and that they aren't doing anything well?

 

[mlw03]

But how do you tell a low quality student that they need to improve their performance in every way, and that they aren't doing anything well?

just like that. tell them they aren't where they should be in terms of either their effort or their knowledge base, and that you expect more from them. i'd rather have heard it early from a disappointed resident than not hear it at all and then get a horrible evaluation.

 

[3dtp]

Warning: this is a hypocritical post.

I can't stand our team's med student. I remember reading similar posts about this in the past and thinking "what a hypocrite, he/she was just a med sudent a few years ago." I know, but it's still incredibly annoying.

Don't worry, soon, he too will be soon sold into slavery. The match is coming.

 

[Tired]

just like that. tell them they aren't where they should be in terms of either their effort or their knowledge base, and that you expect more from them. i'd rather have heard it early from a disappointed resident than not hear it at all and then get a horrible evaluation.

Unfortunately it's just not my place to make such a global evaluation. I can point things out as they come up (ie - "You should really try to get your notes done before rounds"), but at the end of the day the Chief is the one responsible for evaluating his overall performance, not me.

And in all honesty, I doubt there's a whole lot he could do to substantially improve. Either you learned anatomy or you didn't. Either you have a work ethic or you don't. If you don't remember the major blood vessels in the brain by 3rd year, you're pretty much toast.

 

[funkless]

He thinks he can get into Urology with a 195 on step 1.

Whew! Up until that last line, I thought you were talking about me...

 

[group_theory]

He didn't see any patients before rounds until I suggested it.
After seeing one patient on the first day, he didn't do a note until I suggested it.
The following day he didn't see the patient again because I didn't tell him to.
He shows up 5-10min late to rounds every day.
He goes to his lectures at 2:00p and never comes back.
He never takes the initiative to go get things the team needs.
He constantly asks me the plans on patients instead of reading my notes.
It takes him more than an hour to gather labs on 5 patients.
He doesn't know anatomy.

Maybe he is suffering from senioritis (aka MS4itis, Post-ERAS-submission-itis, Fourth-Year-itis)

 

[eforest]

The problem is that evals aren't objective and we've had it drilled into our heads since the beginning that third year success has as much to do with how we present ourselves as what we know and how well we do. And, we're told to be enthusiastic, to ask questions, and to stay late. The lazy student sounds a little more hopeless, but maybe tell the overzealous one that he can chill.

 

[colbgw02]

The problem is that evals aren't objective and we've had it drilled into our heads since the beginning that third year success has as much to do with how we present ourselves as what we know and how well we do. And, we're told to be enthusiastic, to ask questions, and to stay late. The lazy student sounds a little more hopeless, but maybe tell the overzealous one that he can chill.

Either that or that guy is just a tool. Sad thing is, he'll likely run into at least one resident who will reinforce that behavior.

There's a student on service with us right now who is overly polite and helpful. Luckily, I don't have to work with her very much. She offers to do things that are way too imposing - things that I wouldn't even consider asking of a medical student. If you drop something, like a pencil, she'll rush from across the room to pick it up for you. I'm like, am I supposed to tip you or something, because I don't have any ones?

Yeah, third year sucks.

 

[PediBoneDoc]

*snickering to self*

perspective is everything isn't it. looking from med stud perspective is one thing, now as a resident your view changes. it will change again.

med stud come in all flavors. you all will develop your own style of how to deal with the good, the bad, and the ugly. the hardest thing is to be unbiased in your opinion if someone's personality irritates you.

Fang for your over enthusiastic student just tell s/he to relax, take a breath and chill out.

Tired for you under performer, well i got nothin' for ya.

for both of you, one of the most important things to do is set your ground rules up front. so, if they fall short, they should know it.

 

[mlw03]

Unfortunately it's just not my place to make such a global evaluation. I can point things out as they come up (ie - "You should really try to get your notes done before rounds"), but at the end of the day the Chief is the one responsible for evaluating his overall performance, not me.

And in all honesty, I doubt there's a whole lot he could do to substantially improve. Either you learned anatomy or you didn't. Either you have a work ethic or you don't. If you don't remember the major blood vessels in the brain by 3rd year, you're pretty much toast.

why isn't it your place to critique this student? i was told of some of my failings by a pgy-1 ob/gyn resident. i happened to disagree with her assessment and didn't change anything, but i certainly wasn't put off by her having said it.

as to your second paragraph, we all forget way more anatomy than we remember. what this student's failing is that he's not reviewing it. i certainly don't remember every neuro pathway that i did at the end of the neuroscience course. i do agree with your statement that by ms3 you either have a work ethic or you don't - and there's little you can do to change it. as this student's resident i would encourage you to convey your thoughts to the chief so this student gets an appropriate evaluation.

 

[elwademd]

why isn't it your place to critique this student? i was told of some of my failings by a pgy-1 ob/gyn resident. i happened to disagree with her assessment and didn't change anything, but i certainly wasn't put off by her having said it.

i think what tired meant was more along the lines of the official evaluation at the end of the service/rotation.

i'd say certain things are expected of medical students, just as certain things are expected of interns and residents.
as a medical student, at the very least, see the patient!

