The purpose of this post is to help clue in some of our medical students.  I dont know why and I dont know how else to explain it, but there are some medical students that cannot see how annoying they are or how they are shooting themselves in the foot with every stupid action and word out of their mouth. 

Whether it is right or wrong there is a hierarchy.  The residents on the top can pretty much do and say whatever they want and those below usually just take it.  Once you are a RESIDENT you can talk back a little and bitch a little (its something you earn when you have an MD after your name, once you have taken it up the backside a few times from your chief and attendings, and when you realize the 80 hour rule does not apply to you). 

Anyhow, these are my few suggestions for you, the annoying medical students who just for some stupid reason or another cannot see how it is that you are supposed to act or what you are suppossed to do.  Again, I know that this is not ethically, morally, or politically correct, but this is the system that we went through and if you want to join the club then F-you, start doing what we did.  I know this does not apply to every resident nor every program, but I can tell you that there are residents that think and feel like this at EVERY institution and you will be safer if you play by these rules and live by this advice.

- Despite that fact that you are paying for an education, the truth of it is that residents feel that Medical Students are on a rotation to help us and to impress us, NOT the reverse.  This is the test of your work ethic, show us you can get there earlier, stay there later and work more than 80 hours.  Don’t find excuses or ways out of things.
- The team and chief come before everything else that is personal (except for emergencies).  You can schedule your rotation, so don’t schedule it if you are going to be busy that month or if you have appointments and weddings and that sort of sh*t.  You only get one shot to impress and no, doctors appointments, dentist appointments are not acceptable to me.
- If you volunteer to help with a presentation, a project, or writing up a paper… remember you are there to HELP and to IMPRESS ME (not the reverse) so dont make it more work for me than it would have been should I have done it on my own and don’t bitch about where I put you on the paper or abstract… I could have done it on my stupid… you were expendable and I just saw this as a win-win for both of us.
- If I ask you to do something, do it.  Dont complain, dont ask why, dont take your time getting it done, do it now.  If you cant get it done or dont know how to do it, find someone right away who can help you.  If you cant find someone else, come back to me and I will do it myself (and yes you will loose points in my book if this happens, but you will loose even more points if you didn’t come to me and it didn’t get done).
- Sh*t rolls down hill, you will be made fun of and be picked on just like the interns.  Take it, you day will come to pass it down to if you can learn to do that.  Be sensitive to the hierarchy and learn that a junior resident’s job is to make life easier on the upper levels.  A medical student that sees this and does this will be looked upon much more highly than one who does not as they will likely continue this during residency.
-As a medical student never screw over one of the lower level residents when it comes to procedures or the operating room.  Some of them don’t get to do much and there is nothing worse than when the damn medical students takes their 2 seconds of glory or when the damn attending finally wants to show some interest in the medical student when it is finally the junior’s turn to do something.  If the attending tells you to do something then leaves, ask the junior if they can walk you through it or share it with them.
- You are allowed 1-2 questions per procedure and make sure it is not at a critical time.  Ask them before the procedure or after it- that is usually the safest.  Nothing pisses an attending or chief resident off more than a student who asks 50 questions during a complex skull base dissection when they are TRYING to concentrate on not killing the patient.  Remember the dictum in neurosurgery, less is more, this also applies to your questions and opening your mouth.
- If there is food, or a course, or any sort of handouts make sure you are LAST and that all the residents have gone before you.  This shows great maturity.  Nothing pisses a resident off more than having taken all not call and showing up to conference the next morning and there is no food left and the damn medical students have heaping plates that they are eating.  Or there was this one time when I went to a course and a goddamn medical student had a cadaver to himself and 2 residents had to share (I don’t care if you helped prepare the cadavers… this was not for you, you are not yet a resident, your time will come).
- Have enough self-awareness to take the nonverbal and indirect subtle cues that the residents are trying to portray to you or they will make sure that you don’t match at their program.

I know this advice will make some medical students mad and that it is not politically or academically correct… the truth is that there are many residents that don’t act like this or hold this against medical students, but there are many that do.  That is the purpose behind getting this information out- not the perpetuation of these methods.

