(Serious) Why do 4th year students need supervision but midlevels don't?

[Melchizedek]

You need to hop off your high horse and get a reality check if you think that a med student with two years of didactic is the same as an NP who has two years clinical experience as an RN, two years of didactic in pharm, advanced physiology, and clinical assessment, and then additional clinical training as an NP. Or a PA who has finished 4 years of didactic and clinical training.

You need supervision because you have no idea what you're doing. The NP's/PA's ALREADY had supervision in their training periods, have passed licensing exams and proved themselves competent. You have not.

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[lemurcatta]

An m3 is definitely more knowledgeable than most pas even with experience.

You don't need much to become an np, you can sign up online and be working when you're in your early 20s with zero bedside nursing experience.

That's not what bladder training is.

A fairly ridiculous assertion. But I have seen your posts around this and other topics and it is a general theme.

 

[MedicineZ0Z]

You need to hop off your high horse and get a reality check if you think that a med student with two years of didactic is the same as an NP who has two years clinical experience as an RN, two years of didactic in pharm, advanced physiology, and clinical assessment, and then additional clinical training as an NP. Or a PA who has finished 4 years of didactic and clinical training.

You need supervision because you have no idea what you're doing. The NP's/PA's ALREADY had supervision in their training periods, have passed licensing exams and proved themselves competent. You have not.

lol what? Didactics as an NP is like 1% of a med students didactics. Your "clinical training" is on par with 2 med school rotations at the best. Yet magically these people are more competent and ready to go.

Anyone who knows what the NP curriculum is would instantly agree.

Also you're a premed --> 0 insight into either of these situations.

 

[UnoMas]

A fairly ridiculous assertion. But I have seen your posts around this and other topics and it is a general theme.

See I am at the tail end of my 3rd year right now and just started prepping for Step 2 CK, if you were to take me and a fresh NP grad and make us sit for Step 2 tomorrow and I have to bet on it, I am going to bet my left nut that I am going to outscore that NP or PA. I sound like an arrogant dingus but I have seen them on the wards and it's really no comparison

 

[niko327]

An m3 is definitely more knowledgeable than most pas even with experience.

A 3rd year is infinitely more knowledgeable in all the things that matter so very little in actual patient care. A 3rd year or 4th year medical student is not more knowledgeable or capable than an experienced PA at the bedside (say a guy with 7 or 8 years in the business). No way, no how. You don't have the experience or the intuition to know what a sick patient is yet, let alone know where to start in caring for them consistently, A 3rd/4th year Med student does not have the experience to looking for pitfalls in management or know how to avoid any number of a million little mistakes that will seriously screw things up. All of these things are learned through experience and they are things that the vast majority of medical students don't even know about yet. It will take a couple of years of practice to figure out the nuts and bolts of what you are doing on the wards. Take it easy guys, no one is looking to minimize what you are going to bring to the bedside. Don't let hubris run away with you. You'll have plenty of time to swing it around soon enough.

 

[UnoMas]

You need to hop off your high horse and get a reality check if you think that a med student with two years of didactic is the same as an NP who has two years clinical experience as an RN, two years of didactic in pharm, advanced physiology, and clinical assessment, and then additional clinical training as an NP. Or a PA who has finished 4 years of didactic and clinical training.

You need supervision because you have no idea what you're doing. The NP's/PA's ALREADY had supervision in their training periods, have passed licensing exams and proved themselves competent. You have not.

I dont know what you are smoking but please for the love of god look up their training curriculum. I posted PA clinical training on the previous page, it's barely q equivalent to a 3rd year curriculum. Unless somehow, they were allowed to function as an intern or a resident during these rotations, I don't see how their "clinical didactic" is more valuable than mine, except that I have to take 6 national shelf exams during 3rd year on top of some random in-house exams that I have to sit for. You don't know what you are talking about please stop

 

[Melchizedek]

lol what? Didactics as an NP is like 1% of a med students didactics. Your "clinical training" is on par with 2 med school rotations at the best. Yet magically these people are more competent and ready to go.

