Originally posted May 5, 2014
By Lindsay Heuser
Dear (future) self,
I imagine that you’re busy right now. Like really busy. Like the coffee-driven, adrenaline-fueled, sleep-deprived kind of busy that you experienced to a lesser degree in medical school except now you’re actually expected to care for patients. Of course, by “care for patients,” I mean “avoid doing dumb things to patients.” A terrifying thought, the burden of patient care, but I’m sure you’re learning and becoming more confident by the day. Why, you’re becoming a real physician now! No longer do you float around the hospital following the residents around like a duckling, attempting to show that you too can think independently and provide assessments and plans like a good medical student. No, you are the resident now. The follower has become the followed. You are the mama duck.
And so, self, I am here writing to you as a current medical student on appropriate ways to deal with these so-called ducklings. It seems to me that the vast majority of residents tend to forget what it once was like to be a duckling. How it felt to desperately yearn to have actual responsibility over patients or to be constantly, actively thinking about each and every patient problem because it hasn’t yet become automatic. The algorithms that physicians instantly zip through in their head run a little (okay, a lot) slower in these duckling students. I know they run a little slower in my head now, but with time and practice, these things will become automatic, as I imagine they are for you and most residents. I would like to think that you’re self-aware enough to remember a time when you struggled with the great transformation from didactic thinking to clinical thinking and are thus gentle to any student in the midst of the learning process. But just as a reminder, here are a handful of tips, as selected by your younger self, a current medical student, to better handle any medical students you may encounter during the resident journey:
1. Make a valiant effort to let the medical student interview the patient first. Remember how much you once hated shadowing? Well, it still stinks. Try to let students interview the patient first, present to you, and remind them that it’s okay if they don’t have the correct assessment and plan as long as they try to put one out there. Of course, to even have the opportunity to provide an assessment and plan, the student has to interview the patient first. It’s pretty much a requirement. Remember, independent thinking starts with independent doing.
2. Medical students LOVE to be helpful. Now, this doesn’t mean make medical students do dumb tasks like retrieving coffee. It means, give them useful tasks that simultaneously help you out with your workload. Have them communicate updates to patients and their families. Let them have a first stab at writing the H and P. Encourage them to take responsibility over the patients assigned to them. Giving medical students some semblance of structure and accountability makes their little hearts soar. Whatever you do, just don’t ignore them. Few things in the world are sadder than a medical student scorned.
3. Let the medical student free at the end of the day. Remember how awful it was when you had nothing to do, and you were trapped in the hospital because your resident hadn’t given you the “okay” to leave at the end of the day? Often, medical students express their desire to go home with the age-old question, “Is there anything else I can help you with?” You know you asked this question MANY times. When your students ask you this, and there truly is nothing for them to do, set them free. In fact, if there’s nothing for them to do, be proactive and release them before they even ask you the question. This goes back to the idea of acknowledging the presence of a student on your team. Medical students have certain limitations because they are, well, medical students. If the work left for the day can only be done by a resident, be merciful on the student, and send them away from the hospital to study, eat, sleep, see friends and family, etc. While you may have longer hours as a resident, students have the additional obligation of studying for Shelf Exams and other such delights outside of their time at the hospital. Remember when that was you? Let them do this studying (and/or life living) on their own at home in the peace of a location that is not the hospital.
4. Be patient when a student has a brain fart. It’s happened to you. It’s happened to all of us. Those times when an attending asks a question that you know and then poof…the answer flits away from your head, only to return after you have stared blank-faced at the attending for several seconds. Thoughts are racing through your head. So much is happening up there, and yet, only an “uhhhhhhhhhhhhhhh….” has departed from your lips. Smile at them when this happens, and remind them that it’s “okay” if they don’t know the answer today. Encourage them to learn it for tomorrow, and give them more than just a single chance to succeed.
5. Above all, know that you can make an impact on a medical student, even if they’re on your service for only a day. The best residents you encountered during medical school were the ones that went above and beyond in their effort to teach you. They asked you what you wanted to get out of the rotation and tailored their teaching to your interests. Those residents were the ones that stuck out, and for all the best reasons. They were sincere, passionate educators. You can be like them too. You just need to make it a priority to take each student’s education seriously. Don’t buy into the excuse that a student needs to be on your service for a month before you’ll incorporate them into the team. Don’t buy into the excuse that you’re too busy to educate medical students. Don’t buy into cynicism in general. Embrace each new student on your service regardless of how long they’ll be with you, and do your best to teach the heck out of your specialty. All you need is a day to make an impact.
And so, self, I think most of my advice to you, the resident, on dealing with medical students harkens back to the adage of “Remember where you once came from.” We were all learners at one point or another. We struggled, we goofed up and we endured. Never ever forget that you were once the person struggling in front of you. That you once lacked the innate confidence and instinctual knowledge you now possess. Teach your students when you have free time. Make sure they know the team’s lunch plans for the day. Give them advice on where to park and when to show up. Make them look good in front of attendings. Don’t make them feel awkward if they come dangerously close to following you into the restroom. Be the best mama duck that you can be, and treat those ducklings with grace, finesse and kindness. I know you can do it during your residency and beyond.
Your (younger) self