PLEASE OTHER RESIDENTS ADD MORE ADVICE

Thanks for this post.  I think one of the greatest challenges of beginning the third year has been trying to figure out the unspoken rules of each rotation.  Knowing what you just said, in advance, should help us on any surgical rotation that we choose to complete.  -Neil

neiluswood - 24 October 2007 01:23 PM

Thanks for this post.  I think one of the greatest challenges of beginning the third year has been trying to figure out the unspoken rules of each rotation.  Knowing what you just said, in advance, should help us on any surgical rotation that we choose to complete.  -Neil

groan.

Need a rag to wipe off your nose?

Anonymous User - 24 October 2007 12:30 PM

The purpose of this post is to help clue in some of our medical students.  I dont know why and I dont know how else to explain it, but there are some medical students that cannot see how annoying they are or how they are shooting themselves in the foot with every stupid action and word out of their mouth. 

Whether it is right or wrong there is a hierarchy.  The residents on the top can pretty much do and say whatever they want and those below usually just take it.  Once you are a RESIDENT you can talk back a little and bitch a little (its something you earn when you have an MD after your name, once you have taken it up the backside a few times from your chief and attendings, and when you realize the 80 hour rule does not apply to you). 

Anyhow, these are my few suggestions for you, the annoying medical students who just for some stupid reason or another cannot see how it is that you are supposed to act or what you are suppossed to do.  Again, I know that this is not ethically, morally, or politically correct, but this is the system that we went through and if you want to join the club then F-you, start doing what we did.  I know this does not apply to every resident nor every program, but I can tell you that there are residents that think and feel like this at EVERY institution and you will be safer if you play by these rules and live by this advice.

- Despite that fact that you are paying for an education, the truth of it is that residents feel that Medical Students are on a rotation to help us and to impress us, NOT the reverse.  This is the test of your work ethic, show us you can get there earlier, stay there later and work more than 80 hours.  Don’t find excuses or ways out of things.
- The team and chief come before everything else that is personal (except for emergencies).  You can schedule your rotation, so don’t schedule it if you are going to be busy that month or if you have appointments and weddings and that sort of sh*t.  You only get one shot to impress and no, doctors appointments, dentist appointments are not acceptable to me.
- If you volunteer to help with a presentation, a project, or writing up a paper… remember you are there to HELP and to IMPRESS ME (not the reverse) so dont make it more work for me than it would have been should I have done it on my own and don’t bitch about where I put you on the paper or abstract… I could have done it on my stupid… you were expendable and I just saw this as a win-win for both of us.
- If I ask you to do something, do it.  Dont complain, dont ask why, dont take your time getting it done, do it now.  If you cant get it done or dont know how to do it, find someone right away who can help you.  If you cant find someone else, come back to me and I will do it myself (and yes you will loose points in my book if this happens, but you will loose even more points if you didn’t come to me and it didn’t get done).
- Sh*t rolls down hill, you will be made fun of and be picked on just like the interns.  Take it, you day will come to pass it down to if you can learn to do that.  Be sensitive to the hierarchy and learn that a junior resident’s job is to make life easier on the upper levels.  A medical student that sees this and does this will be looked upon much more highly than one who does not as they will likely continue this during residency.
-As a medical student never screw over one of the lower level residents when it comes to procedures or the operating room.  Some of them don’t get to do much and there is nothing worse than when the damn medical students takes their 2 seconds of glory or when the damn attending finally wants to show some interest in the medical student when it is finally the junior’s turn to do something.  If the attending tells you to do something then leaves, ask the junior if they can walk you through it or share it with them.
- You are allowed 1-2 questions per procedure and make sure it is not at a critical time.  Ask them before the procedure or after it- that is usually the safest.  Nothing pisses an attending or chief resident off more than a student who asks 50 questions during a complex skull base dissection when they are TRYING to concentrate on not killing the patient.  Remember the dictum in neurosurgery, less is more, this also applies to your questions and opening your mouth.
- If there is food, or a course, or any sort of handouts make sure you are LAST and that all the residents have gone before you.  This shows great maturity.  Nothing pisses a resident off more than having taken all not call and showing up to conference the next morning and there is no food left and the damn medical students have heaping plates that they are eating.  Or there was this one time when I went to a course and a goddamn medical student had a cadaver to himself and 2 residents had to share (I don’t care if you helped prepare the cadavers… this was not for you, you are not yet a resident, your time will come).
- Have enough self-awareness to take the nonverbal and indirect subtle cues that the residents are trying to portray to you or they will make sure that you don’t match at their program.