Anyone who knows what the NP curriculum is would instantly agree.

Also you're a premed --> 0 insight into either of these situations.

I'm also a ICU/EM nurse, taking actual first year med school classes, and surrounded by med students.
Your entire mind-set of "I'm a med student and I'm better than everyone" is your biggest problem. Check your ego.

 

[niko327]

You need to hop off your high horse and get a reality check if you think that a med student with two years of didactic is the same as an NP who has two years clinical experience as an RN, two years of didactic in pharm, advanced physiology, and clinical assessment, and then additional clinical training as an NP. Or a PA who has finished 4 years of didactic and clinical training.

You need supervision because you have no idea what you're doing. The NP's/PA's ALREADY had supervision in their training periods, have passed licensing exams and proved themselves competent. You have not.

No. Not quite. You are being supervised very carefully for the first 2 or 3 years after you graduate as a PA. Our senior PAs and physicians provide this supervision. Nothing we did in PA school prepares us to be autonomous from Day 1. We all go through this learning period when we first graduate. We are only autonomous in the hypothetical sense.

 

[Melchizedek]

but hell, if your ego won't listen to me, then lets ask some physicians shall we?

Hey @Mad Jack @dpmd @DocEspana how do y'all feel about MS3's being supervised being compared to a mid level not being supervised?

 

[niko327]

I'm also a ICU/EM nurse, taking actual first year med school classes, and surrounded by med students.
Your entire mind-set of "I'm a med student and I'm better than everyone" is your biggest problem. Check your ego.

There is a lot of ego crap going on with this thread, I totally agree with you there!

 

[Redpancreas]

This thread needs to die. It’s rife with miscommunication and is just pissing off both sides.


Statement: M3s know more than PAs/NPs.

Where it’s true: In terms of mechanisms of disease, presentations, and depth yes the MD student wins hands down.

Where it’s false: A lot of knowledge the medical students count is not stuff nurses respect or are wary of because it’s not really useful to everyday practice. Midlevels on the other hand are more versed with a better fund of practical knowledge so they can do something to help.

All this finger pointing and examples of some ditzy nurse who can’t divide 8 by 3 serves to do is antagonize midlevels and they’ll criticize us for being clueless about practical stuff like lines, tubes, med administration, etc. which is understandable for students to not know based on what we focus on now and then they say we have god complex. I will say though to any non-MD students who are NPs/PAs who think you are or ever will be equivalent to a physician, you are not even close and you never will be but it does not seem like anyone on here is saying that.

@MedicineZ0Z , you need to stop fanning the flames here. I get that you’re nearing the end of your M3 year and are frustrated because you’ve been treated like garbage by everyone from surgical/OB attending/resident physicians to floor nurses who think you’re dumb. I get that you’re also frustrated that physicians are selling out by giving PAs/NPs increased autonomy to increase efficiency/$$$ because they don’t care about investing resources in teaching a medical student. The solution though is not to point the finger at midlevels even if it’s true that there are very pathetic standards at some programs. You can only control what’s in your sphere of influence and here there are only MD/DO students. Something more productive to talk about is how M3 medical students refuse to even help each other unless they can be in earshot of those grading them.

 

[DocEspana]

but hell, if your ego won't listen to me, then lets ask some physicians shall we?

Hey @Mad Jack @dpmd @DocEspana how do y'all feel about MS3's being supervised being compared to a mid level not being supervised?

I have my issues with NPs and PAs practicing wholly independently - its inefficient but i should be around because the times when they ask me questions are timed when lives are saved.

But good lord, PAs and NPs (in the ER) are doing it 95% on their own and doing damn good. They just have to know when to ask for help and be humble enough to do so.

Ms3's? Oh lord. Theyre like little cats i have to nurture to health. Yeah, sure, youre good at preclinical stuff. Hell you're probably better at biochemistry than i am. But you're functionally ******ed at patient care. I have two years to make you "sort of bad" at patient care and your residency has another 3+ to make you good at it.