 

[DreamLover]

I'll trade you, mine is completely the opposite.

He didn't see any patients before rounds until I suggested it.
After seeing one patient on the first day, he didn't do a note until I suggested it.
The following day he didn't see the patient again because I didn't tell him to.

wow...laughed out loud at this....because I can remember my first roation 3rd yr and I was on peds wards and I had no clue what it meant to pre-round, round, follow patients...I was totally cluless...it took me an hour to write a SOAP note...and I still didn't understand exactly what went into the Subjective Vs Objective! That could've been me the first couple days...but I was a quick learner...I wasn't doing that stuff a month in...

 

[persia]

Well, I can see how both sides are sort of frustrated. I remember when I first started no one ever sat down with me to go over anything, notes, patient questions, or the nuts and bolts of the rotation. I sort of was just thrown in. I am not dumb and I am normally a quick learner, but I somehow missed the instruction sheet for third year and no one ever clued me in. Sometimes I would get chewed out for things I didn't really even know I was/wasn't doing but no one ever said, here is what you need to be doing, get this done at XX o'clock, and oh, by the way here is how to log into the OR schedule/patient scheduler, etc. It was a terrible feeling.

I am sure they had many conversations about what a dumb$$$ I was, but that wasn't true. I think there is a real lack of basic teaching that goes on, residents and interns are busy. I hope that I can remember what that felt like when I am a resident and stop and make sure I lay out the ground rules for my students. "Do it this way, by this time; show me your notes I have 10 minutes to look them over; what books are you reading," or whatever. It doesn't serve anyone to just roll your eyes over a student, who knows what is going through their head? and I totally agree that it should be done sooner than later. Not addressing it during the time the student can actually learn from it, and then writing a terrible eval is not teaching - because what do they really learn from that? Teach upfront, look for change - and encourage it. Anyway, just my fourth year student 0.02 worth. There is alot in medicine that is unspoken, and it's hard to sort of decipher what it all means and what is your place on a team.

 

[brewmeistervi]

For the record, I'm a first year, and you guys are freaking me out.

I can't wait until I get chewed out for being an overacheiver/ slacker who is annoying because he doesn't walk on the tight rope with a smile. No net for me, I don't want to slow you guys down.

 

[Top Gun]

Warning: this is a hypocritical post.


He comes up to me 10 minutes before rounds to ask questions about his patient when I'm trying to get labs on 12 people and check telemetry.
quote]

I've thought of one way you can put his zealousness to good use. Is 12 the number of patients you're team is following right now? If so, try putting him to work helping you with checking those labs and telemetry. He'll have to learn to do it anyway, and it will help you save some time.

 

[funkless]

I've thought of one way you can put his zealousness to good use. Is 12 the number of patients you're team is following right now? If so, try putting him to work helping you with checking those labs and telemetry. He'll have to learn to do it anyway, and it will help you save some time.

Yeah, but could you trust such a slacker to copy everything down accurately? I can just hear it: "Oh, I meant to write potassium of TWO point four, not four point four. My bad. Oh, and did I mention the funny EKG tracing?"

 

[Tired]

Well, I can see how both sides are sort of frustrated. I remember when I first started no one ever sat down with me to go over anything, notes, patient questions, or the nuts and bolts of the rotation. I sort of was just thrown in.

I think it's unlikely that the jokes made at your expense were anything out of the oridinary, just as all the comments about "July Interns" being thrown at me are par for the course. We always laugh at inexperience, it's the nature of things in medicine.

And yes, everyone is aware that there is no handbook detailing your responsibilities for 3rd year.

The difference is that most students will steadily pick things up by observing their environment, asking questions, and talking to their classmates. There is a fast learning curve in 3rd year, and most people are starting to feel comfortable in their role after 3-4 weeks.

In my case, there has been an obvious lack of initiative, and not in terms of volunteering for scut, but basic initiative to try to learn the role of the Junior Medical Clerk. This is my objection. Only a jerk would denigrate an MSIII for not knowing what to do on their first week. But after a month, shouldn't you have figured out what all your classmates are doing, and compare it to yourself?

 

[EM_Rebuilder]

Well, I can see how both sides are sort of frustrated. I remember when I first started no one ever sat down with me to go over anything, notes, patient questions, or the nuts and bolts of the rotation. I sort of was just thrown in. I am not dumb and I am normally a quick learner, but I somehow missed the instruction sheet for third year and no one ever clued me in. Sometimes I would get chewed out for things I didn't really even know I was/wasn't doing but no one ever said, here is what you need to be doing, get this done at XX o'clock, and oh, by the way here is how to log into the OR schedule/patient scheduler, etc. It was a terrible feeling.

