The Expert Opinion of Medical Students

med student

Ok. I am an old and cranky surgeon. And this post is going to make me sound positively ancient. It starts off with

When I was a medical student……

Is it just me, or are the medical students these days getting more brazen, opinionated and full of self-importance?

I used to love clinical teaching. Our students used to turn up early on consultant ward rounds, some with prepared case studies of patients on the ward, and helped out our residents and interns with preparations of the round. In the operating room, they used to stand quietly at the head of the patient, peering over the anaesthetic drape and asked intelligent questions. Questions that showed they had checked what was on the list and read about it the night before. They stayed until the case was finished, whether it would be 6pm or 1am. They were eager to scrub in if they were offered the chance and absorbed information like sponges.

Nowadays, they turn up on the ward round at the same time as me, with no idea of the patients on the ward, nor their names and procedures, let alone their histories. The interns and residents struggle with charts, dressings and memorising lab results for each patient, whilst the students look on with vacant smiles, hands firmly tucked into their pockets.

When I was a medical student, I used to arrive an hour before my consultant, print out a patient list, and write out all lab results next to their names for the intern. I would then put all the charts onto a trolley, opened to the latest page, and stamp in the date, ready for the round. While the round is happening, I would carry a box of gloves so that the senior doctors can open the dressings, and be the official scribe in the notes while decisions are made and patient discussed. I would hand the latest lab results to my intern and make sure he/she was aware of any abnormalities. I never spoke unless spoken to. My role was to be helpful to the junior staff and be a thirsty sponge to absorb all the information bantered around my head.

Over the last few years, something changed in our medical students. I don’t know why these young minds are being poisoned, but I sure would like to correct whatever delusions some idealistic non-clinical academic lecturer are feeding them. Whatever fibs they are being told – may work great in theory and on campus, but disastrous if they really want to gain the most out of their clinical attachments. The attitude these beliefs breed in our medical students, alienates them from the real doctors in the ‘real’ world.

1. You are an important member of the clinical team.

Then they get fed this bullshit story about how once there was a patient nobody knew why he was dying and some medical student came alone, discovered the diagnosis and saved the patient. It is an Urban Legend, people. Don’t come onto my team thinking you are going to discover some astonishing fact, talk to us as if everything you have to say is of utmost importance, and please don’t look at us expectantly for a thank-you for your effort. Oh, I don’t dispute that sometimes the medical student finds something that no one else on the team knew, but it is often either of small significance, or most commonly something that would not have changed the big picture.

Nope. You kids are not important. You earn your importance. If you put in the work and help out with the team, then maybe, just maybe, you are useful. Students are actually economic burdens. Teaching takes time, time cuts into efficiency, and decreased efficiency means less thorough-put. Less thorough-put means I don’t meet my KPI (key performance indicators), and failure to meet my KPI means I don’t get my bonus. Oh, and did I mention that I don’t get any extra pay for being a teacher or having students on my team? So to cut a long story short – teaching you kids cost me my bonus. For those who put in the work, I consider it worthwhile, I’d be happy to give you my bonus just so you can stay on the team longer and learn more, because sometimes listening to my students talk intelligently makes me puff up with pride.

You are also not so important that you can call me ‘Tiff’. My intern, residents and registrars call me Dr Tiffany, and that’s forgivable because I have a unpronouncable surname (thanks to my Eastern European husband). So, at the very least, you could do me the same courtesy. Yelling down the corridor, ‘Hey, wait up Tiff’ is just not acceptable behaviour for a student on my team. Why the hell would I wait for you when you are late to the ward round anyway?!?!

2. As a medical student, you have ‘rights’

Hahahahahahaha. Sorry, I had to laugh at the absurdity of this concept. What ‘rights’ would you be referring to?

Last month, we were doing a six-hour operation which started at three pm. The student was scrubbed in to help with some retraction. As a ‘reward’ for his efforts, the senior registrar showed great patience and took her time teaching him how to stitch. When it turned six o’clock, the student wanted to be excused. The registrar made a comment that if he stayed, he could practice more suturing and close one of the wounds. His reply was, ‘I am not paid to be here. I am only here to learn. As a student, I have the right to leave when I have done my allocated hours.’

The registrar looked at me and said, ‘Great. Dr Tiffany, why don’t we all just leave the patient on the table and go home? I think I am  on the 40th hour over my allocated hours for this month. The anaesthetist here is on his 37th hour, How about you?’