 

[Oso]

See I am at the tail end of my 3rd year right now and just started prepping for Step 2 CK, if you were to take me and a fresh NP grad and make us sit for Step 2 tomorrow and I have to bet on it, I am going to bet my left nut that I am going to outscore that NP or PA. I sound like an arrogant dingus but I have seen them on the wards and it's really no comparison

I just don't get all this business with comparing our knowledge base with NP's and PA's. They're separate jobs dude. Like, why are you talking about outscoring them on some test?

And I kinda get it now, end of M3 year, prepping for CK, feel like all the knowledge is falling into place and finally feeling like a doctor kinda. I get it. No doubt you've learned a ton of **** over the past year - no one is denying that. But just wait until you do your Sub-I during 4th year and realize you're pretty useless and have to ask the residents a hundred questions about how to complete the most seemingly simple tasks -- then you will realize how little practical knowledge we actually have.

 

[Melchizedek]

This thread needs to die. It’s rife with miscommunication and is just pissing off both sides.


Statement: M3s know more than PAs/NPs.

Where it’s true: In terms of mechanisms of disease, presentations, and depth yes the MD student wins hands down.

Where it’s false: A lot of knowledge the medical students count is not stuff nurses respect or are wary of because it’s not really useful to everyday practice. Midlevels on the other hand are more versed with a better fund of practical knowledge so they can do something to help.

All this finger pointing and examples of some ditzy nurse who can’t divide 8 by 3 serves to do is antagonize midlevels and they’ll criticize us for being clueless about practical stuff like lines, tubes, med administration, etc. which is understandable based on what we focus on now and say we have god complex. I will say though to any non-MD students who are NPs/PAs who think you are or ever will be equivalent to a physician, you are not even close and you never will be but it does not seem like anyone on here is saying that.

This I agree with, and am not disputing. There is a marked difference between mid-levels and full-fledged MD's. But what this thread seems to want to do is drag down mid-levels to below the level of med students which is downright ridiculous.

Johari's Window. You don't know what you don't know. Med student agreeing with OP's thought process will look back 5 years from now when they understand that book learning does not equate to patient care, and realize how wrong their thinking is.

 

[Redpancreas]

This I agree with, and am not disputing. There is a marked difference between mid-levels and full-fledged MD's. But what this thread seems to want to do is drag down mid-levels to below the level of med students which is downright ridiculous.

Johari's Window. You don't know what you don't know. Med student agreeing with OP's thought process will look back 5 years from now when they understand that book learning does not equate to patient care, and realize how wrong their thinking is.

I completely agree with everything you’re saying. It’s become an obnoxious thread. I don’t want to point the sole blame at OP because he has every right to be frustrated. We as student doctors can’t just have this generic negative view of mid levels. Some good points in the thread were made like the lack in quality of some NP programs and that needs to be addressed but that’s not the central issue to why we are doing glorified shadowing.

 

[MedicineZ0Z]

A 3rd year is infinitely more knowledgeable in all the things that matter so very little in actual patient care. A 3rd year or 4th year medical student is not more knowledgeable or capable than an experienced PA at the bedside (say a guy with 7 or 8 years in the business). No way, no how. You don't have the experience or the intuition to know what a sick patient is yet, let alone know where to start in caring for them consistently, A 3rd/4th year Med student does not have the experience to looking for pitfalls in management or know how to avoid any number of a million little mistakes that will seriously screw things up. All of these things are learned through experience and they are things that the vast majority of medical students don't even know about yet. It will take a couple of years of practice to figure out the nuts and bolts of what you are doing on the wards. Take it easy guys, no one is looking to minimize what you are going to bring to the bedside. Don't let hubris run away with you. You'll have plenty of time to swing it around soon enough.

Correct, but I'm comparing to a new PA.

