Ok, so who here abuses Med Students????

[Paws]

Ok, well I agree that chewing a student out is bad, but what about when a student is just plain ignored? I find that I am often ignored on a rotation. And I mean, I just do my work, write my notes, etc. and the interns and residents seem to operate in another different dimension. If I don't absolutley hang on their a$$, or chase them down the hall or get right in their faces, then they pretty much don't include me in stuff.

I see some students who seem to become 'best friends' with their interns, but I have no idea how that happens. I feel aware that I am missing out on alot of learning by being left to one side. They're nice to me and all, but I sort of become invisible. It's the strangest thing and I don't understand it. Most people don't ignore me, in general.

On this last rotation my classmate did ALOT of one intern's work for him, and she was just adored. I think in the end most people respect me, but I am not popular in the same was as my classmate and I see myself losing out on some opportunities to learn. Very frustrating trying to learn medicine this way ...

Am I supposed to be doing the intern's work for them in order to learn or be treated with interest?

---

Members don't see this ad.

 

[Dr. V]

A couple of observations from an intern here.

I too have been guilty of forgetting I even had a med student on the rotation, we come to work every day, med students get breaks etc and we have periods with no med students and sometimes it's easy to forget you have them unless they make a point to hang around etc. The quieter/more timid you are the easier it is to forget you're around (that could be a good thing because the opposite end of the spectrum makes us wish they were NOT around sometimes LOL). Bottom line is residency is very, very busy and it is real easy to get caught up in doing the job to the oblivion of everything else.

As far as "doing the work for the intern" well if you chose to look at it that way that's your choice. However, HELPING the intern with their work gives you practice for when in just a few short months YOU will be the intern. Believe me the more you have done as a student the easier transition you have to intern year. Things like dictation, tucking patients in, making sure a patient is preoped properly etc take practice to get right fluidly on the first attempt (remember doing something in 5 minutes and having to do it twice because you forgot something is ultimately slower than doing it correctly in 7 minutes the first time).

On that same note, you slow the intern down in getting his or her work done. Don't take offense to that, that's just the way it is. Students slow down the interns, interns slow down the Sr.'s, we all slow down the attendings. Don't think for a minute that the Attending couldn't get his or her work done quicker without having to teach the residents, just the same as the residents can get thier work done quicker without having to teach the med students.

That said, I feel it is our duty to teach, we were just in your shoes a couple of months ago. But, if you can actually help the intern it can give him more time to do what YOU need him to do, teach.

So don't think of it as "doing the interns work" think of it as freeing up some time for the intern so he can do something for you, teach, allow you to take the extra time for the procedure etc.

 

[Mumpu]

To rule out a common and obvious cause of being ignored, what do you do when you are not actively rounding with your team? Are you in some computer lab, library, or call room? There are places where the residents hang out when they are not busy (nurses' stations, MD work areas, etc.) If you are not physically around, you are likely to be ignored. If some random interesting teaching tidbit comes up, I usually will not run around and look for my students because it's too much work -- instead I'll teach the ones in my line of sight. If you are going to sit and read a book or surf teh internets, sit and read in the work area instead of the call room or the library. (And yes, I pretty much tell the above to my students from the start).

 

[Tired]

To rule out a common and obvious cause of being ignored, what do you do when you are not actively rounding with your team? Are you in some computer lab, library, or call room? There are places where the residents hang out when they are not busy (nurses' stations, MD work areas, etc.) If you are not physically around, you are likely to be ignored.

Bingo! If I had a dollar for every time one of my idiot classmates said something like, "They put in a central line on a crashing patient, and they didn't even bother to page me!!!"

Face time is exactly that. Put in the effort to be around, and you're less likely to get ignored.

 

[Paws]

Why do you assume I am away in the library? I am sitting right there in the team room, or walking right behind everyone. I am not out of sight, nor am I playing around on the computer.

I don't think it's an issue of not putting in face time. Thanks Dr. V, I think your comment is the most accurate. People are busy and I don't take it personally. Usually I end up working with a quiet, but hardworking resident or intern and so that is ok with me. It's an interesting economy, where you have little value when you know nothing, and so people are less willing to spend time teaching you. But when you do finally figure things out on your own and you know alot, then suddenly your value goes way up and then people want to spend time teaching you. Kind of nuts really ...

 

[Mumpu]

I didn't say you were hiding away, I said I wanted to rule out the most common/obvious reason. Part of the issue will always be the residency structure. If the interns and residents are overworked, they simply will not have time to teach you. However, it is a part of their job. If people don't volunteer, you need to be asking to go over your patient presentations before rounds, etc. Since I'm easily irritated by long presentations, I have a strong motivation to teach my students to make 'em short and sweet, but obviously a lot of people are happy to lean against the wall and space out for 30 minutes at a time.