Another example of the so-called ‘rights’ was demonstrated to me by a student who stood at the head of the table observing an operation last week. It was a difficult case – I was digging through scar tissue to access some very fine blood vessels without clobbering any of them and causing a blood bath. There was concentrated silence in the theatre for 2 hours. During which time, I was trying not to get too annoyed with his continuous fidgeting, coughing and sighing. When we finally negotiated through the difficult part of the operation, and I was able to relax (i.e. multi-task), I asked the student if he saw what we were trying to do. He shrugged and said that he didn’t really understand because I didn’t talk to him. I held onto my patience and pointed out all the blood vessels I have dissected out and asked him if he recognised them.

‘No, I have never seen them before. I wouldn’t know what they are. You are supposed to teach me today, but i haven’t learnt anything. I have just stood here for two hours. I don’t think we learn very much watching operations, when are you giving us a tutorial? We have a right to proper teaching.’

Time paused. I could see myself pointing to the door, and yelling ‘Get the F%$#& out of my theatre and don’t ever let me see your #$@% face ever again!’

Instead, I said, ‘If you go home and read about the anatomy of this area, you can give me a tutorial tomorrow on it, and I will tell you whether I could have done that dissection better.’

3. Your opinions are important

Trust me when I say, No, Your opinions are best kept to yourself. In regards to opinions, I have two rules I live by: One, your opinions are only worth mentioning if you are either as old as the person you are giving the opinion to, or you have at least half the experience of the subject as the person you are talking to. Two, some opinions are best left unsaid even if it is a good one.

So if you have had no experience in surgery, you need to shut up, watch and learn. I asked a medical student on her first day once, about what she think Plastic Surgery was about. She said that she knew it was all about reconstruction after removal of cancer and injuries, but ‘in my opinion, it is not really essential, so I think they should cut it out of the public health budget.’

Hmm. Let’s imagine the scenario of Miss Smartass getting run over by a car, then carted into my theatre with crushed legs. There I was, standing over her, waving my amputation saw, as she is drifting off to sleep under anaesthetic,  ‘so who think plastic surgery is not essential now?! Mwahahahaha.’

My pet hate is the student who watches me do an operation and tries to tell me how they would do it and why. Ah huh, and sorry if I sound rude, but how many of these have you done? I had to laugh once when a student actually replied, ‘Oh, I haven’t done any, but I have seen quite a few.’ My dear boy, this is not a football game, everyone is an expert because they have watched the game for years. Trust me, if you put any one of those loud, opinionated, beer-drinking, fat bastards who are always yelling obscenities from the couch, onto the football field to play, do you think they can score?! You think they’d win the game? Why don’t you just finish off this operation while I go for my tea break.

4. Medicine can be mastered with ‘Problem Based Learning’ (PBL)

I don’t think I have ever hated a mnemonic more than PBL. Don’t get me wrong, I understand the basis behind PBL, but I think PBL should be taught at the level of training registrars and residents. Teaching PBL to medical students, is like teaching a 17-year-old how to drive without him/her having passed the traffic rule-book written test. You cannot solve the problem, without rote-learning the basics. Yep. Rote-learning, reading, studying and memorising. No shortcuts or ‘I will be able to work it out.’ If you don’t have the knowledge, you won’t be able to ‘wing-it’. And trust me, when someone is bleeding to death on the operating table, they wouldn’t want you to ‘wing-it’ either. Medical school is all about garnering the basic knowledge required to make decisions, and clinical experience during internship and residency is about using that knowledge to perfect the art of clinical judgement. I am still doing problem based learning every single day I am at work. It is something I believe I will continue to do until the day I retire.

Back in the days when I was a medical student (here she goes again *eye-rolls*), we had structured learning of all sciences. It was boring, it was tough, and the amount we had to know seemed irrelevant and insurmountable. But man, was it all so useful when I started surgical training. I am a firm believer that my role as a clinical teacher is to demonstrate to my students the importance and relevance of the basic sciences. I am not trying to teach them how to do an operation, diagnose a disease or to predict prognosis. That is something I teach my surgical trainees. For the medical students, all I am trying to do, is to show them that if they know their sciences well, there will be a whole new world for them to explore with the knowledge they have.

5. There is no such thing as a Stupid Question

WRONG. There is such a thing as a stupid question. Like, ‘What sort of surgery do you do?’ Ok, let me get this right. You have been assigned to my team for 6 weeks and you have no idea what specialty we are in?