I dont know what you are smoking but please for the love of god look up their training curriculum. I posted PA clinical training on the previous page, it's barely q equivalent to a 3rd year curriculum. Unless somehow, they were allowed to function as an intern or a resident during these rotations, I don't see how their "clinical didactic" is more valuable than mine, except that I have to take 6 national shelf exams during 3rd year on top of some random in-house exams that I have to sit for. You don't know what you are talking about please stop

Huh? I know exactly what the PA and NP curriculum is. I've rotated alongside both of their students too and seen both fresh and experienced midlevels in action.

Would I trust an experienced midlevel to handle basics better than a med student? Absolutely.
Would I trust a fresh midlevel? No, wouldn't trust the student either.

Most of the PA clinicals consists of doing what med students do, only less. Not to mention you're coming in with a far smaller knowledge base due to the shorter and less intensive preclinical didactic time.
Anyway PAs function under supervision... NPs do not and that's where the focus is.

I have my issues with NPs and PAs practicing wholly independently - its inefficient but i should be around because the times when they ask me questions are timed when lives are saved.

But good lord, PAs and NPs (in the ER) are doing it 95% on their own and doing damn good. They just have to know when to ask for help and be humble enough to do so.

Ms3's? Oh lord. Theyre like little cats i have to nurture to health. Yeah, sure, youre good at preclinical stuff. Hell you're probably better at biochemistry than i am. But you're functionally ******ed at patient care. I have two years to make you "sort of bad" at patient care and your residency has another 3+ to make you good at it.

Exhibit A: Classic doctor who allows midlevels to slowly turn physicians into midlevel supervisors.

I just don't get all this business with comparing our knowledge base with NP's and PA's. They're separate jobs dude. Like, why are you talking about outscoring them on some test?

And I kinda get it now, end of M3 year, prepping for CK, feel like all the knowledge is falling into place and finally feeling like a doctor kinda. I get it. No doubt you've learned a ton of **** over the past year - no one is denying that. But just wait until you do your Sub-I during 4th year and realize you're pretty useless and have to ask the residents a hundred questions about how to complete the most seemingly simple tasks -- then you will realize how little practical knowledge we actually have.

How's it a separate job when a fresh graduate NP is seeing patients with zero supervision and doing full comprehensive primary care?? This has been repeated like 50x this thread.

 

[UnoMas]

I just don't get all this business with comparing our knowledge base with NP's and PA's. They're separate jobs dude. Like, why are you talking about outscoring them on some test?

And I kinda get it now, end of M3 year, prepping for CK, feel like all the knowledge is falling into place and finally feeling like a doctor kinda. I get it. No doubt you've learned a ton of **** over the past year - no one is denying that. But just wait until you do your Sub-I during 4th year and realize you're pretty useless and have to ask the residents a hundred questions about how to complete the most seemingly simple tasks -- then you will realize how little practical knowledge we actually have.

I was just simply trying to prove that a newly minted 4th year has a much broader and deeper medical knowledge base than any fresh grad NP or PA. Obviously an experienced NP or PA knows the floor stuff better than I do, no argument there. But make no mistake that after a 3-4 months of subI/ICU, I think I can hold my own when it comes to floor stuff.

And why are we not even allowed to compare knowledge base between medical students and NP/PA? Their national organization is working in full-force trying to prove they are just as good or even better than a fully-trained physician; but that is a whole other discussion.This forum is for discussion of ideas and the OP brought up a valid one, I have always been wondering myself seeing the fresh faced PA who graduated 2 months ago running around seeing Cardio, Pulm consults writing notes and putting in orders.

 

[MedicineZ0Z]

I was just simply trying to prove that a newly minted 4th year has a much broader and deeper medical knowledge base than any fresh grad NP or PA. Obviously an experienced NP or PA knows the floor stuff better than I do, no argument there. But make no mistake that after a 3-4 months of subI/ICU, I think I can hold my own when it comes to floor stuff.

And why are we not even allowed to compare knowledge base between medical students and NP/PA? Their national organization is working in full-force trying to prove they are just as good or even better than a fully-trained physicians. This forum is for discussion of ideas and the OP brought up a valid one, I have always been wondering myself seeing the fresh faced PA who graduated 2 months ago running around seeing Cardio, Pulm consults writing notes and putting in orders.