 

[Tired]

Why do you assume I am away in the library? I am sitting right there in the team room, or walking right behind everyone. I am not out of sight, nor am I playing around on the computer.

Oh, I wasn't referring to you personally. I was just venting about a common problem I saw in my peers last year. Nothing directed at you about my post.

 

[Paws]

No worries Tired, I am just really frustrated that this is how my education dollars are being spent. I would like to be the student who is shining in her presentations, is able to do the interns' work for them, who never makes a mistake and whom the attendings love to teach, etc. Instead, I seem to be the slow and steady one, well liked by staff and patients but not given much attention by residents or interns.

I am worried that I am missing out on alot of important things I will need to know for internship. Unless, it's all learnable in the first few weeks on service, trial by fire-style. Plus, I see some classmates who kiss *** and seem to get stellar evals from their residents. I find that really disheartening.

I am trying to be more assertive and asking for more attention, feedback, etc but it is hard.

 

[fang]

Personally, I like pimping. At my school in general people ask you useful questions, and it's much more practical than sitting in a room in a boring lecture because the answers to the questions have implications for a patient's care.

Panda/toofache and others, I think you and I have vastly different views of medical education. I think it DOES require moral strength, and it's not "just a job" that can be plowed through like some complicated tax return. Education is something you need to participate in, and that means doing more than the bare minumum. Even though it's not your choice, don't pick on people who have chosen to put some extra effort, or people who encourage that effort (by pimping, asking student to stick around for other learning opportunities, etc.).

 

[8744]

Personally, I like pimping. At my school in general people ask you useful questions, and it's much more practical than sitting in a room in a boring lecture because the answers to the questions have implications for a patient's care.

Panda/toofache and others, I think you and I have vastly different views of medical education. I think it DOES require moral strength, and it's not "just a job" that can be plowed through like some complicated tax return. Education is something you need to participate in, and that means doing more than the bare minumum. Even though it's not your choice, don't pick on people who have chosen to put some extra effort, or people who encourage that effort (by pimping, asking student to stick around for other learning opportunities, etc.).

I agree with you completely. However, tolerating abuse which is the result of somebody's bad manners, poor upbringing, or lack of social skills has nothing to do with morality.

When I say that medicine is a job, I'm not denigrating it at all. I'm a working man and take my job seriously. I recoil at the idea, however, that medicine is some kind of cult in which members may be hazed and abused (sleep deprived, for example) with impunity.

 

[AFS]

Hi all,

I am happy to say that I was never overtly discourteous or disrespectful when I was interacting personally with medical students for my entire five years of residency. However, it would get kinda hard at times when things were very busy and my interns were neck deep in chaos; having to hear "can you read and sign my note, please, it's in the chart" over and over again would sorta make my skin crawl after awhile... so I unfortunately would have to at times walk up to the chart rack, remove the medical student's note (when they weren't around) and score two points in the wastebasket. After all, the chart is a legal document and what if in haste I missed the S3 murmur documented in the student's note when they was none.

Thanks guys, I needed to get all this off my chest- I feel much better now.

 

[8744]

Hi all,

I am happy to say that I was never overtly discourteous or disrespectful when I was interacting personally with medical students for my entire five years of residency. However, it would get kinda hard at times when things were very busy and my interns were neck deep in chaos; having to hear "can you read and sign my note, please, it's in the chart" over and over again would sorta make my skin crawl after awhile... so I unfortunately would have to at times walk up to the chart rack, remove the medical student's note (when they weren't around) and score two points in the wastebasket. After all, the chart is a legal document and what if in haste I missed the S3 murmur documented in the student's note when they was none.

Thanks guys, I needed to get all this off my chest- I feel much better now.

Huh? All you have to do is write an addendum at the bottom: "Examined patient. No murmer heard. Otherwise agree with medical student note," and then sign that mother****er and your eager but unskilled medical student has saved you a a few minutes of writing the note yourself. I examine my patients myself but if the medical student's note covers it all I might just ammend the assesment and plan and count myself lucky that I have medical students helping out.

Seriously.

 

[AFS]

I understand what you're saying but unfortunately residents at my hospital are no longer allowed to sign off on the medical student's note as their own, so in addition to our notes we would have to read and sign their notes as well.

I am not justifying my behavior, just offering a clarification.

 

[Mumpu]

There are very few places where med student notes count anymore because Medicare will only pay for an attending addendum to an MD note.

 

[8744]

There are very few places where med student notes count anymore because Medicare will only pay for an attending addendum to an MD note.

You mean the billers go through every chart and look for the attendings note for every day? I thought the attendings just filled out their billing sheets every day and turned them in.

Oh what a crappy job it must be to be a medical biller.

