This "you need to be assertive" as a med student thing needs to stop

[Redpancreas]

What?
People go into academia because they have an interest in at least 2 of the 3 pillars of academic medicine. Clinical work, education and research.


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Il Destriero

That's not been my experience with some medicine attendings

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[Mad Jack]

Certainly a bigger problem with DO schools but many MD ones too. Not going to rant about this but people are paying big loaned money for rotations. It's the schools job to ensure that preceptors are adequately teaching. And guess what? As an attending, it's part of the job description.
If you don't want to follow that then why take an academic job?

I'm not saying med students need to have their hand held. But like cmon... sure some attendings and rotations are pretty good but its the school's job to ensure that standards are equal for EVERY rotation. I'd be all over this as an accrediting body....

You've clearly never been in a clinical teaching role before. It's not as easy as it looks and at many DO and community rotations it's just kind of foisted upon doctors that wanted to work in the community specifically to avoid the headaches of academics.

 

[WingedOx]

You've clearly never been in a clinical teaching role before. It's not as easy as it looks and at many DO and community rotations it's just kind of foisted upon doctors that wanted to work in the community specifically to avoid the headaches of academics.

I'm going to make a post that's heresy on SDN, but here goes:

There's value in shadowing-only rotations. There. I said it.

I never would have known this at the time, but one of the most valuable rotations I did was a "uhh I need SOMETHING elective to do" MS4 rotation in sleep medicine. My main preceptor was an awful teacher, basically told me to not say a word and stand in the corner in clinic most days, and I basically followed him and the fellows around the clinic for a month. And yet, I saw a ton of patients that month, got to observe the various problems they had with their machines, etc...which is a LOT more sleep med experience than most physicians have.

Nowadays I work at a VA in psych where probably half the Vietnam-era patients in my outpatient clinic have sleep apnea either diagnosed or undiagnosed, and their management is something that comes up A LOT, particularly when insomnia is a major complaint. Plus I've picked up an occasional zebra from what I saw in that clinic. Caught a central apnea case that the primary IM team missed when I was on consults back as a PG2.

 

[TheFutureFatMan]

Certainly a bigger problem with DO schools but many MD ones too. Not going to rant about this but people are paying big loaned money for rotations. It's the schools job to ensure that preceptors are adequately teaching. And guess what? As an attending, it's part of the job description.
If you don't want to follow that then why take an academic job?

I'm not saying med students need to have their hand held. But like cmon... sure some attendings and rotations are pretty good but its the school's job to ensure that standards are equal for EVERY rotation. I'd be all over this as an accrediting body....

How would you suggest the accrediting body address this? Keep in mind that if a school does not meet a standard, then there has to be a consequence, what would you have in mind? If you have legitimate feedback there are productive places to put it. You should reach out to your student government.

 

[NYCdude]

I'm going to make a post that's heresy on SDN, but here goes:

There's value in shadowing-only rotations. There. I said it.

I never would have known this at the time, but one of the most valuable rotations I did was a "uhh I need SOMETHING elective to do" MS4 rotation in sleep medicine. My main preceptor was an awful teacher, basically told me to not say a word and stand in the corner in clinic most days, and I basically followed him and the fellows around the clinic for a month. And yet, I saw a ton of patients that month, got to observe the various problems they had with their machines, etc...which is a LOT more sleep med experience than most physicians have.

Nowadays I work at a VA in psych where probably half the Vietnam-era patients in my outpatient clinic have sleep apnea either diagnosed or undiagnosed, and their management is something that comes up A LOT, particularly when insomnia is a major complaint. Plus I've picked up an occasional zebra from what I saw in that clinic. Caught a central apnea case that the primary IM team missed when I was on consults back as a PG2.

Imagine how many more zebras you could catch if your preceptor did his job and taught some **** once in a while.

 

[WingedOx]

Imagine how many more zebras you could catch if your preceptor did his job and taught some **** once in a while.

It's not that he didn't teach. He just kind of sucked at it.

 

[Crayola227]

Academic jobs, unless I'm mistaken, are not taken. Y the most passionate, but the ones who need something in medicine now and settle for it. Many actually go in looking forward to teach, but many do not.

What?
People go into academia because they have an interest in at least 2 of the 3 pillars of academic medicine. Clinical work, education and research.


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Il Destriero

It's more true of basic science research PhDs in universities. Not at all true of physician educators.

 

[Crayola227]

The problem has a lot more to do with the infrastructure of modern medicine than the idea that most attendings don't give a damn about education.

I wanted to be a junior high or high school teacher (chew on that, for a minute, how dedicated to teaching you have to be to want to forever repeat and hang out with that age group... cray cray!) before I wanted to be a doctor. I was heavily involved in education in my med school, and opportunities for teaching as a resident played heavily into my final rank list.

