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garlic

When a resident tells you to go home?

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Hey all, I was hoping to get your opinions on a topic (just for discussion/out of curiosity). I'm an MSI3 on rotation with another student from a foreign institution. Post-call I'm usually given patients to round on whereas the other student gets to go home when they're post-call. Obviously it differs person to person, but what are your thoughts on this? I'd like to think it's because my home school is trying to train me better or that I'm capable at ward stuff, but I highly doubt that's the case. If not, then am I being punished because the resident(s) don't like me or something....

Also, what is the etiquette when a resident tells you to go home? As an MSI3 I imagine it'd be annoying for them to have me around, so it seems like I should just say thank you and leave. Is it any different as an MSI4 when youre trying to impress them?

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27 minutes ago, garlic said:

Is it any different as an MSI4 when youre trying to impress them?

Why aren't you trying to impress as an M3? My understanding is that all rotations are evaluated and matter. 

Sorry this doesn't answer your question, but I'm a second year med student so I'll let people knowledgeable on this topic answer.

 

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Specific expectations for core/elective students tend to differ. In my experience, not all school's automatically put elective students on call for a rotation you may have to specifically request it by contacting the chief resident etc. (you should IMO if you are interested in a program).

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4 hours ago, JohnGrisham said:

If they tell you to go home, and youre done your work..you go home. Take the opportunity its not a trap. Nor will you get any demerits.

This. It's not a trap. Either they want to be alone or they remember the pain of being a clerk and want you to relax. Just go. 

As to why your given extra load: many foreign medical education systems don't have clerks doing very much. They basically follow staff, observe, and answers questions. They don't really get involved or work independently until their intern year (first year of residency). North American clerkship is very different (and strong) in that regard. Many residents are aware of this difference, and will assign tasks/workload appropriately.

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again to add - not a trap. 

Residents know clerks are unpaid trainees often in a stressful overwhelming situation. We just went through that experience very recently ourselves. We shield clerks in a ton of ways that are both obvious and not. If someone tells you to go - go.

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23 hours ago, garlic said:

Hey all, I was hoping to get your opinions on a topic (just for discussion/out of curiosity). I'm an MSI3 on rotation with another student from a foreign institution. Post-call I'm usually given patients to round on whereas the other student gets to go home when they're post-call. Obviously it differs person to person, but what are your thoughts on this? I'd like to think it's because my home school is trying to train me better or that I'm capable at ward stuff, but I highly doubt that's the case. If not, then am I being punished because the resident(s) don't like me or something....

Also, what is the etiquette when a resident tells you to go home? As an MSI3 I imagine it'd be annoying for them to have me around, so it seems like I should just say thank you and leave. Is it any different as an MSI4 when youre trying to impress them?

If you are really interested in the rotation, i.e. its a specialty you want, it may be beneficial to be extra keen. All this depends on the service, your interest etc., but generally, if they tell you to go home, always double check theres nothing you can do. If you have that confirmed, you can safely go home. If this is your specialty of interest, ask residents and seniors for advice, some specialties/location combinations have hidden expectations that you may need to be in the know to fulfill and do well. 

If this is not a specialty you are interested in, go home when they tell you to. Often times they don't expect as much out of elective clerks, it could be for a variety of reasons, the elective clerk may not be as experienced or expected to do as much. If the elective clerk is just here to have fun and travel, they wouldn't be expected to stay post-call for example. 

 

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I would tend to agree with the last post, i.e. not to come across as *too* eager to jump on an offer to go home. I don't think any deliberate trap-setting exists per se, but it is generally appreciated if a trainee double-checks that there is truly nothing useful that they can do before they leave, and that they are getting in the way if they stay longer.

With regards to keenness (not that you need to go the extra mile on all rotations), I've seen staff back off their initial offer to go home if the trainee expresses a true desire to stay for that upcoming late case, and then comment favourably on their enthusiasm. It's doubly impressive if a trainee is keen on a rotation that they are clearly not going into, or are an off-service PGY1, with word even travelling back to their home program. 

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On 7/17/2018 at 11:04 PM, Lactic Folly said:

I would tend to agree with the last post, i.e. not to come across as *too* eager to jump on an offer to go home. I don't think any deliberate trap-setting exists per se, but it is generally appreciated if a trainee double-checks that there is truly nothing useful that they can do before they leave, and that they are getting in the way if they stay longer.

With regards to keenness (not that you need to go the extra mile on all rotations), I've seen staff back off their initial offer to go home if the trainee expresses a true desire to stay for that upcoming late case, and then comment favourably on their enthusiasm. It's doubly impressive if a trainee is keen on a rotation that they are clearly not going into, or are an off-service PGY1, with word even travelling back to their home program. 

