Sub-i blues!

[PopeChaChaStix]

Hey all,

Looking for opinions about a preceptor's opinions!

I've been on this Sub-i for 2 weeks. At the end of week 2, I had a sit down with the CMO who is also the preceptor I spend the most time with. I had just given a short presentation.

Preceptor says:

Presentation was great. Really appreciates all the hard work I've been putting into my notes. That I'm very good at taking feedback and incorporating it right away. The staff all like me, I'm a team player.

BUT. She is a little concerned that I will be starting residency in 10 months. She blamed it on the covid online training I've had for most of the last 4 months as well as a "soft 3rd year experience" at a local hospital. Mostly, it seems she is worried about my plans for patient care.

And, let me be honest, as an early 4th year, I can ballpark a plan, but need to read guidelines to really fine tune it. Been seeing 6-8 patients and day, and often have not had the time to read up before I present. It is often just me and the preceptor, so I rarely have the ability to run my plan by residents first.

SO, finally, 2 questions:

Should I be worried about residency?? and: I'm planning to ask for a letter of rec anyway...does that seem reasonable?

Thanks world of SDN!

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[IMGASMD]

1. No
2. Yes

Your plans really aren’t plans. Sorry to break it to you.
6-8 patients for sub-I I think is a little high.

Most CMO are out of touch with daily management of patients.

Getting a letter from your sub-I preceptor is pretty standard. These letters usually won’t help, but can hurt. I hope someone from your school administration will give you some sort of indication whether to use it or not.

Good luck

 

[PopeChaChaStix]

1. No
2. Yes

Your plans really aren’t plans. Sorry to break it to you.
6-8 patients for sub-I I think is a little high.

Most CMO are out of touch with daily management of patients.

Getting a letter from your sub-I preceptor is pretty standard. These letters usually won’t help, but can hurt. I hope someone from your school administration will give you some sort of indication whether to use it or not.

Good luck

Appreciate it!

 

[Giovanotto]

youre seeing 6-8 patients a day, and are expected to have plans ironed out for all of them? As a medical student? Yeah, no. She sounds delusional.

 

[PopeChaChaStix]

youre seeing 6-8 patients a day, and are expected to have plans ironed out for all of them? As a medical student? Yeah, no. She sounds delusional.

This is what I was thinking....but the med student in me was afraid I had some how totally missed the point of 3rd and 4th year. I work with other preceptors and haven't had the issue, but most days I'm with this particular one. Yahoo! Anyway thanks!

 

[JibsGuy52]

Lmao. Interns usually see 4-6 patients at my hospital and don’t have plans perfectly ironed out. This is all practice. Don’t worry.

 

[MLNS]

Is this person a practicing physician? I ask because they sound so clueless that I’d be baffled if they were

Their only saving grace is if they have been out of the game for DECADES

This is the kind of attending (if they are still one) that you smile and nod and think to yourself, “ok jackass.”

 

[PopeChaChaStix]

Is this person a practicing physician? I ask because they sound so clueless that I’d be baffled if they were

Their only saving grace is if they have been out of the game for DECADES

This is the kind of attending (if they are still one) that you smile and nod and think to yourself, “ok jackass.”

So...yeah. They practice still. They're dual boarded and CMO. I see the patient's off their list. I don't know...super type A?

 

[Tangerine123]

youre seeing 6-8 patients a day, and are expected to have plans ironed out for all of them? As a medical student? Yeah, no. She sounds delusional.

Mmm is it? i'm an IMG so take this with a grain of salt I guess.

In my last year of med school (MS6) students managed 10-12 outpatient consults per day (mix between IM/Peds/Ob mostly) with little to no supervision. You had to Evaluate, Order and interpret labs/imaging, Diagnose, Treat and schedule Follow-ups. Every now and then we would get audited and had to detail a case and go over our management and approach in a meeting with the other students and staff.

When it got out of hand you had to refer the patient to a specialist, with a well documented description of the case, what you did, the labs, your plan etc. I remember referring an Antifosfolipid Syndrome, Ectopic Pregnancy and Tuberculosis among others. But I digress.

Thing is. You are a last year medical student. The only thing that separates you from an MD are legal obligations/responsabilities and a piece of carton with your name on it. Therapeutic plans don't have to be perfect, you aren't a specialist. But you must have an idea of what's happening, react accordingly and know when to consult/refer.

 

[Dr. Rafiki]

Mmm is it? i'm an IMG so take this with a grain of salt I guess.

In my last year of med school (MS6) students managed 10-12 outpatient consults per day (mix between IM/Peds/Ob mostly) with little to no supervision. You had to Evaluate, Order and interpret labs/imaging, Diagnose, Treat and schedule Follow-ups. Every now and then we would get audited and had to detail a case and go over our management and approach in a meeting with the other students and staff.

When it got out of hand you had to refer the patient to a specialist, with a well documented description of the case, what you did, the labs, your plan etc. I remember referring an Antifosfolipid Syndrome, Ectopic Pregnancy and Tuberculosis among others. But I digress.

Thing is. You are a last year medical student. The only thing that separates you from an MD are legal obligations/responsabilities and a piece of carton with your name on it. Therapeutic plans don't have to be perfect, you aren't a specialist. But you must have an idea of what's happening, react accordingly and know when to consult/refer.