I am sure they had many conversations about what a dumb$$$ I was, but that wasn't true. I think there is a real lack of basic teaching that goes on, residents and interns are busy. I hope that I can remember what that felt like when I am a resident and stop and make sure I lay out the ground rules for my students. "Do it this way, by this time; show me your notes I have 10 minutes to look them over; what books are you reading," or whatever. It doesn't serve anyone to just roll your eyes over a student, who knows what is going through their head? and I totally agree that it should be done sooner than later. Not addressing it during the time the student can actually learn from it, and then writing a terrible eval is not teaching - because what do they really learn from that? Teach upfront, look for change - and encourage it. Anyway, just my fourth year student 0.02 worth. There is alot in medicine that is unspoken, and it's hard to sort of decipher what it all means and what is your place on a team.

On surgery, we were put together in pairs. My classmate and I was very good about getting there very early and seeing 3-4 patients and telling a resident about them. Then we had surgery conference....after than we would go chill at breakfeast with a family medicine intern and roam around with him (he was on surgery floor service)...he would send us home or we would get paged at close to noon from an OR asking us to come help. Nobody bothered to clue us in until we both got nasty calls from a chief that first weekend...partly for not showing up to round for the weekend (hey, out intern told us no bother... but he was FM and that did not count in the surgery residents eyes...)

We got black balled after about a week of that. Nobody once told us that we should 'check' the OR schedule and be at those rooms when surgeries are to start. The next 11 weeks of surgery sucked; I think we regained a tiny bit of respect by the end...

I think its best to pull an ill performing medical student aside and make sure they are aware of what they should be doing. Often times, I like to think anyhow, that the lack of doing is pure ignorance and not laziness...

 

[sirus_virus]

Just tell him you will put in a good word for him in exchange for your freedom.

 

[persia]

Tired, I DID ask questions and my intern's answers were along the lines of 'you should already know that, didn't they teach you anything in your first two years?!'

Some of my classmates were helpful in explaining basic things but I was alone on my first service for the whole time. I don't think that refusing to answer a new third year's questions or explain anything to them is adequate teaching. The attendings were really great tho and taught me alot and made me feel welcome. I agree with EM, that most students are probably unaware of something and that explaining things can go along way. Communication is key!

 

[Top Gun]

Yeah, but could you trust such a slacker to copy everything down accurately? I can just hear it: "Oh, I meant to write potassium of TWO point four, not four point four. My bad. Oh, and did I mention the funny EKG tracing?"

Uh, I didn't mean the slacker. I meant the overenthusiastic one.

 

[Tired]

Some of my classmates were helpful in explaining basic things but I was alone on my first service for the whole time. I don't think that refusing to answer a new third year's questions or explain anything to them is adequate teaching.

It's more than "inadequate teaching", it's obnoxious and just plain stupid. Any resident worth 2 cents should know that a good med student can take a lot of pressure off you in terms of running errands, gathering data, and talking to consultants. Failure to use tools at your disposal is ******ed. Sorry you have such a crappy team.

 

[Substance]

Ah, clerkship. It could be better. I'm at the end of mine and I've become more cynical as the days go on.

The unfortunate thing is that the medical student, who pays tens of thousands of dollars to learn how to be a doctor, is seen more often than not as a scut monkey. If a student is not learning anything on a rotation, then they are not getting their money's worth, and they are not gaining the essential critical thinking skills needed to be a medicolegally adequate physician.

Knowing where to get lab values and how to set up a patient on the OR list is not learning medicine. You could pay a high school student minimum wage to do that kind of stuff for a summer job. Heck, if I were a rich kid, I'd just hire some people to do my scut for me while I actually seeked out the useful learning experiences.


As for your problem students:

1. Ask the keener what they want to do for a specialty. I bet the answer will be a ROAD. Either way, although they may be annoying, if they're getting the job done, then they're doing a good job. If you have a problem with the way they do things, tell them. How else will they know they're pissing you off?

2. The lazy student sounds like he's given up hope. He wants uro but knows that with his board score he's not going anywhere near it. I bet right now he feels as if any other scars on his file won't really matter, since he's already screwed up bigtime, so he doesn't lift a finger unless he's asked; what's a few comments on the transcript about laziness matter when you have a ****ty board score? I bet he's a hardworker when he has a prayer for the future. Bring this up with him in a non-confrontational way. I bet you'll find out more about him than you've thought previously.

Unfortunately its this kind of guy who's going to end up being a poor quality FM doc.

3. The pen-picker-upper does not have confidence in her abilities and is afraid of pissing people off, so she's being a doormat. Tell her to gain confidence. Give her a bit of encouragement. Tell her it's not necessary to be your slave.


If only clerkship could be less of an auditioning process and more of a learning experience.