Because we need to be politically correct and be "collaborative." Continue getting bent over until you're a medical manager of 6 midlevels (ex. the anesthesia group who got pushed out of the Cali hospital in favor of more CRNAs).

Problem starts with attendings who belittle students and favor midlevels and down to students who defend them too. Although I've seen many attendings do the opposite nowadays.

If an NP/PA says they're as good as a doctor, they get an applause. Other way around? Everyone's suddenly pissed.

 

[UnoMas]

Because we need to be politically correct and be "collaborative." Continue getting bent over until you're a medical manager of 6 midlevels (ex. the anesthesia group who got pushed out of the Cali hospital in favor of more CRNAs).

Problem starts with attendings who belittle students and favor midlevels and down to students who defend them too. Although I've seen many attendings do the opposite nowadays.

**** that ****. I am going into Anesthesiology and you bet your sweet ass I will be at the forefront of fighting midlevels
And Yes, on more than 1 occasion, I do feel that Medicine tends to eat their youngs

 

[Redpancreas]

Because we need to be politically correct and be "collaborative." Continue getting bent over until you're a medical manager of 6 midlevels (ex. the anesthesia group who got pushed out of the Cali hospital in favor of more CRNAs).

Problem starts with attendings who belittle students and favor midlevels and down to students who defend them too. Although I've seen many attendings do the opposite nowadays.

If an NP/PA says they're as good as a doctor, they get an applause. Other way around? Everyone's suddenly pissed.

Checked OPs history. Seems like he’s applying either Gas or EM. Anti-mid level sentiment checks out.

 

[UnoMas]

Checked OPs history. Seems like he’s applying either Gas or EM. Anti-mid level sentiment checks out.

It's Gas and EM for NOW, stay woke my friend

"
First they came for the Socialists, and I did not speak out—
Because I was not a Socialist.

Then they came for the Trade Unionists, and I did not speak out—
Because I was not a Trade Unionist.

Then they came for the Jews, and I did not speak out—
Because I was not a Jew.

Then they came for me—and there was no one left to speak for me."

A little dramatic but fitting hehe

 

[DocEspana]

Correct, but I'm comparing to a new PA.


Huh? I know exactly what the PA and NP curriculum is. I've rotated alongside both of their students too and seen both fresh and experienced midlevels in action.

Would I trust an experienced midlevel to handle basics better than a med student? Absolutely.
Would I trust a fresh midlevel? No, wouldn't trust the student either.

Most of the PA clinicals consists of doing what med students do, only less. Not to mention you're coming in with a far smaller knowledge base due to the shorter and less intensive preclinical didactic time.
Anyway PAs function under supervision... NPs do not and that's where the focus is.

Exhibit A: Classic doctor who allows midlevels to slowly turn physicians into midlevel supervisors.

How's it a separate job when a fresh graduate NP is seeing patients with zero supervision and doing full comprehensive primary care?? This has been repeated like 50x this thread.

You may wish to know my qualifications. I was a prior lobbyist (had a fancier name, but lets call it what it is) for the AMA. If there is a person more against inappropriate practice by midlevels - i haven't met them. I got the job because i was so good at towing the pro-doctor line. But there is totally appropriate practice environments too.

 

[MedicineZ0Z]

You may wish to know my qualifications. I was a prior lobbyist (had a fancier name, but lets call it what it is) for the AMA. If there is a person more against inappropriate practice by midlevels - i haven't met them. I got the job because i was so good at towing the pro-doctor line. But there is totally appropriate practice environments too.

It's totally pro-doctor to push med students down? This whole "team approach" buzz phrase is all nice when it comes to midlevels but not so nice when it comes to our profession huh.

 

[Redpancreas]

It's totally pro-doctor to push med students down? This whole "team approach" buzz phrase is all nice when it comes to midlevels but not so nice when it comes to our profession huh.