If you are thinking of asking a stupid questions, it is better that you say nothing at all. There is nothing more annoying than silly questions from medical students which reflect their complete lack of preparation. Not to mention the polite but pathetic inane questions that accentuate their complete disinterest, absence of comprehension and desire to be somewhere else. Just give me the goddamn attendance form, I will sign it so that you can get your irritating bored ass out of my theatre.

I do like questions when I operate. I like intelligent questions from my students. When a student asks me a question which showed that they have actually done some background reading, I am in seventh heaven. I would take them on a tour of every detail, every aspect and every possible outcome of the surgery we are doing. It is almost orgasmic when my diatribe generates more intelligent questions, showing that they understood what I have been trying to show them, and their interest in what I do. To me, that is like the ultimate ego-stroke.

Sometimes the students are very quiet in my theatre. I suspect it is because they don’t want me to know that they have NFI (No F%$#&ing Idea).

6. Participate in ‘Active Learning’ – speak up and question your clinical teacher

This is like a fast train wreck combining both number 3 and 5.  This is an example of ‘active learning’ from a 3rd year medical student I had last year.

Expert Medical Student: Why are you removing the rib like that?

Me: Because it is a safe way of doing it and it is how I normally do it.

EMS: I don’t think you are doing it right.

Me: Why do you say that?

EMS: I have seen Dr X and Dr Y do this operation last week and that’s not how they did it.

Me: There is usually more than one way of doing an operation, we all have our own preferences.

EMS: But I think their way is better.

Me: Because?

EMS: They are older and much more experienced, so I think you should do it like them.

I wondered if I would get reported if I picked up my sharps dish and bitch-slapped his face with it.

Me: Why don’t you just watch the way I do it and see if it achieves the same result.

EMS: I wasn’t trying to be rude or anything, it’s just that we are told to question everything so that we can learn why you do what you do.

Me: Ask me why then.

EMS: Why what?

Deep breath.

Me: Forget it.

I love my students. Really. I do. I am just very selective whom I show my love to. I love them by teaching them, and I only teach the ones that put in the effort, show respect for their teachers, don’t take our time for granted and don’t make unnecessary noises. I am too old to waste my time and effort on the others.

I sound like an old, arrogant and cranky surgeon. In actual fact, I am afraid to say that my rant reminds me of the Professor of Surgery I had when I was a medical student. Oh God, I really am ancient. I will know I am archaic when I find my portrait next to his in the hallway of the department of surgery.

 

34 thoughts on “The Expert Opinion of Medical Students

  1. Oh. My. God.
    Again, they know YOU know how to wield a scalpel. In my mind, that’d make me respectful to the nth degree.
    What’s wrong with these people? (And how do I avoid ever having to be on the receiving end of their scalpels?!)
    Too much Grey’s Anatomy/ER/Scrubs as kids perhaps? :-/

    • I really hate mentioning this… But, it might be a little of that Gen Y attitude. I try not to stereotype them, because i have had really good students. I give them all the benefit of the doubt when them arrive on the team, but it is getting harder and harder!

      • No, you are very right about your Gen Y guess. It’s not just by you! It is very much happening in the U.S. too. hahaha – Imagine an American with that type of attitude!!

  2. This was funny and sooo informative in many ways. I’m not sure how children are raised in your neck of the woods but I suspect it isn’t that different than Canada. The problem you speak of is systemic. For the past twenty years or so, starting in elementary school, grade inflation is indulged. If a student produces D work, then he or she is given a C because it is believed that to give a child an accurate assesment of the the work they do would damage the perception they have of themselves. This has infiltrated high schools and now is a full on practice in the universities. My wife, who teaches at two universities here in Edmonton, is regularly confronted with students who not only produce shit work, they demand a mark far beyond what they have earned. These dumb bunnies should not be in university but are regularly accepted. When my wife gives a mark, or a fail, the reaction is almost always a complaint that she marks too hard rather than trying to come with ways to improve. It is particularly devastating when little Suzy, who was an academic rock star in Buttfuck Alberta, is told that she is not anywhere near as clever as her parents and teachers led her to believe. What scares the shit out of me is that this collective indulgence of delusion has seeped into the sciences where right and wrong answers could mean the difference between life and death. Great post.