 

[PreMedAdAG]

I think it would be helpful if residents laid out their expectations right off the bat. I'm a no nonsense kind of person and find that I'm struggling in 3rd year in trying not to be annoying - but in not being annoying do I seem disinterested, lazy, dumb? In another sense, when I try to participate, I get a lot of "no's" and "you don't need to do that". It's an awkward role as you know and I wholeheartedly agree with the idea that not enough teaching goes on. I also can't stand the passive aggressive types that are trying to be "professional" but it comes across as "I'm just faking being nice to you - I actually hate you" - like if you like a student awesome - if you hate them, well then you do - but candidness does amazing things for getting what you want out of us.

Example:

1. For most students: "This note was great - here is what I would fix... x, y, z"
2. For lazy students: "this note is incomplete - I'd like you to go pick up another patient's chart and look at an example of how we write notes here - redo it and show it to me in 15 minutes, then I'll sign you off - that's the best way to learn what we expect here"
3. For the overly annoying/writes way to much student: "Your note is thorough, but you spent too much time on this - try to limit the wordiness and really focus on the patient's problems at hand"

The problem med students face:
-not a ton of time to study so if you're an average joe like me (in other words - things don't just pop in my head - I'm not gifted like that - I'm what you would call a toiler by nature - i have to look things up, write them down - then see it multiple times - does that make me dumb - maybe in some people's eyes - but it also makes me anal - so you can trust what I write and present)
-We realize that residents probably have longer hours than us - but we have a poor grasp on patient care - so home time is totally miserable - I find myself researching and researching only to find that the next day I'm pimped on a topic I've not read about and I look like an ass.

Anyway - my point is - if someone would just say, "Hey look - this is what you should be doing, this is what you shouldn't be doing, here are common themes that you should know about - my best suggestion is to use this resource" that would be amazing - this whole process is foreign - we don't know where things are - we're basically borderline ******ed!!! Bare with us - we're trying our best even if we look like idiots and you are amazed that we even passed our first 2 years.

thanks for listening - hopefully I didn't offend anyone

 

[Tired]

I'd like to suggest that scut isn't as educationally-devoid as many think. Reading through a chart, gathering the latest labs or films (and actually looking at them), talking to the consultants, all these things are the basis of real clinical medicine. If you're not paying attention to the scut, then yes, you learn nothing. But if you take it as an opportunity to get more info on your patients, that is incredibly educational, and can serve as a jump-off point for questions to ask your residents.

 

[GoodMonkey]

I'd like to suggest that scut isn't as educationally-devoid as many think. Reading through a chart, gathering the latest labs or films (and actually looking at them), talking to the consultants, all these things are the basis of real clinical medicine. If you're not paying attention to the scut, then yes, you learn nothing. But if you take it as an opportunity to get more info on your patients, that is incredibly educational, and can serve as a jump-off point for questions to ask your residents.

it can also help you learn to start functioning as a bottom-level resident. i learned more about "being a doctor" by doing mundane, routine things on my patients as a med student. i can now recognize labs that are a little off or the significance of a rising (or falling) white count, or interval CXR changes or how to find out what the consulting team had to say about my patient by having repeatedly done things like you mention above when i was a medstudent. i learned a lot about what it was going to be like to be an intern by doing all the data-gathering work on some patients on my services as an m3 and m4.

i like to give my med students one or two patients from my list and have them follow those one or two in detail, rather than have them just gather global info on everyone or try to follow me while i follow everyone ... i think it's a better learning experience for them and it's more help for me.

 

[GuP]

I'd like to suggest that scut isn't as educationally-devoid as many think. Reading through a chart, gathering the latest labs or films (and actually looking at them), talking to the consultants, all these things are the basis of real clinical medicine. If you're not paying attention to the scut, then yes, you learn nothing. But if you take it as an opportunity to get more info on your patients, that is incredibly educational, and can serve as a jump-off point for questions to ask your residents.

Gime a break! Do you really believe what you just wrote?

Reading through a chart? Have you tried this yourself? Most of the charts look like monkeys have scribbled in them using crayons. Granted there is info in them, but would you really look at it if you didn't have to?

Gathering the labs and films - I am all good with labs but films are a different story. As a MS3 or MS4, I doubt many students know how to read a film - unless its a CXR. PLus its not reading thats a problem, its actually finding the film that is!

Talking to consultants - I have never done that b/c I never see them so I can't comment. But I am pretty sure they won't be very much interested in being questioned by med students since most of them are residents/fellows themselves.

 

[Tired]

Gime a break! Do you really believe what you just wrote?

Reading through a chart? Have you tried this yourself? Most of the charts look like monkeys have scribbled in them using crayons. Granted there is info in them, but would you really look at it if you didn't have to?

Gathering the labs and films - I am all good with labs but films are a different story. As a MS3 or MS4, I doubt many students know how to read a film - unless its a CXR. PLus its not reading thats a problem, its actually finding the film that is!

Talking to consultants - I have never done that b/c I never see them so I can't comment. But I am pretty sure they won't be very much interested in being questioned by med students since most of them are residents/fellows themselves.