Do you really need to be provocative to get answers?

 

[niko327]

But make no mistake that after a 3-4 months of subI/ICU, I think I can hold my own when it comes to floor stuff.

What!!!!

I have always been wondering myself seeing the fresh faced PA who graduated 2 months ago running around seeing Cardio, Pulm consults writing notes and putting in orders.

What you don't understand is that, that fresh faced PA is not just writing what they've been instructed to write, but also probably using the font, line spacing and preferred punctuation, their supervising attending told them to use. Honestly, truly and sincerely, this new mid-level cowboy stuff is all in your head.

 

[UnoMas]

What!!!!



What you don't understand is that, that fresh faced PA is not just writing what they've been instructed to write, but also probably using the font, line spacing and preferred punctuation, their supervising attending told them to use. Honestly, truly and sincerely, this new mid-level cowboy stuff is all in your head.

Yeah except that I have seen it first hand and my IM attending wasnt too happy having a 23 yo PA saw her patients putting in a medical student level SOAP note. Where do you think I came up with these notions? Imagination?

 

[DocEspana]

It's totally pro-doctor to push med students down? This whole "team approach" buzz phrase is all nice when it comes to midlevels but not so nice when it comes to our profession huh.

Med students dont know their ass from their elbow about clinical practice. Its just flat amusing to ask them simple clinical questions and watch them not have any clue despite having tons of basic science knowledge.

But... its my job to make them good. Its just a multi year process. Us doctors arent allowed to be wrong. So you need to be ready to be 100% right and thats the bar you're held to. A PA or NP needs to be pretty darn good, but really they need to be 100% aware of when they dont know the answer. Its a different goal. I have pA and med students. My PA students are trained to identify the normal and abnormal. To know when the pattern doesnt fit and to ask for help. My med students are trained to just always know the answer. There is no help. There is "figure it out".

 

[Psai]

What!!!!



What you don't understand is that, that fresh faced PA is not just writing what they've been instructed to write, but also probably using the font, line spacing and preferred punctuation, their supervising attending told them to use. Honestly, truly and sincerely, this new mid-level cowboy stuff is all in your head.

Not true.

Gail Ingram NP (@NurseGAILINGRAM) | Twitter

Barely out of NP school, running a cash only concierge solo practice in New York. She had business cards made that stated that nurse practioners are the new primary care doctors except better than MDs.

 

[MedicineZ0Z]

Med students dont know their ass from their elbow about clinical practice. Its just flat amusing to ask them simple clinical questions and watch them not have any clue despite having tons of basic science knowledge.

But... its my job to make them good. Its just a multi year process. Us doctors arent allowed to be wrong. So you need to be ready to be 100% right and thats the bar you're held to. A PA or NP needs to be pretty darn good, but really they need to be 100% aware of when they dont know the answer. Its a different goal. I have pA and med students. My PA students are trained to identify the normal and abnormal. To know when the pattern doesnt fit and to ask for help. My med students are trained to just always know the answer. There is no help. There is "figure it out".

When you hand NPs an independent license, they don't need to ask for help.

 

[MedicineZ0Z]

Not true.

Gail Ingram NP (@NurseGAILINGRAM) | Twitter

Barely out of NP school, running a cash only concierge solo practice in New York. She had business cards made that stated that nurse practioners are the new primary care doctors except better than MDs.

Ah yes Gail Ingram... thread on this a week ago and ZdogMd posted about this on his Facebook too. You'd be surprised at how many NPs secretly agree with her.

Her reviews also have patients calling her "physician" which leads me to believe she is misrepresenting herself too. There's always the odd review (that she didn't do herself lol) which says she's clinically clueless.

 

[UnoMas]

I don't know what is more concerning, people like Gail Ingram or medical students defending them

 

[niko327]

Yeah except that I have seen it first hand and my IM attending wasnt too happy having a 23 yo PA saw her patients putting in a medical student level SOAP note. Where do you think I came up with these notions? Imagination?

