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“It is not about the biological therapies we give patients. It is not about the medicine. At the end of the day, it is about the relationship you forge with your patient and the trust and understanding that comes with that that dictates their compliance and willingness to continue.”—A psychiatrist discussing the importance of the therapeutic relationship.
Advice to Med Students: How To Impress a Resident/Attending (The Patient Care Episode)
Since a lot of you are about to start the clinical part of your training, and I’m about to get med students for the first time, I figured I’d put together a little how-to (in 3 episodes) with the help of my fellow residents.
- Take initiative with your patients. Know all their info: what meds they’re on, their labs, their histories, etc.
- Check back on your patients in the afternoon. Follow their labs or tests done during the day and think about what needs to be done about them. Otherwise you’ll find that a ton of stuff has happened the next day and you’ll be out of the loop.
- Have your notes written before the resident rounds so they can read them and hopefully give you feedback on them.
- Always attempt to write an assessment and plan on your notes, no matter how simple it is. “Continue current management” is usually not an acceptable plan. What needs to be done before this patient can go home?
- In surgery, always ask permission (preferably from the attending) to scrub in. I do this still as a resident. If they say yes, get your gloves and gown for the scrub tech because they’re probably not prepared for you.
- Ask to do procedures, but don’t expect to get them. The residents are always first in line. If it’s a procedure they’re confident doing and they have time to teach you, they’ll probably let you do it.
- If we ask if you want to do a procedure, always say yes. Even if you don’t want to.
- In the outpatient setting, always offer to help write the note. Rarely will a resident turn you down, and you will really help them out. They will still review and change it, but it will definitely help.
- Be available. You don’t have to be a shadow, but don’t expect your resident to call you for admissions/procedures/check out, because she will forget. If you haven’t heard from the resident in a while, check back in with them. She may have forgotten you were around and might send you home early!
How to Impress a Resident / Attending (the Respect Episode)
- Even residents who were gunners hate other gunners. So just don’t be one. If the resident tells you to go home at 4:30, for heaven’s sake, go home. They probably have run out of things to teach you for the day, and they have work they need to get done with peace and quiet. If they tell you to leave, they’re not going to rat you out for leaving early.
- Get to know your resident as much as you can. Don’t take up work time, but when there’s downtime, don’t disappear immediately. Have a conversation.
- Stay out of the way. This will be hard to do because you will always feel like you’re in the way. I still feel like I’m in the way as a resident.
- If there are no chairs available and a nurse, attending, or resident needs one, you are expected to give yours up. This is something I still practice, and it weirds me out when nurses offer me their chairs.
- Don’t steal the resident or attending’s computer. And don’t log them out.
- Don’t misrepresent yourself to your patients. They should understand that you are not a doctor yet.
- Be a team player. Don’t fight other students for procedures or throw them under the bus. If we perceive that you are trying to tear down your fellow students, our opinion of you will automatically fall. Help other students when they’re slammed. Remember, attendings are looking for good things to say about you in a letter of rec, and programs love residents who are easy to work with.
- Don’t try to teach your resident. We already know you’re smarter than we are. You’re closer to step 1 than we are. But we have plenty to teach you.
- Ask your residents for advice about residency applications, clerkships, whatever. It’s flattering to us.
“The nerd that I am, I looked up ‘sarcasm.’ And ‘sarcasm’ in Greek comes from the word, ‘sarkasmos,’ which means, ‘cutting people up; fleshing and peeling of someone’s skin.' So, basically I’m not away from my original profession.”—Bassem Youssef, on being a cardiac surgeon and a comedian. x
The Only Correct Way...
- Dr. A: This is the way you should do this procedure for your final assessment. It is how it is written in your notes.
- Dr. B: Do not go by what is in your book. That is the classic method. There are better ways to do it.
- Dr. C: Why are you doing it that way? This is the best way to do it according to studies.
- Dr. D: I see you picked up some bad habits. And by "bad habits" I mean "not the way I do it." While you are with me do it this way.
- Dr. E: I ran into trouble before with the way you are doing it so I do not do that anymore.
- Dr. F: Do it however you like.
- Me: Brain cannot compute.
Anon asked: How did you meet CuteBoy? If you don’t mind me asking :) And also, is it true that one you begin medschool your whole social/dating/relationship life is put on hold? And that you won’t make friends within your program because everyone is ultra-competitive? I know there are a lot of questions about getting INTO med school here, but I’m also wondering about what it’s like when you actually begin the program. Thank you so much!
Ok. It seems I have a couple myths to dispel. Where is my wand?
(haha I am hilarious!)
#1: I met the Cute Boy in November at a friend’s birthday party. It was a trap- I literally went facebook shopping one night when she came over for cheeseburger/JamesBond/champagne girl’s night. Neither of us were looking for anything serious, but we quickly realized that we liked each other WAY too much, and now we are hopelessly disgustingly in love and sooooo happy.