Yes, I do believe what I wrote, because it's what I did as a student, and that experience served me well as a sub-i and now an intern. But here's let's break down your objections real quick:

1) Charts are hard to read - I know, but as an intern, that won't be an excuse when your Chief asks you to look up the Neurology note from three weeks ago.

2) I shouldn't have to do hard things if I don't "have to" - great attitude, it should serve you well down the road

3) I don't know how to read films - you can wait for someone to teach you, or you can just start doing it yourself, and correlate your read to the radiologists. Your choice.

4) Sometimes films are hard to find - again, this excuse won't really fly when your chief tells you to get it as an intern

5) I've never talked to consultants, but I'm sure they wouldn't answer my questions anyway - you're so wrong; consultants tend to have a lot more time and a lot less interaction with med students than your attendings do. Consequently they are, in general, nicer and more interested in sharing their knowledge with you. They like their fields, and don't often have the chance to talk about it with other people. If you're not talking to your team's consultants yourself, you are throwing away a great opportunity.

 

[smq123]

But how do you tell a low quality student that they need to improve their performance in every way, and that they aren't doing anything well?

Unfortunately it's just not my place to make such a global evaluation. I can point things out as they come up (ie - "You should really try to get your notes done before rounds"), but at the end of the day the Chief is the one responsible for evaluating his overall performance, not me.

I don't see why you can't point all of these things out to your slacker med student. (I just started MS3, so I'm in the same position as your student.) I don't think there's anything wrong with pulling aside the med student during lunch one day and saying nicely: "Listen, I just want to warn you - the way you're going is not going to get you any awards. I know that you're just starting out - I was in your shoes a couple of years ago - but you need to take more initiative and you also need to make sure that you're studying at night. If you're feeling lost, just come talk to me about it, and I can help you - but I need to make sure that you're just lost and not being lazy. I just want to give you a heads up before the Chief comes down hard on you for not pulling your weight." Actually, I'd probably appreciate the heads-up from the intern.

It's not a formal evaluation, but it does let the med student know that he needs to put his ass in gear. If it just turns out that he's not "interested" in surgery (and is therefore just trying to coast), then...well, you did your best. If it turns out that he's just lost but too embarrassed to ask for help, then it lets him know that he can ask you for a little guidance now and then.

EDIT - If your med student is upset because he feels like urology is out of reach (which, okay - maybe it is), you'd think that he'd try to redeem himself by doing really well on surgery. By giving him a heads up, hopefully it will make him realize that.

I hate it, hate it, hate it. But when I brush him off it's like kicking a puppy and then I feel guilty. Beleive me, I remember the awkwardness of being a 3rd year, but I think I knew when to lie low and let people get their work done, my residents never spent more than 10-15 minutes going over the details of my plan with me, and I didn't wear my insecurity on my sleeve.

Don't feel guilty. Isn't part of MS3 trying to learn how to function as a part of a team? Your med student clearly isn't learning that - looking for a shoulder to cry on about his Step 1 score is CERTAINLY not beneficial to the team! Maybe the next time he asks you "How am I doing?", you can say "Fine, but I think you need to learn how to work as a member of this team a little more efficiently. Talking to me about the mechanics of statins when I'm trying to write a progress note is not very efficient." He might sulk, but at least you got the point across.

 

[smq123]

Gime a break! Do you really believe what you just wrote?

Reading through a chart? Have you tried this yourself? Most of the charts look like monkeys have scribbled in them using crayons. Granted there is info in them, but would you really look at it if you didn't have to?

Gathering the labs and films - I am all good with labs but films are a different story. As a MS3 or MS4, I doubt many students know how to read a film - unless its a CXR. PLus its not reading thats a problem, its actually finding the film that is!

Talking to consultants - I have never done that b/c I never see them so I can't comment. But I am pretty sure they won't be very much interested in being questioned by med students since most of them are residents/fellows themselves.

I don't think there's anything really terrible about doing scut work. (Granted, I just started MS3, but still.) When you're a 3rd year, you don't know anything - so everything (even calling consults or trying to decipher a messy chart) is a chance to learn something. Why not encourage your med student to take advantage of that?

 

[GuP]

Yes, I do believe what I wrote, because it's what I did as a student, and that experience served me well as a sub-i and now an intern. But here's let's break down your objections real quick:

1) Charts are hard to read - I know, but as an intern, that won't be an excuse when your Chief asks you to look up the Neurology note from three weeks ago.

2) I shouldn't have to do hard things if I don't "have to" - great attitude, it should serve you well down the road

3) I don't know how to read films - you can wait for someone to teach you, or you can just start doing it yourself, and correlate your read to the radiologists. Your choice.

4) Sometimes films are hard to find - again, this excuse won't really fly when your chief tells you to get it as an intern

5) I've never talked to consultants, but I'm sure they wouldn't answer my questions anyway - you're so wrong; consultants tend to have a lot more time and a lot less interaction with med students than your attendings do. Consequently they are, in general, nicer and more interested in sharing their knowledge with you. They like their fields, and don't often have the chance to talk about it with other people. If you're not talking to your team's consultants yourself, you are throwing away a great opportunity.