OK I got you. It's actually really good that you saw this, but the story doesn't typically end there. What typically happens after a situation like that is your IM attending will no doubt have a quick hallway chat with the attending consultant at some point. In a few weeks time one of 2 things will typically happen: 1. the PA will be taking time off to spend more time with his family or 2. the consult notes suddenly become quite uniform. I'm not naïve enough to believe that mistakes and poor consults never happen, I've seen some real turkeys too. But as you start to work in the hospital year after year, you'll see what I mean with respect to things falling in line.

The reason I think its good that you got to experience this is because you will have some of your consults kicked back to you in a similar fashion. Its nothing personal against you, of course, but you will start to adapt to the culture of the respective service you are rotating through that month.

 

[Redpancreas]

I don't know what is more concerning, people like Gail Ingram or medical students feeling the need to trash midlevels

FTFY.

 

[UnoMas]

FTFY.

LOL who is trashing midlevels? I think so far in this thread I have been quite respectful and matter of fact. I even openly discuss this with the PA/NP students I have met, they agreed too but it's just the way it works and they are not going to turn down an 90k job offer next year and seek extra training.

 

[niko327]

Not true.

Gail Ingram NP (@NurseGAILINGRAM) | Twitter

Barely out of NP school, running a cash only concierge solo practice in New York. She had business cards made that stated that nurse practioners are the new primary care doctors except better than MDs.

I am talking about PAs. Again: PA. PA, PA, PA. PA is NOT NP. Sorry if I wasn't clearer about that. I can not speak for NPs because I'd be talking out of my @ss since I am not an NP. I will leave any arguments/defense for NPs turned Med students/Docs. I will say to just keep in mind that outliers exist everywhere. An N of 1 or even 100 can not and should not indict an entire profession where N= many thousands. I will leave it at that for NPs.

 

[niko327]

I don't know what is more concerning, people like Gail Ingram or medical students defending them

You talking to me about that bro?

 

[UnoMas]

You talking to me about that bro?

Come at me bro!

 

[DocEspana]

When you hand NPs an independent license, they don't need to ask for help.

There is a huge jump from NPs and PAs practicing semi-autonomously (with dr oversight and always a room away) and independently.

Again - no ome is more against indepdnent practice than me. Youre barking up the wrong tree.

But med students? They should have someone literally over their shoulder if doing more than an h&p. Just the way it is. Direct 1:1 guidance is a part of getting to that competency they need to achieve

 

[jw3600]

This thread. Wow. I really am not going to add anything to the endless mid level debate.

I will say I find rntomd87’s attitude about...well everything absolutely disgusting. I’m starting residency in 3 months and working with nurses like that is legitimately my biggest fear.

 

[Mad Jack]

but hell, if your ego won't listen to me, then lets ask some physicians shall we?

Hey @Mad Jack @dpmd @DocEspana how do y'all feel about MS3's being supervised being compared to a mid level not being supervised?

As a MS4 near the end of my training, I can assure you I require supervision and I would be fearful of not having it. PAs and NPs theoretically are trained to recognize when they should consult out due to lack of experience, thus even when unsupervised they should reach out for assistance when needed. Physicians are trained to be experts in their given fields, where the buck stops within their given wheelhouse. Medical students have no wheelhouse and thus no purpose or training with which to act independently.

 

[niko327]

Come at me bro!

lol, yeah I just wanted to know if you were addressing me brah. Wait until that VTEC kick in brah.

 

[dpmd]

I only have experience with midlevels who work with physicians. I haven't dealt with any new grads in a clinical setting but I would anticipate their supervisimg physician would provide similar graded autonomy to that provided in residency and if they fail to do so that is on their license. I don't think complete autonomy is appropriate for any midlevel but an experience midlevel can provide good care for appropriately selected patients when they recognize their limitations. as for trying to compare them to physicians in training or medical students, there is no set direct comparison to be made as they are different roles. A medical student may be way more knowledgeable than me about book stuff but they are completely useless in the OR until I teach them. Guess which one of us is better qualified to do the job?