Dating in med school is not easy. I’m lucky because he generally makes it as easy as possible for me. He is very mature, has a grownup job, his own group of friends that he sees often, band practice a few days a week, and hobbies, so he isn’t always bugging me to pay attention to him. He never ever ever made me feel bad about having to study (protip to anyone dating a med student: FOLLOW HIS EXAMPLE). During the week when school was in session, we generally didn’t see each other until we were getting in bed to go to sleep, which sucked. We texted each other periodically throughout the day and if we were not going to see each other on a given day we would always make sure to talk on the phone for a little bit. I always made an effort to make time for him and he always made an effort to support me. It takes a lot of compromise, selflessness, and communication- but having a happy, healthy, super rad relationship while in med school is definitely possible.
#2: Med school does not necessarily mean your life will completely be put on hold- your priorities will shift completely. You will figure out how much you need to study/go to class and then everything else generally gets arranged around that. Yes, some people will fade out of your life if they aren’t willing to contact you and work with you in order to remain in touch. Luckily for me, I have a fantastic group of girl friends who always made sure to invite me to things and to keep in contact with me, even if I didn’t see them for a few weeks, even if I could only come out for an hour or showed up late, they always made me feel included.
I also tried to have at least one non-med friend social type thing a week when possible. My friends would come read while I studied just so that I wasn’t by myself- we’d make dinner, eat, and then spend the evening drinking tea and reading. It was really nice.
#3: What? Shut the front door. Not make any friends? That is bullshit.
Do you see these two girls with me?
These are my classmates and some of the smartest people I’ve ever met to boot. We took this photo a couple days ago at an outdoor concert type event. We studied together at least once a week during the semester and have probably the most hilarious GroupMe conversation history in… well, the history of ever. They even helped me build my patio just for kicks and giggles. And those aren’t my only school friends.
To be completely honest, making friends in med school is pretty much what YOU make of it. I know many people in my class who are just there to get their learn on and then go home; they aren’t interested in making friends, and that’s ok. There are also the mega-competitive stereotypical gunner type kids in my class. They all hang out together.
It’s generally pretty easy to find people who you will get along with if making med school friends is a priority for you. Personally, I think having a handful of fellow med student friends is really important because they are going through the same things you are. I can complain to my roommate or the Cute Boy about how much I loathe renal calculations, but they don’t have any idea what I’m talking about.
#4: Have you ever ridden a roller coaster? Do you remember the first one you ever rode? The path to med school is like that. So you get off this first roller coaster and decide that you are tough stuff, so you get on a bigger roller coaster. Only this is the biggest roller coaster in the world- it goes to the flipping moon! So you get on this ludicrous speed roller coaster and are whisked away, it’s bonkers. You hear people on the platform asking you how the ride is- how are you going to explain it to them? They’ve never been on anything like this.
That’s kind of what being in med school is like. It has the highest highs and the lowest lows. It’s an alternate reality. It’s the most wonderful and terrible thing I’ve ever experienced next to falling in love. It will change you. You have no idea what’s coming until you’re in the the thick of it. You will feel like you are drowning, that you’ve made a terrible mistake, that you are a complete and total idiot for even thinking you deserved to become a doctor. All these things shall pass.
Hope this helped.
“We, as wives, need to believe in our husbands. We need to be understanding – even when we don’t like it – of their long hours and limited family time. We need to give them a safe place to come home to after being run through the garbage disposal all day. They need to hear, “Thank you for working so hard for our family” and “You are going to be an incredible (doctor/specialist).” They need to hear, “I am so proud of you.” They need to know that they are heroes at home, even if they are peons at the hospital. They are working their butts off in order to learn how to save someone’s life. They need – and deserve – our respect.”—Survivor Stories: What I have learned about being a doctor’s wife
Re-imagining medical education
Two stories out in the past couple of weeks talk about how medical education needs to change in order the meet new health care challenges. I found it interesting that in both of the pieces there was discussion of first identifying health care needs, then working backwards to determine what curricula changes need to be made to address those needs. We definitely need better curricula based on the realities of practicing medicine today.
Currently, medical students spend their first 2 years learning the “basics” of medicine. In reality, much of the time in these first 2 years is wasted because it focuses on well-characterized, but obscure and rare diseases or molecular pathways. A classic example is Kreb’s Cycle. At one time or another, any medical student was able to regurgitate the precise machinations of this pathway. But once they get into their clinical training (Year 3 and beyond) they lose this ability because it has almost zero relation to clinical medicine. Yet the ritual of memorizing Kreb’s Cycle is a persistent component of pre-med and pre-clinical training. The opportunity cost, of course, is less time spent on things like heart disease, diabetes, and cancer; not to mention increasingly important non-clinical skills like evaluating medical evidence or learning about quality improvement and patient safety or interdisciplinary teamwork. There seems to be a lot of good rhetoric out there regarding medical school curricula changes, now let’s see what we could do if we never read Flexner or the subsequent 100 years of medical education history.