    • Yes. The sense of entitlement and constant praise is rife in this lot. They have even made it compulsory now for us to attend seminars (before we were given students) so that we know how to ‘criticise positively’. Hmmm, so if one of them makes a mistake I am supposed to say, that was a good try but next time you should try it this way (don’t worry that the patient died, just don’t kill your next one).

      • Wow. I wonder what the tipping point will be? The stakes are so much higher in areas surgery and bridge building. If I ever need surgery you’ll need to fly to Edmonton and perform it on my dining room table because I don’t trust these children.

  3. In my extremely limited experience with surgeons, they are generally arrogant. But they get forgiven because one fixed my son’s heart, my surgical oncologist knew exactly what to do to get me well and my reconstructive surgeon fashioned a breast the size and contour of the other one. Your student may think that boob jobs and tummy tucks are not medically necessarily but my insurance company disagreed.

  4. I love reading your posts, Doctor. It’s a whole new world for me that gets opened up, and the obvious commentary is quite funny too. This did speak to me in many ways, as I have had this struggle with young chefs / students (I am a chef, 20 yrs now, and also taught at the top culinary college here). Ego, apathy and sloth seems to be intertwined into some sort of evil braid that chokes me whenever I have my run ins with these cats. I think it cuts across all industries, this sense of entitlement. I have had this conversation with people of all different kinds of craft, trade and industry. The kids come in expecting us to promote them because they just show up, or to praise them because they don’t come in hungover.

    In a kitchen, I am afforded more blunt and frank (and worse) comments towards said kids. I have yelled at entire groups and individuals about this type of attitude. Not always proud of that, but it is necessary to get their heads out of their butts…lol (talk about surgery needed there). I admire your responses to the dullard comments by your students. Kinder than I would have been…ha ha.

    Great post…loved it.

    Paul

    • Gosh we both sound old and grumpy 😛 I may not yell at my students but I am definitely guilty of a being a lazy teacher! A good teacher tries to spark interest in bored students. I basically go by the motto that I will only teach you if you are interested and name an effort. But my view is that we are dealing with adults, so I really shouldn’t spoon feed or force feed them!

  5. I remember spending hours the night before surgery planning out my third order questions based on the posted case list. I remember not drinking any fluids before a big operation for fear I would have to scrub out to pee and miss something (or get cussed out by the attending). There was no such thing as a smart phone to surreptitiously look up info with on the wards. We had to actually know our stuff. Work hours laws have created a degree of entitlement here in the US. Finding good physicians out of residency is becoming increasingly difficult. They do not posses the same work ethic or knowledge base. Great post, as always! I don’t know how I miss it in my reader each and every time but you can bet I will come looking for my Surgery at Tiffany’s fix!

  6. Old and grumpy – yep, my hand’s up! This post made me laugh out loud (oh sorry should that be LOL) because it makes me realise that badass attitude isn’t limited to the students who attend our home visits. You’re very gracious in your teaching approach, I’m listening. Great insight and brilliantly executed reflection 🙂

    • Thank you for your lovely compliment! I think the changes in generation is seen across board in all areas… I heard my plumber whinging about his lazy apprentice last week and I swear he sounded just like me!!! 🙂

  7. As a student, I found it wildly shocking that these sorts of things actually go on. Honestly, I can’t imagine doing anything like that and being able to avoid an instant ass-chewing.

    Personally, I think the sense of entitlement that students today express is something that is handed to them by the administration. At my school we are repeatedly encouraged to report any sort of mistreatment from inappropriate behavior to perceived ‘unnecessarily harsh comments’ on our performance. We review our residents and attendings anonymously and without reprieve. This causes residents and attendings who do not want their files filled with scathing reviews to provide average reports to sub-average students and reinforces bad behavior.

    I’m not sure how to fix this, but I do know that moving forward the workforce of young physicians cannot be coddled and expected to perform anywhere above a mediocre level.

    • So very true! You have hit the nail on the head about the administration and the consequence in student mentality! Thanks for reading my blog! You are obviously one of the students that I would have loved to have on my team 🙂

  8. I wish…my issue is the opposite: I am one of those eager med student you seem to enjoy teaching to, yet this attitude (being eager to learn and do well basically) is frown upon (read I can’t do “pre rounds” as a student as junior doctors/registrars barely do them these days in the teaching hospitals of my institution and a student can’t wander the ward on his own). That’s why I don’t want to stay here. I care about my craft and between the selection process, the culture and the work hour restrictions, I will never be half a surgeon my American/French/Canadian friends are if I stay in the UK…
    Here, students are encouraged to do the 9-5 and leave it at it.. Or maybe I just picked the wrong university…

    • Yes. I understand it can be do frustrating for some students. We don’t really have this problem but I often have students who approach me for extra time which I try to accommodate in extra clinics or theatre time. I think administration at medical schools are making things harder for both sides! Keep at it, enthusiasm doesn’t hide well when it is genuine, any clinical teacher can see it clearly despite the time constraints.