 

[RNtoMD87]

C'mon man, this reads like something straight out of /r/Iamverybadass.

None of the attendings are intimidated by your physique, big guy.

I notice that there's a clear difference in the way they talk to myself and my female colleagues, especially the female residents which seem to be more numerous than the males. Generally the males seem more easy going altogether. But the female residents are really.. short and catty with the female RNs, and sweet and totally different with me. I've seen it. Also, patients just do what I ask them. I always took it for granted but now a lot of my female coworkers ask me to try to convince their patients to take meds, agree to treatments, etc. just what I've seen. It was like that when I subbed for my ex who was a first grade school teacher also. The kids listened to me much better than they did her. Not saying I'm a badass, but people react differently to a large man than they do a small female.

 

[RNtoMD87]

I'm not saying intimidated. More of some sort of respect. And it may have more to do with male vs female but I didn't want to just come out and say that.

But I've realized my female coworkers don't work the same job I do. I coast through as a nurse as far as doctors and patients pretty much being easy going- not like that for them at all.

 

[jw3600]

.

 

[W19]

You need to hop off your high horse and get a reality check if you think that a med student with two years of didactic is the same as an NP who has two years clinical experience as an RN, two years of didactic in pharm, advanced physiology, and clinical assessment, and then additional clinical training as an NP. Or a PA who has finished 4 years of didactic and clinical training.

You need supervision because you have no idea what you're doing. The NP's/PA's ALREADY had supervision in their training periods, have passed licensing exams and proved themselves competent. You have not.

Seriously! What do you think 3rd/4th year medical school is? Our clinical training is overall better than PA/NP's... You have no idea what you are talking about.

 

[W19]

A 3rd year is infinitely more knowledgeable in all the things that matter so very little in actual patient care. A 3rd year or 4th year medical student is not more knowledgeable or capable than an experienced PA at the bedside (say a guy with 7 or 8 years in the business). No way, no how. You don't have the experience or the intuition to know what a sick patient is yet, let alone know where to start in caring for them consistently, A 3rd/4th year Med student does not have the experience to looking for pitfalls in management or know how to avoid any number of a million little mistakes that will seriously screw things up. All of these things are learned through experience and they are things that the vast majority of medical students don't even know about yet. It will take a couple of years of practice to figure out the nuts and bolts of what you are doing on the wards. Take it easy guys, no one is looking to minimize what you are going to bring to the bedside. Don't let hubris run away with you. You'll have plenty of time to swing it around soon enough.

So PA magically learn these thing after 12 months of clinical training...

 

[W19]

No. Not quite. You are being supervised very carefully for the first 2 or 3 years after you graduate as a PA. Our senior PAs and physicians provide this supervision. Nothing we did in PA school prepares us to be autonomous from Day 1. We all go through this learning period when we first graduate. We are only autonomous in the hypothetical sense.

So someone who completed 4th year med school can not be supervised for the first 12-24 months just like PA...

 

[Melchizedek]

Seriously! What do you think 3rd/4th year medical school is? Our clinical training is overall better than PA/NP's... You have no idea what you are talking about.

Before you get riled up, try reading the thread/posts. We’re talking about med students BEFORE they finish 3rd/4th year

 

[W19]

I dont know what you are smoking but please for the love of god look up their training curriculum. I posted PA clinical training on the previous page, it's barely q equivalent to a 3rd year curriculum. Unless somehow, they were allowed to function as an intern or a resident during these rotations, I don't see how their "clinical didactic" is more valuable than mine, except that I have to take 6 national shelf exams during 3rd year on top of some random in-house exams that I have to sit for. You don't know what you are talking about please stop

I don't get it either why people think PA clinical training is better than med school when you can google them and see they are on par with our 3rd year curriculum... I just did a EM rotation and I was responsible to see 6+ patients in 7 hrs, write the notes, put in orders, come up with 3+ likely differentials etc... I rotated with PA in 3rd year and they did not ask them to do all these things...