I am still very proud of how much I did to try to educate med students as a resident, and hell, here I am on SDN. Lol, there's a lot of docs on SDN helping anonymously behind a keyboard. Anyway, despite all the good intentions I enumerate here, it was damned hard to even give the patients the care and education they needed, let alone get the education I needed, let alone pay it forward to the next generation. I didn't want the med students to learn as I did, standing in a corner watching, but I also didn't want some patients to die that did, or get denied care by their insurance. Them's the breaks.

I'll say it again. I don't think the problem in medicine or medical education is in the intentions. I'm so sick of the script where we yet again question the good intentions of the average doc regarding their patients and their students.

Those in an academic appointment I wouldn't even call average, as pointed out, they are typically the ones among us that want to go above the average appt or surgery and billing, they have an eye for the future or the bigger picture, in research or education.

I think everyone is doing the best they can. I don't blame the white coats, I blame the suits.

 

[IlDestriero]

It's more true of basic science research PhDs in universities. Not at all true of physician educators.

Oh, sorry, I don't know anything about academic medicine.


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Il Destriero

 

[Crayola227]

Oh, sorry, I don't know anything about academic medicine.


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Il Destriero

Are you being sarcastic? I probably wasn't being clear.

I think I was agreeing with you, and trying to point out where backtobasics was correct and where he was not. I was contrasting the attitudes in basic science research at the undergraduate level with that of those in academic medicine.

I have years of first hand experience with someone who climbed through academia to go from grad student to professor in the basic sciences at a prestigious undergraduate university with a $1 million in grant money to start (not a lot, still), and in that time had a lot of opportunities to rub shoulders with basic science researchers, PIs, and professors behind the scenes. I also saw one of these high powered PIs go from a public teaching institution to a private research-only facility. It seemed that outside of clinical medicine at the undergraduate level, most basic scientists were focused on research. In fact, quite a few of them start their appointments with no teaching duties whatsoever for years as they establish their labs.

I've also found the math instructors to be much the same - definitely top of their field and into their research, hit or miss on teaching. Most of them didn't get to the top of their field because of a focus on education.

As far as those that want to teach, this was one reason mentioned to me when I was at community college, why our community college had a better teaching reputation than the state university down the street. ALL of the teachers chosen for the CC were chosen to teach, and the ones who applied where generally there for the purpose of being professional teachers. This most definitely could not be stated for the university science department. It's been said some are teaching at the CC level because they are industry and other sorts of wash outs, but I imagine it depends on the competition for such appointments as to the quality of the teaching there. In any case, no one was there to do research as their #1 or even #2 goal or duty. (I'll spare the paragraph on the place of research at the CC level)

Now, I likely don't know as much as you do about academic medicine, although medical education has always been my passion.

It seemed to me that you have MDs in academia at medical universities whose career pattern is much like the basic science researchers above, often MD/PhDs and others with bench research or big grants. And while all academic positions have an expectation of "scholarly" work in the field, it isn't always what I think a lot of green med students imagine it to be. Often that sort of work involves being published on topics in medical education, developing curriculum, etc. Basically, advancing education. At least those were a lot of the role models I worked with at my medical school. Most of the MDs in academia at medical universities in my experience were not just there for basic science research, but a heavy component of their job was clinical practice and education.

TLDR:
The stereotype of the science professor that only cares about his research and is high on the autism spectrum and can't teach, is only really true at the undergraduate level. The MD is a different degree, it's a different beast, the sort of person selected to even get one differs from PhDs. People who take the MD pathway and go into academic medicine, will most often, as @IlDestriero points out, be focused on clinical medicine or education as part of their duties. People that only give a **** about research don't usually go the this pathway.

 

[ortnakas]

I don't blame the white coats, I blame the suits.

This should be /thread, really.

I've had attendings and residents not have time to teach me, but I don't think I've ever had one who truly didn't want to.

 

[sliceofbread136]

I love the common theme in medical education "yes it sucks balls and we charging you crazy prices for a garbage education but you should be happy anyway". This whole attitude is what has made a mess of the whole medical system. Someday we are going to have to step up to the plate and make some changes

 

[12glaucoma34]

I love the common theme in medical education "yes it sucks balls and we charging you crazy prices for a garbage education but you should be happy anyway". This whole attitude is what has made a mess of the whole medical system. Someday we are going to have to step up to the plate and make some changes

All true, additionally we are stuck with our school after starting. Transferring is basically impossible. Medical schools go to great lengths to make their program look exceptional until you have paid first semester tuition and can't back out. Then its downhill for a lot of schools, it certainly was at mine.

 

[Redpancreas]

Oh, sorry, I don't know anything about academic medicine.


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Il Destriero

Hey man, didn't say you didn't. I'm sure those who you teach have benefited.