1) this is ridiculous and would never (and and should never) fly in the US.

2) I'm pretty sure this person is talking about inpatient managment, not outpatient.

3) in your example, your plans SHOULD be perfect, since they're letting you practice medicine unsupervised and you might kill someone as a result.

 

[Tangerine123]

1) this is ridiculous and would never (and and should never) fly in the US.

2) I'm pretty sure this person is talking about inpatient managment, not outpatient.

3) in your example, your plans SHOULD be perfect, since they're letting you practice medicine unsupervised and you might kill someone as a result.

Ahahaha that's why I said you should take it with a grain of salt.

And if it's inpatient, then the intern should be able to follow the whole 20-ish admited patients in a Unit. When the 1st year residents had other resonsibilities to attend to then interns had to hand over the whole unit to the incoming shift team. Following 5 patients is at a clerkship (MS4) level. Interns (MS6) should know what's happening with all of them. You are the first year resident's right hand. Sometimes the resident won't be there and you have to call the shots.

 

[Dr. Rafiki]

Ahahaha that's why I said you should take it with a grain of salt.

And if it's inpatient, then the intern should be able to follow the whole 20-ish admited patients in a Unit. When the 1st year residents had other resonsibilities to attend to then interns had to hand over the whole unit to the incoming shift team. Following 5 patients is at a clerkship (MS4) level. Interns (MS6) should know what's happening with all of them. You are the first year resident's right hand. Sometimes the resident won't be there and you have to call the shots.

I don't think you are grasping how things work in the US. MS stands for medical STUDENT and they are not calling the shots, ever. Interns ARE the first year residents and are not MS anything, they are physicians. The post on which you are responding is about a sub-internship AKA clerkship for a medical student. Your assertions are absurd and should not be the standard in any country, let alone in the US.

 

[Tangerine123]

I don't think you are grasping how things work in the US. MS stands for medical STUDENT and they are not calling the shots, ever. Interns ARE the first year residents and are not MS anything, they are physicians. The post on which you are responding is about a sub-internship AKA clerkship for a medical student. Your assertions are absurd and should not be the standard in any country, let alone in the US.

Yar! I'm aware of the acronym. In my post MS4/MS6 = 4th and 6th year students.

Different countries, different systems hmmm. Then I guess 5-7 is fine as a student.

Now, I need to cook dinner.

Also, happy Bad Poetry Day (18th of August). To that, I leave this Haiku

What are we treating?
I don’t know, but it’s Sepsis!
Antibiotics.

OP don't worry, everything ends up being alright

 

[MLNS]

 

[Fatalis]

Hey all,

Looking for opinions about a preceptor's opinions!

I've been on this Sub-i for 2 weeks. At the end of week 2, I had a sit down with the CMO who is also the preceptor I spend the most time with. I had just given a short presentation.

Preceptor says:

Presentation was great. Really appreciates all the hard work I've been putting into my notes. That I'm very good at taking feedback and incorporating it right away. The staff all like me, I'm a team player.

BUT. She is a little concerned that I will be starting residency in 10 months. She blamed it on the covid online training I've had for most of the last 4 months as well as a "soft 3rd year experience" at a local hospital. Mostly, it seems she is worried about my plans for patient care.

And, let me be honest, as an early 4th year, I can ballpark a plan, but need to read guidelines to really fine tune it. Been seeing 6-8 patients and day, and often have not had the time to read up before I present. It is often just me and the preceptor, so I rarely have the ability to run my plan by residents first.

SO, finally, 2 questions:

Should I be worried about residency?? and: I'm planning to ask for a letter of rec anyway...does that seem reasonable?

Thanks world of SDN!

As said above, your preceptor will write you a good LOR and don’t worry about residency, you will learn everyday and coming up with plans will be second nature.
Real example: I never delivered a baby as a Med student (ob rotation was awful and all we could do was write notes for the residents). Either way I knew starting my OB rotations as an intern would be a challenge but I let my uppers know, tried to learn as much as I could and it turn out fine. Case and point, you will do fine!

 

[PopeChaChaStix]

Thanks all! Honorable mention to Tangerine123.

 

[Tangerine123]

Ok, I might or might not have been drunk when I posted all that. However, the content is (surprisingly!) real.

You guys enjoy the rest of your week. Sending positive vibes *Hugs OP*

I'll prepare for my walk of shame now. The streets of King's Landing await.

 

[IMGASMD]

Ok, I might or might not have been drunk when I posted all that. However, the content is (surprisingly!) real.

You guys enjoy the rest of your week. Sending positive vibes *Hugs OP*

I'll prepare for my walk of shame now. The streets of King's Landing await.

View attachment 316363

Unless you’re queen cersi else I don’t want any part of it.

 

[ace_inhibitor111]

So...yeah. They practice still. They're dual boarded and CMO. I see the patient's off their list. I don't know...super type A?

Don’t tell me they’re Med/Peds?

 

[Spectreman]

Don’t tell me they’re Med/Peds?

That hits too close to the chest. My Peds in-patient preceptor was completely like the OP’s CMO person, and it was so clearly a power trip.

 

[PopeChaChaStix]

@tangerine: I'm just kidding! Don't do that walk it looked terrible, even made me feel bad for Cersei.

@Ace: She is FM/Psych. I thought that would be a pretty chill combo but...