  9. I just love your posts! Your honesty is refreshing. I’m just now starting out as a medical student, but I’m definitely going to keep this in mind during my clinical years.

    • I am sure you will be great. Just remember that everyone has something that you can learn from! I was told that applies to even the worst surgeon in the world, because you learn what Not to do 🙂

  10. First let me thank you for blogging, your candor is not only entertaining but refreshing as well. To your topic, I took a course over the spring 2014 semester where I was required to attends rounds with Docs in many of the major medical specialties and the attitudes of the med students on the teams was quite appalling. Even though I’m MUCH older than your average premed, I think the Docs I shadowed with could appreciate the fact that I didn’t behave like “them”. In fact, they all invited me to come back!!

    There’s no doubt in my mind that the negative impact in the field of medicine thanks to the “entitlement generation” is yet to be seen!

    Kimberly

    • Thank you for coming by my blog! Having students with positive attitude and respect such as yourself is very rewarding for us, keep it up and Not only will you learn a lot more than everyone else, but it will also make you a better and more open minded doctor.

  11. We just spent 2 weeks in a children’s hospital with 2 of our children. One of the students would literally talk over the doctor in rounds. As a worried parent I wanted to scream at him to shut up. He should be glad we didn’t have scalpels!

    • That’s a real worry when they start to undermine the doctor on the rounds….. I hope you haven’t come across any more unpleasant incidences… they usually know their place and majority of them are quite good. Really. And welcome to my blogs, and thank you for reading them. Love it when one of my new readers leave a comment! Please don’t be a stranger.

    • I am old and cranky. It is my aim to one day become seriously ancient AND grumpy, so I will be that legendary urban myth of the surgery professor who eats medical students on morning rounds for breakfast!!! 😀

  12. I finished my residency a year ago, and honestly, I would have been “finished off” by my head of department if I behaved the way you described.
    Moreover, I worked too damn hard to land a spot there, and being a girl- I had to work ten times harder to prove myself …
    But yes, as I progressed to my final year, I met a lot of undergraduates, interns and junior residents just like the ones you just described. Wanted to wring them dry…of all the “attitude”…
    Also please tell me who discovered PBL, I have a few choice words for him/her…

  13. OMMGEEEE This is so freakin Hilarious!! and informative! Finally I find someone who also believes there ARE such things as a Stupid question!!! pahahaha
    Im so glad to see Im not crazy. Ive over heard some of the ridiculousness of residents, as a med school applicant, working in Hospitals and clinical research and its unbelievable arrogance and entitled attitudes. I can’t imagine coming so far and not remaining ultra humble and forever hungry to learn! If its in the water, Im drinking Aquafina once accepted!

    • I think lack of insight is a real issue with students sometimes, but that inherent arrogance is part of youth and humbleness is part of growing up! Thanks for coming back and following my blog 🙂 stick around as I am planning to get back into it as soon as crazy time at work is over next month!!

  14. I just found this blog from a post on Dr Kate Granger’s website and have loved reading some of your articles. I’m currently a final year medical student in the UK and am SO shocked at some of these stories; I can’t believe how disrespectful some of those students are and how they can have the gall to say these things. I think when you’ve got someone who’s gone out of their way to teach you (or even just acknowledge your existence and try to engage and involve you), to show a complete lack of interest is beyond rude. I’ll admit to perhaps not being the most conscientious of med students, and that sometimes you really do feel like a spare part who can’t do anything, but I have found that if you show up regularly and ask for things to do, you’re more likely to get somewhere. Great reading.

    • Hello!!!! I love new visitors to my blog! Thank you for coming by and reading my posts. I don’t think you are not conscientious at all, I think you’d be surprised with the impressions you are making just simply by showing up and asking to do stuff! When my students do that, I wouldn’t know if their knowledge is deficient, I would just think they are enthusiastic, keen learners and hard working. You would go far! 🙂 keep up the good work and enjoy your studies, with the right attitude, you’ll be an awesome doctor one day. Come back and visit again soon.

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