I know this advice will make some medical students mad and that it is not politically or academically correct… the truth is that there are many residents that don’t act like this or hold this against medical students, but there are many that do.  That is the purpose behind getting this information out- not the perpetuation of these methods.

PLEASE OTHER RESIDENTS ADD MORE ADVICE

While the above author is a little over the top and dramatic, he does make some good points.  I don’t agree with everything he wrote… but I do agree with most of the underlying reason for his points.  I just think there are ways to still be nice and friendly as resident while still having high expectations and standards.

.

Anonymous User - 24 October 2007 12:30 PM

I know this advice will make some medical students mad

It is interesting that you added this point.  As I read your post, my feelings were of pride and determination--and these feelings escalated with each sentence I read.  What you describe is exactly why I love neurosurgery.  High standards and objectively earned respect are two things that make the field so desirable to me.  I have only been spending time casually with the residents at my school during down time with my graduate studies, but have quickly learned that the hands on education they are providing me is indeed a privilege.  As you stated, not all residents are as you describe, but the ones who aren’t seem to respect those who are, and at the end of the day really are impressed by the same qualities that are important to “harder” residents.  And I have found that when you do show your worth to the residents who are on the harder side, and earn their respect, you will learn a lot.

Thank you for the kick in the pants.  And thank you to the residents (fellow and attendings, of course) who have been showing me the ropes without holding my hand.

Anonymous User - 24 October 2007 02:14 PM

neiluswood - 24 October 2007 01:23 PM

Thanks for this post.  I think one of the greatest challenges of beginning the third year has been trying to figure out the unspoken rules of each rotation.  Knowing what you just said, in advance, should help us on any surgical rotation that we choose to complete.  -Neil

groan.

Need a rag to wipe off your nose?

I appreciate your maturity.  Your insight into the motivations behind my post is truly impressive.

Either the med student was truly annoying, or you are a resident at a malignant institution. Who has the time to write a 500-word essay rant when they should be resting?

And to all the MS 2’s, 2.5’s and 3’s. Trust me, a resident like this is NOT what you need. There are plenty of great programs out there that treat everyone respectfully like the adults that we all are. If you needed a “kick in the pants” to remind you not to be a tool, that says something about you.

I think the origincal poster must have had some really annoying med students.  I’m an aspiring surgeon and learned about the OR as an organ preservation specialist at the Cleveland Clinic.  It’s basically a job only a wannabe surgeon would take.  You go out with the transplant fellows/residents at odd hours (2/3am)and pick up livers and kidneys from brain dead people.  You get to package the organs and eagerly wait for the fellow to let you help dissect, close, do a biopsy, whatever and you are grateful to just hold a needle.  It was a good experience and I approach the OR like a dog.  Med students should be like a well trained labrador retriever.  As a med student you need to sense the environment and your owner’s mood.  Every surgeon is different some like if you anticipate their next move and have a needle driver ready, some growl at you when you’re in their space.  Basically it’s common sense....get a feel for the surgeon and be a good work dog...run, fetch and be happy to get a scratch behind the ears (i.e. being allowed to close).  I HATE the people who ask a lot of questions and I hate the people who get up in the surgeons grill.

Anonymous User - 24 October 2007 05:29 PM

Either the med student was truly annoying, or you are a resident at a malignant institution. Who has the time to write a 500-word essay rant when they should be resting?