Nah... I'd take the offer and go home. :D

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I would just add to the OP that not all residents find it annoying to have medical students around - I find them to be immensely helpful and, being in the early stages of residency, find myself working with students more or less as level colleagues, minus teaching them what I know when they're up for it and being there for them when shit hits the fan. I have no reason to have forgotten what it feels like to be a med student and when I suggest to my med students to go home it's honestly b/c I want them to get rest and have time to study for their million exams around every corner. I have yet to come across a med student who I wanted to send home b/c I was annoyed with them, although I guess there might be a first for that later.

tl;dr don't get discouraged when residents tell you to go home thinking they're annoyed with you! chances are they mean well.

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It seems the OP has the opposite issue than most of the responses, but I do think the above is generally awesome advice. OP is asked to round post-call whereas their counterpart from another institition is told to go home.

As someone mentioned, sometimes the expectations for home-school trainees are different than elective students from other institutions. Residents/staff may be asking you to round based on these expectations. Similarly, if you're post call and it's not 24+2hrs worked, it's fair to expect that you may need to wrap up work (especially on rotations such as MTU/CTU). I also don't know the context of the overseas trainee. If this is a person who has already graduated medical school and is gaining further experience for the purposes of 

At the end of the day, the answers you get here will be speculation. Something that I think is reasonable in all rotations is the check in with a resident on the team to see how you're doing and if you could be doing anything differently. I wouldn't necessarily approach your issue off-the-bat, but if there's something they are concerned about with your performance then it should come out in that conversation if they're decent mentors.

If nothing comes of that conversation and you're finding yourself working much past the 24+2, I would either bring it up with your rotation supervisor at your medical school or simply inform the most responsible resident on your service of your concern.

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Thanks for all your advice and perspectives, everyone! Really helpful to have gotten feedback from people at all different stages of training/practice. Can confirm that no changes in group dynamic have occurred since I've actually started going home after calls or when offered. Nice to know it wasn't a test of how dedicated I was to the rotation or team or whatever else.

Oh and it turns out the foreign student asked not to be given certain duties since they're not comfortable with it. Apparently clerkship back home for them is more like shadowing from 9-5...

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While on the Internal Medicine CTU, I usually send my medical students home early. On week end day calls, I send them home by 4 pm if nothing is scheduled to happen  (no admission, no deteriorating patient...) while I stay until 8pm for the sign over. 

I usually get a positive answer and the student leaves with a smile. Who wants to stay to work if nothing happens ?

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On 7/17/2018 at 9:32 PM, mavrik13 said:

Three rules to surviving clerkship.

1) If there is a chair, sit in it

2) If there is food, eat it

3) When someone tells you to go home, don't ask twice... go home!

inspired by the house of god ha. 

 

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On 7/17/2018 at 12:43 AM, NLengr said:

GTFO asap before someone changes thier mind. 

Couldn't agree more. Junior people are always scared to leave. I always found myself hanging around for hours, doing nothing, waiting to be 'sent home'. I've grown up. If i'm not doing anything and the team doesn't need help, I'm watching netflix and napping on the couch at home. I might even think about going to the gym. 

#worklifebalance?

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On 7/17/2018 at 7:51 PM, Edict said:

If you are really interested in the rotation, i.e. its a specialty you want, it may be beneficial to be extra keen. 

 

I'm not going to lie, I sometimes find extra-keen medical students really annoying. The best students are the ones who do the work without having to be asked. They are the ones that take initiative to help out without the expectation of being rewarded. They're the ones who are generally pleasant and enjoyable to be around. I've sent students home because they were driving me nuts or they had a poor attitude. 

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51 minutes ago, sleeping_sickness said:

I'm not going to lie, I sometimes find extra-keen medical students really annoying. The best students are the ones who do the work without having to be asked. They are the ones that take initiative to help out without the expectation of being rewarded. They're the ones who are generally pleasant and enjoyable to be around. I've sent students home because they were driving me nuts or they had a poor attitude. 

I agree. by "extra keen" i was actually referring to the things you described i.e. doing the work without having to be asked, and taking the initiative without expectations of reward.

The picture you are describing sounds like someone who is "in your face keen" which is not the way to go for sure. 

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Just now, Edict said:

I agree. by "extra keen" i was actually referring to the things you described i.e. doing the work without having to be asked, and taking the initiative without expectations of reward.

 

 

55 minutes ago, sleeping_sickness said:

I'm not going to lie, I sometimes find extra-keen medical students really annoying. The best students are the ones who do the work without having to be asked. They are the ones that take initiative to help out without the expectation of being rewarded. They're the ones who are generally pleasant and enjoyable to be around. I've sent students home because they were driving me nuts or they had a poor attitude. 

I know I’m just entering the system, but what would you consider “extra keen”. Like asking if there is something you can help with or fill out? Or that’s a good amount of keen? Thanks, just trying to gauge what’s “extra” in med compared to my previous career where most people are not that keen on volunteering for things lol.

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I don't think any residents have any ulterior motives. If they're sending you home, it's either because there's really nothing left to do (or there's scutwork that only they can really do) or because they want you to go because they're in a bad mood/not in the mood to teach/just want to be alone. Just go home.

 

"Overkeeness" would be highly dependent on each resident/staff. For me, asking a million questions, just for the sake of asking questions "and looking interested" drove me nuts.

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