 

[AFS]

I think the important question is whether or not you are willing to go to court and defend your medical student's note or not. Plaintiff's attorneys are more than happy to base an entire case on one line, or even one word, of a medical student's note. You sign it, you become responsible. Ready for that?

 

[8744]

I think the important question is whether or not you are willing to go to court and defend your medical student's note or not. Plaintiff's attorneys are more than happy to base an entire case on one line, or even one word, of a medical student's note. You sign it, you become responsible. Ready for that?

I don't just sign it, I review it and make an addendum at the bottom agreeing with or refuting any or all aspects of it.

I don't kow any attendings that write detailed progress notes after their interns or residents (or medical students) but I also don't know any who just co-sign the note and don't write an addendum either.

 

[Hurricane]

At my med school, the students were no longer allowed to put notes in the chart in the MICU because of some lawsuit where there was a discrepancy between the students' notes and the residents'. Some of the attendings would sit down with the students each day after rounds and go over the notes in detail, which was a much better learning experience than having the resident write "agree with above" without reading it. Made up for the fact that our notes went in the trash afterwards.

As an intern, I've been told that in order to be billable by the attending, our notes have to include 3 ROS items in the subjective, and vitals + five physical exam items in the objective, and the problem list, which is why we can't simply write "agree with above." (I tell my med students this so they don't think I'm ignoring their note.) And the attending note has to say "patient seen and examined with Dr X and I agree with her findings as outlined above."

Now that I'm on a consult service and I have to read charts for patients on the hospitalist services, it's amazing how much thinner their charts are when there's not three people writing notes on the patient every day.

 

[Mumpu]

The attendings fill out the billing cards, but they have to be supported by the appropriate documentation. AFAIK the attending note has to be linked to an MD note.

I hate this 3 ROS 5 exam crap. A lot of hospitals design H&Ps and progress notes around this which makes them totally worthless for actual medical care. At one of my sites, the progress note has five half-page-wide lines for assessment and the same number for plan. Most of the page is taken up by a very detailed breakdown of exam elements and vitals. The H&P ROS section is twice as long as the space allotted for A/P. Needless to say, I predominantly use generic case records rather than the special progress note forms so I can actually elaborate on A/P.

 

[f_w]

If you want to know what can happen if you don't check your 3rd years notes and don't document your own findings appropriately:

http://www.koskoff.com/index.cfm/hurl/SectionID=15/NewsID=75

(article from the Hartford Courant posted on an attoneys website)

 

[Hard24Get]

If you want to know what can happen if you don't check your 3rd years notes and don't document your own findings appropriately:

http://www.koskoff.com/index.cfm/hurl/SectionID=15/NewsID=75

(article from the Hartford Courant posted on an attoneys website)

Seems like they just needed to examine their pt. Weakness from a tumor compressing the spinal cord is a surgical emergency, no?

This co-signing stuff is another reason why e-charting rocks. I can write the notes, and my residents can review and sign them. Any relevant findings/etc should come up at rounds (or before if emergent), anyway. The attendings have to write their own notes but can import resident statements into their template to make their note more complete.

 

[f_w]

Seems like they just needed to examine their pt. Weakness from a tumor compressing the spinal cord is a surgical emergency, no?

Not necessarily if there are no neurologic deficits. The contention of the defendants (neurosurgery attending and residents) was that they DID examine the patient several times throughout the day and that NO neurologic deficit was present. Unfortunately, they neglected to document their disagreement with the M3s assessment and on paper it looked like the only person who had seen the patient was the M3.

 

[EctopicFetus]

Not necessarily if there are no neurologic deficits. The contention of the defendants (neurosurgery attending and residents) was that they DID examine the patient several times throughout the day and that NO neurologic deficit was present. Unfortunately, they neglected to document their disagreement with the M3s assessment and on paper it looked like the only person who had seen the patient was the M3.

You know if its not documented.. it didnt happen.. ouch..

 

[Sebastian.]

5. If you pimp me I will probably answer correctly and pimp you back.

If that's the case then I'm sure you're no stranger to the response "hmm, that's a very interesting question. Why don't you prepare a presentation on the topic for tomorrow".

Bottom line. Be respectful. You're a transient guest in someone else's permanant workplace.

 

[EctopicFetus]

If that's the case then I'm sure you're no stranger to the response "hmm, that's a very interesting question. Why don't you prepare a presentation on the topic for tomorrow".

Bottom line. Be respectful. You're a transient guest in someone else's permanant workplace.

Agreed.. turdish responses wont do you any favors. Your grade will suffer as will your LORs and you will get some serious backlash..

 

[da8s0859q]

Agreed.. turdish responses wont do you any favors. Your grade will suffer as will your LORs and you will get some serious backlash..

Not an MS yet, but amen to this. I think that applies in many fields.