And to all the MS 2’s, 2.5’s and 3’s. Trust me, a resident like this is NOT what you need. There are plenty of great programs out there that treat everyone respectfully like the adults that we all are. If you needed a “kick in the pants” to remind you not to be a tool, that says something about you.

My thoughts exactly. I’d have fucking hated to end up with senior residents like the OP. Thankfully none of the seniors at my place are like that.

I’m a PGY5 at a relatively benign program, and I’ll agree that most of the points made above are certainly what we think about in the back of our minds.  There are two exceptions: I never ask a medical student to do anything (if they offer, that’s a different story) and we do not “pick on” our medical students/Sub-Is. 

Doing anything that annoys the attendings (e.g. asking questions as we’re trying to clip an aneurysm) is bad form.

But you should remember that anything you guys can do to make our life easier is much appreciated.  Hard work and students that don’t complain, make fun of patients and staff, and are truly interested in neurosurgery are the kind of people I want as Interns.

Anonymous User - 24 October 2007 05:47 PM

Anonymous User - 24 October 2007 05:29 PM

Either the med student was truly annoying, or you are a resident at a malignant institution. Who has the time to write a 500-word essay rant when they should be resting?

And to all the MS 2’s, 2.5’s and 3’s. Trust me, a resident like this is NOT what you need. There are plenty of great programs out there that treat everyone respectfully like the adults that we all are. If you needed a “kick in the pants” to remind you not to be a tool, that says something about you.

My thoughts exactly. I’d have fucking hated to end up with senior residents like the OP. Thankfully none of the seniors at my place are like that.

I AM the OP and my program is not malignant and I generally treat medical students and juniors with a great deal of respect.  In fact, I am typically the greatest advocate of students at my institution and try as much as I can to get them involved and make life easy for them… I dont want the sort of environment I described, but at the same time NOTHING pisses me off more than a medical student who is selfish, not a team player, and feels he/she is so entitled and is so out of touch with the system (and a realistic perception of self) that they feel that the conventions and hierarchy somehow does not apply to them.

Infact, it WAS a visiting medical student that pissed me off and pushed me over the edge, trying my patience which has put up with years of dealing with patient’s family members, incompetent hospital staff, and varying degrees of interest and caliber of rotating medical students without ever before blowing up.  I could not believe that a medical student (applying right now for residency) could be so clueless and oblivious about the code of conduct (some of which is just purely respect and foresight of your place/role in the system) that has been established and has been place for so many years and DOES exist at ALL programs to varying degrees- what people will tell you to your face and behind closed doors are different.  I respect medical students, patients, their families and hospital staff, but is it too much for me to expect them to also respect me and the system of training in which I am involved? 

Back to the original ethical question of whether it should be this way or not, well I agree that it should not but it is not going to change over night and when it does change it will start from the top down, not from a F-ing medical student up.  For the other junior residents who are commenting, you may be lucky and have had the honor of participating in a gentlemanly program, again this probably started from the top-down, do your best to perpetuate this optimal environment and hopefully it will continue and spread to other programs.  The one caveat I have for you, now that I am setting up a position at the end of my training, is that once you complete training you enter either the dog-eat-dog world of Academics or Private practice where seniority and heirarchies are much harsher, the stakes and implications upon careers and discoveries/remuneration are much higher and the politics and modus operandi is much more complex and intricate.  If you cant do it as a medical student, you wont be able to do it as a resident, and if you cant do it as a resident you will fail successfully at the next level as well.  My concluding words for medical students and residents combined, again these have your best interest and hope for success for you at heart, know your F-ing place.  Yes, I need to know mine too so I will shut up and get back to work.  Thank you for permitting my “rant” and yes I am busy, more so than you know.

Were all (or most) of these criticisms based off of one medical student?

...and was it recently or awhile ago?

I hope you at least talked about it face to face with the ‘’med student’’.

I think lots of MS fail to see the point here. your job is to make everyone else’s day easier even though you are paying for it. I hate to say it, but learning neurosurgery during a subI is secondary. If you grasp these two points, you will be fine.