Sunday, September 27, 2009

Medical Students

A while ago I was walking towards my room first thing in the morning when I saw what could clearly only be a medical student hanging around outside. Immediately one thought came to my mind, " Please let him be for the urologist and not for me". Fortunately he was for the urologist and I had as pleasant a day one can have in a urology room. I did feel bad about how I thought when I saw the student however when I related the story to another staff member, she said feels exactly the same way when she sees a student in her room.

I used to love teaching. I really believed that anaesthesia was the coolest specialty, I wanted every medical student to go into it. I wanted to teach everybody to intubate. Even those people who had a clear career path mapped out already, I thought I could help. The future internists I felt I could teach them not to write those stupid consults; the future surgeons I felt I could teach to, well just not be so stupid. I loved having students in the Pain Clinic; I was evangelical about chronic pain back then.

No more. I decided I wouldn't take students in the Pain Clinic over 10 years ago (I make exceptions for students who contact me personally). Conditions of my hospital appointment require me to take medical students (and RT students and paramedic students) in the OR; that doesn't mean I have to enjoy it.

There is no single reason.

I like to work alone. In the OR I work with the nurses and with (or against) the surgeon. Medical students somehow ruin that dynamic. I have what I call my crease. That is a triangle with the three points being the patient, the machine and the anaesthetic cart. I don't like people in my crease; medical students get in my crease. In the Pain Clinic at least one patient every day is either going to cry or else call me an asshole. Why would I want someone to witness that.

I have gotten older. When I started medical students were often only a few years younger than me, occasionally my age or older. Just about every medical student now was born after I graduated from medical school. Generation gap city. (This also applies to residents but I can actually get some work out of them).

Over two years of interviewing prospective residents, I have learned that most medical students' shit doesn't smell. All that volunteer work, overseas missions etc. Sometimes I just don't feel worthy having them in my crease.

How many times can one explain how an anaesthetic machine works or the difference between a depolarizing and non-depolarizing muscle relaxant. Or explaining why we don't use halothane and enflurane like they learned about in pharmacology (actually I can't explain why we don't use them anymore).

I feel I have to entertain them and I usually run out of material by about 10 am.

Nowadays you have to be so careful about what you say.

As students have to make their life decisions so early in medical school, many students are doing an elective in order to get a letter of reference from you or from the fool who agreed to coordinate students for your department. This means that you have to fill out an evaluation and woe to you if you check anything less than excellents dooming them to a career in radiation oncology. A colleague of mine at another hospital who coordinates students says she spends a great deal of time dealing with complaints about such evaluations. By the way, when I got to interview prospective residents I read some of those reference letters and couldn't believe what was written because I have never seen a student that was as good as some of those letters made them out to be.

Certain cases of course aren't good for teaching. The patient is too complex, the operation too risky, tension in the OR, having to do things quickly no time to explain why. I always feel bad telling them they should go and read for a while but sometimes the best way to help me is not to "help" me. One introduction since I trained is the laryngeal mask. I love this device and use it for about half my cases, many of whom I used to intubate. I just can't see modifying my technique for teaching purposes. Actually a couple of years ago I was assigned a medical student for a week which is normal at our hospital. By Friday he hadn't intubated a single patient. Friday I had a list of arthroscopies, who I usually do with an LMA. I felt sorry for the poor guy (even though he wanted to go into ortho) and so I modified my technique so he could intubate. Anyway, they were all smokers who coughed, bucked, horked and generally desaturated post-op and of course my student missed all five intubations.

I of course did an anaesthesia rotation as a student and again as an intern. Some staff were friendly and pleasant to work with, some were not. It was the ones that weren't friendly (and the prospect of 6 months on internal medicine) that lead me to not apply for anaesthesia right away. I realize the necessity to teach the incoming generation just as I was taught. Next time I see a student in my room however, I will be keeping my head down and avoiding eye contact.


Medical Assistant Employment said...

There is really nothing else you can do except try to stay amused. Considering the politics and the strictness of the medical industry, especially as a student, there is not chance for real opinion. Every step taken has to be carefully thought out, and reflected upon. Many medical students that I have come in contact with have become over-stressed and over-worked, all to get the exactly right result, or exactly right answer. The drive they all had in the beginning is watered down and forgotten by the time they leave medical school. My favorite example of this is the movie "Patch Adams".

Bleeding Heart said...

Medical students are overstressed mainly by the pre-licensing system that was imposed on everybody by a small group of self-interested physicians 20 years ago.


See some of my previous posts on this.

Anonymous said...

I hated medical school. For the most part I just kept my mouth shut and my eyes averted for fear of pissing someone off. I went into medicine because the science was interesting and the employment would be steady. From clerkship onward its less about science and more about sucking the right cocks.