The cycle continues - just b/c you did it or were made to do it, you think it's only right that you return the favor.

And another point you are missing is that a student is NOT an intern. You keep writing that xyz won't fly when you are an intern - but guess what students aren't interns. I am sure we are competent enough to do an intern's taks but why do them when they aren't our responsibility yet? Finding a film in MS3 or MS4 is really gonna teach me the value of hardwork. Yah ok.

Actually not doing something b/c you don't have or it just isn't needed to isn't a bad attitude at all. It's called being smart and efficent.

 

[Hard24Get]

Yes, I do believe what I wrote, because it's what I did as a student, and that experience served me well as a sub-i and now an intern. But here's let's break down your objections real quick:

1) Charts are hard to read - I know, but as an intern, that won't be an excuse when your Chief asks you to look up the Neurology note from three weeks ago.

2) I shouldn't have to do hard things if I don't "have to" - great attitude, it should serve you well down the road

3) I don't know how to read films - you can wait for someone to teach you, or you can just start doing it yourself, and correlate your read to the radiologists. Your choice.

4) Sometimes films are hard to find - again, this excuse won't really fly when your chief tells you to get it as an intern

5) I've never talked to consultants, but I'm sure they wouldn't answer my questions anyway - you're so wrong; consultants tend to have a lot more time and a lot less interaction with med students than your attendings do. Consequently they are, in general, nicer and more interested in sharing their knowledge with you. They like their fields, and don't often have the chance to talk about it with other people. If you're not talking to your team's consultants yourself, you are throwing away a great opportunity.

Tired:

I think it is funny comparing your responses to GuP's. We clashed over ocean11's thread because I advocated for my fellow med students to take more responsibility, and you called me overserious. People are either preparing to be students (shrugging responsibility) or preparing to be interns (seeking responsibility). Very few of us are perfect. What type of med student do you want, exactly?

 

[swpm]

I felt that part of my job as an intern was to make the students look good in front of the chief and attending. So for example if we'd admitted a patient with pancreatitis overnight, I'd tip off the student who picked up that patient that there was a high probability that they'd be pimped on Ranson's criteria, EtOH vs gallstones vs zebras like scorpion stings, what made a pseudocyst not a true cyst, specific labs to follow, expected hospital course, etc.

Students who shine on rounds and avoid the wrath of the malignant chief because you've set them up for success are more likely to have a positive attitude toward the rotation and be willing to help you out. It's depressing to be clueless. Interns know 90% of the fertile med student pimping ground ... try to make the weak ones look good, and the strong ones look like geniuses. It's the humane thing to do.

 

[snoopy brown]

I felt that part of my job as an intern was to make the students look good in front of the chief and attending.

I've heard this before and disagree. I always feel that the students are there to demonstrate whether they are good or not which is the point of grading after all. If you hold their hand on the patients, feed them the answers for all pimp questions, and do everything for them so they look stellar, why are they there? We had students who did practically nothing. For example, they'd sometimes do an exam and sometimes not (no joke) and when they didn't some intern would always key them in on the right thing to say. It was sad. At the end of the rotation the attendings all thought they were amazing students and performed at a great level. I told them the truth. I'm sure a bunch of med students will now post complaints that I was a jerk and how dare I do that because eveeryone should look good and I interfered with their career plans or something.

 

[Dr JPH]

I've heard this before and disagree. I always feel that the students are there to demonstrate whether they are good or not which is the point of grading after all. If you hold their hand on the patients, feed them the answers for all pimp questions, and do everything for them so they look stellar, why are they there? We had students who did practically nothing. For example, they'd sometimes do an exam and sometimes not (no joke) and when they didn't some intern would always key them in on the right thing to say. It was sad. At the end of the rotation the attendings all thought they were amazing students and performed at a great level. I told them the truth. I'm sure a bunch of med students will now post complaints that I was a jerk and how dare I do that because eveeryone should look good and I interfered with their career plans or something.

Medical school is 'big kid school'. Time for people to grow up and become responsible...not look for an easy way out.

 

[Dr JPH]

Reading through a chart? Have you tried this yourself? Most of the charts look like monkeys have scribbled in them using crayons. Granted there is info in them, but would you really look at it if you didn't have to?

So what are they going to do when THEY are the intern?

When my resident and/or attending ask me "what is Heme/Onc planning for this patient?" I cant tlel them "I couldnt read the chart.

Gathering the labs and films - I am all good with labs but films are a different story. As a MS3 or MS4, I doubt many students know how to read a film - unless its a CXR. PLus its not reading thats a problem, its actually finding the film that is!

As above. When I present cases at morning conference or M&M I need to have every single piece of data that was compiled on this patient. This means going to Rads and getting copies of films, going to the Cardiologists office and reading the EKG with him and even going to Med Records and telling the old lady with thick glasses the patients name (very loudly sd she can hear me) and getting the chart.

Students need to learn this process as well.

And maybe, just maybe one of them will be proactive enough to ask a Radiologist to go through a CT with them or perhaps even listen to the dictation while viewing the film.

Talking to consultants - I have never done that b/c I never see them so I can't comment. But I am pretty sure they won't be very much interested in being questioned by med students since most of them are residents/fellows themselves.

Wrong again.

While having a 3rd year medical student talk to a consultant isnt always the best idea, I think you will find that in many teaching hospitals having at least a Sub-I contact them is a valuable experience. I can remember several instances as a med student where I would call or bump into a consultant on one of my patients and go through the care plan. And guess what? I was the only person to know what the hell was going on!

Again...as an intern you need to play quarterback for the team youre on.

The attendings and residents rely on you to pull the information together so that THEY have it on rounds or when they ask you.

Not knowing how to do these tasks can be frustrating. Getting experience with "scut" can make that seem a bit easier.

Now Im not saying that students need to be doing all the menial tasks...but as I told one 3rd year the other day "Youre a 3rd year medical student...EVERYTHING you do is a learning experience because you dont know anything yet."

So pulling JP drains and NG tubes, writing med lists for discharge and copying labs might be scutwork. But if you have never done it before there is learning involved.

 

[GoodMonkey]

So what are they going to do when THEY are the intern?

... cutting for brevity ...

exactly what i think. a point to note, too, is that there is a HUGE difference between making the student do this on every patient on the service and giving them one or two of their "own" patients and having them follow them closely (and doing some of the scut on them.) i felt i learned well this way as a med student and the m3 students i've had on my services as a (very green) resident seem to handle the 1 or 2 patients very well. the subI is obviously a little different story, as they should be progressing towards functioning as an intern.

there's a difference between just scutting out med students all.the.time. with menial work and having them do some of the menial work on the specific patients that they are following (the ones that you, presumably are also going through the plan for, what to watch, what to ignore, and having them write a note on, etc.)

 

[mlw03]

med school is meant to prepare one for internship and residency, so i take the side that anything related to patient care isn't scut. to the student who keeps writing that students aren't interns, the whole idea of medical education is one of progressive responsibility. if you don't try to do some of the intern type activities as an MS3 then it's gonna be a much bigger step when you have to as a PGY-1. plus, the reality is that your classmates are mostly going to be trying to be helpful, so if you keep pulling the 'it's not my job' line you're just gonna compare poorly to your colleagues. it's your choice.

 

[GuP]

So what are they going to do when THEY are the intern?

When my resident and/or attending ask me "what is Heme/Onc planning for this patient?" I cant tlel them "I couldnt read the chart.

Ok and your point is? So YOU read the chart. Why are you making students read the chart? I am sure students can figure out how to interpret a chart when they are an intern - they don't need 2 years of training to do so.

As above. When I present cases at morning conference or M&M I need to have every single piece of data that was compiled on this patient. This means going to Rads and getting copies of films, going to the Cardiologists office and reading the EKG with him and even going to Med Records and telling the old lady with thick glasses the patients name (very loudly sd she can hear me) and getting the chart.

Students need to learn this process as well.

What is there to learn? How to play fetch? There is nothing to learn - these are tasks which need to get done. There is nothing educational about them. You as intern should do them yourself and stop pawning them off to a med student.

While having a 3rd year medical student talk to a consultant isnt always the best idea, I think you will find that in many teaching hospitals having at least a Sub-I contact them is a valuable experience. I can remember several instances as a med student where I would call or bump into a consultant on one of my patients and go through the care plan. And guess what? I was the only person to know what the hell was going on!

Wrong about what? I am wrong b/c I never saw a consultant? So since you happen to bump into them and get some info, I am wrong for not being there when they came? Or are you saying that ALL consultants are nice people who like to have long chats about patients and their girlfriends? I have "bumped" into some before and my experiences have not been pleasant.

Now Im not saying that students need to be doing all the menial tasks...but as I told one 3rd year the other day "Youre a 3rd year medical student...EVERYTHING you do is a learning experience because you dont know anything yet."

What a nice thing to say! I am sure that student was head over heels in love with you. It's funny how you being an intern can tell a student they don't know anything yet when you have working for what like a month now?

 

[snoopy brown]

Here's the bottom line. In medicine there are all types of people, which is why there are all types of residents and attendings. GuP, you have the attitude that it's not your job (yet) to do certain things and that will show. If the people around you don't care that's fine. However we've all worked with interns and residents who clearly had that same mentality as medical students and carried it into residency. If you go into a field where that is acceptable like ER then fine. If you go into a field where it's not like surgery then you'll find out quickly that you are unqualified. That's all there is to say.Sure, I know some interns make MS's do stuff so they don't have to. But I bet that JP Hazleton also read the note and didn't just trust the MS to do it. Med students are oblivious to a lot of stuff that happens around them. Students like you seem more focused on whether you're getting screwed by the call schedule or when you get to go home. Again, it will show in your work ethic. Lots of interns hate scut, too, but they know it's their responsibility unfortunately because our hospitals use residents like slave labor. But you can't just not do it because you don't like it.I know that sounds harsh, but you're coming off with this big entitlement attitude and acting like people who have expectations are jerk-offs.

 

[Dr JPH]

Ok and your point is? So YOU read the chart. Why are you making students read the chart? I am sure students can figure out how to interpret a chart when they are an intern - they don't need 2 years of training to do so.

I do. I also make them do it too.

What is there to learn? How to play fetch? There is nothing to learn - these are tasks which need to get done. There is nothing educational about them. You as intern should do them yourself and stop pawning them off to a med student.

I do these tasks on my entire service. Having a student closely follow their patient and know all the intimate details of their case, so much so that they could present the patient to anyone at anytime...there is a lot to learn in that.

Wrong about what? I am wrong b/c I never saw a consultant? So since you happen to bump into them and get some info, I am wrong for not being there when they came? Or are you saying that ALL consultants are nice people who like to have long chats about patients and their girlfriends? I have "bumped" into some before and my experiences have not been pleasant.

Perhaps your negative interactions with physicians have been a result of your poor attitude...the same poor attitude that you are demonstrating here.

What a nice thing to say! I am sure that student was head over heels in love with you. It's funny how you being an intern can tell a student they don't know anything yet when you have working for what like a month now?

Ah yes. Im just a "tad" beyond a 3rd year med student, right? You must be a 3rd year yourself to think that!

 

[Dr JPH]

Here's the bottom line. In medicine there are all types of people, which is why there are all types of residents and attendings. GuP, you have the attitude that it's not your job (yet) to do certain things and that will show. If the people around you don't care that's fine. However we've all worked with interns and residents who clearly had that same mentality as medical students and carried it into residency. If you go into a field where that is acceptable like ER then fine. If you go into a field where it's not like surgery then you'll find out quickly that you are unqualified. That's all there is to say.Sure, I know some interns make MS's do stuff so they don't have to. But I bet that JP Hazleton also read the note and didn't just trust the MS to do it. Med students are oblivious to a lot of stuff that happens around them. Students like you seem more focused on whether you're getting screwed by the call schedule or when you get to go home. Again, it will show in your work ethic. Lots of interns hate scut, too, but they know it's their responsibility unfortunately because our hospitals use residents like slave labor. But you can't just not do it because you don't like it.I know that sounds harsh, but you're coming off with this big entitlement attitude and acting like people who have expectations are jerk-offs.

I dont find anything wrong with having high expectations for people who are soon going to be DOCTORS.

Patients (and their lawyers) are going to hold them to even higher standards.

Don't slack off, stop complaining that you have to be at the hospital so early and do your damn job. And at this point in your career (3rd year student) your job is to learn as much as you can...whether it be by writing notes on your patient to sticking your finger in their ass to check for blood. When you look at the relatively easy job of collecting labs and xrays...some things could be worse.

 

[GuP]

Perhaps your negative interactions with physicians have been a result of your poor attitude...the same poor attitude that you are demonstrating here.

Perhaps you should not pass judgment on people you know nothing of. And I am not demonstrating poor attitude - I am just speaking from what I see and from experiences of my friends and I (granted not a lot!).

Ah yes. Im just a "tad" beyond a 3rd year med student, right? You must be a 3rd year yourself to think that!

I wasn't talking about you persay but rather an intern telling that to a student. I have no clue what PGY you are. Regardless, being condescending is not taking the high road. True character can be easily seen by how one treats their inferiors.

 

[colbgw02]

Actually not doing something b/c you don't have or it just isn't needed to isn't a bad attitude at all. It's called being smart and efficent.

I call it bureaucracy. You should consider a career at the DMV.

persay

Nice.

 

[Tired]

Perhaps you should not pass judgment on people you know nothing of. And I am not demonstrating poor attitude - I am just speaking from what I see and from experiences of my friends and I (granted not a lot!).

I suppose may be right, that all scut work is really easy to do, and takes no learning at all. You may also be right that there is absolutely nothing to learn from looking at labs and films, or talking to consultants or . . .

No wait, you're not right. You're totally wrong. And if you don't take the time to learn these processes now, as a student, you are totally boned come internship. Knowledge of how to function on the wards doesn't magically come into your head, it takes training and practice, which is the point of being there as a student. If it wasn't, you'd just sit in lectures your last two years of school.

 

[Samoa]

"persay"...

It drives me nuts how people know they can't spell well, and yet aren't embarassed enough about it to either look up the spelling of a word they're unsure about, or else think of another word to use.

 

[GuP]

"persay"...

It drives me nuts how people know they can't spell well, and yet aren't embarassed enough about it to either look up the spelling of a word they're unsure about, or else think of another word to use.

How about you get off my nutz and worry about other things than my spelling? O ya I am so emmmbbbarrassed pllease comme help me.

 

[GuP]

.