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question of the week 
23rd-Jan-2009 11:38 am
PMR
What is the story of the worst med student you ever supervised?
Comments 
23rd-Jan-2009 10:02 pm (UTC)
I was on Nephro consults with a third year named (oh we'll call him) Joe. Joe looked very professional and after my previous medical student, I had high aspirations. The attending told me to give him an interesting patient and for him to go through the chart, see the patient, and present the whole history & physical. So I gave him a patient with ARF secondary to lupus nephritis. After about three hours, no one had seen him. We paged him to meet us at the patient's room so he could present on rounds. He presented that she was here with ARF, that she was up-to-date on her immunizations, and gave us a very detailed family history. But he'd forgotten to do a physical exam, and he had no idea what her lab values were (even though someone had consulted us for ARF). THREE HOURS!

A close second would be the student we had before Joe. He was very smart, but incredibly lazy... he was given 1-2 patients to see before rounds each day. My first day there, I came to see a patient that we were co-managing... no note from him. I wrote my note and went about my business. When we rounded on that patient in the afternoon, his note was right underneath mine and it was something like...
"Mrs M is a 37 year old Hispanic female with unresolved ATN. Her vitals are stable. She is getting dialysis today. She complains of not being able to make it to the bathroom on time. Plan: foley cathether"
When we told him that he needed to write the vitals, do a physical, and write up a full assessment/plan, he went back, pretty much copied my note into a word document, printed it out, and then taped it over his original note in the chart...
24th-Jan-2009 04:30 pm (UTC)
That is awesome :) I love these stories.
24th-Jan-2009 02:01 am (UTC)
I had one on inpatient peds who was *very* lazy. If his patients had gotten discharged, he'd just show up to rounds without having asked anybody for new patients or seeing anyone. So he'd walk around with us and just listen. No initiative! Worse than that though was his attitude on call. Our med students only take short call, until 10pm. (And then they get to leave at noon the next day! These kids - pampered, I tell you.)
Anyway, he was on call with me the one night and we admitted a patient with CF. He sighed over having to write a H&P on the patient. Then we got a new kid in DKA, and my upper level resident asked him (in that not-really-asking way) if he wanted to come along to admit the kid. He said "Only if I don't have to write an H&P on him!" I had to sit him down and explain that one of the major reasons for having the students take call is so that they get practice doing H&Ps, since most of our admissions come in the evenings. He did the H&P, reluctantly, but tried to get out of writing out the plan for how we were going to cover the patient with insulin. I made him write out the entire sliding scale, only to discover that he had no idea even what type of insulin we used for high coverage/carb coverage, etc. even though our attending had given us a lecture on it only two days earlier! (Seriously, it doesn't take much thought to realize that we don't cover highs with lantus.)
24th-Jan-2009 04:29 pm (UTC)
Well, if he actually knew what he was doing, he probably wouldn't have been so reluctant to write the H&P. I remember on my first rotation as a 3rd year, writing the A/P always seemed so challenging because I didn't know what I was doing.
24th-Jan-2009 04:17 pm (UTC)
Last year when I was a surgery intern, I had this one student...let's call him Steve. Steve was a very smooth talker, and I didn't really care about surgery a whole lot, so even though I normally hate people like that, I didn't give it much thought. My thing was (and still is), as long as you show up on time (most of the time..crap happens), at least try to do some work to help the interns out, and are honest, I'll give you a great eval.
THIS kid was a piece of work. Among his infractions:
1) the very first day of his rotation, he somehow made his way into the resident lounge, and we found him laying down on the couch with his feet up, watching tv, drinking a soda he had stolen out of our resident fridge
2) "disappeared" for 3 hours while taking a weekend call (he had left to "go pick up a prescription he needed")
3) came up to the chief and myself when we were discussing a patient and said "you know, I don't think Stephanie (other student on our team) has read up on cholecystitis. She doesn't know anything about it. Can I scrub in on the lap chole today instead?" he always put down his fellow students
4) failed to round on his ONE PATIENT three days in a row. First day: "oh I forgot . I'm sorry." Second day: "my alarm didn't go off, I'm so sorry". Third day: " i was up all night vomiting, I feel so sick, I'm so sorry." (mind you, minutes later I see him leaving the cafeteria with an enormous greasy omelet and a giant cup of coffee. I don't know about you, but when I've been up all night vomiting, the last thing I want to eat or drink is grease and coffee).
5) he was scheduled to be on call one saturday. the other student was on call with me overnight friday. she told him that he didn't have to worry about rounding on our patients sat. morning, because she would do it. he took that to mean "don't show up for call at all" and didn't show up until the intern on call that day finally tracked him down at 3 pm.
6) looked aghast when i told him that when writing a note, we had to look at all the vitals and write the lowest and highest (i.e. Temp 99-102 overnight), and actually said "I am supposed to look at EVERYTHING? And be able to do this within an HOUR?"
7) gave me attitude when I told him that our patient with gallstone pancreatitis admitted overnight would NOT be going home that day when he started talking to our ATTENDING about discharging her that day
8) had the gall to say to me, "you know, I have ADD, and I literally spend every minute outside the hospital studying. Even at red lights. So, you know, if you could let me go early every now and then, I'd really appreciate it."
the kicker to this story is, I'm now a radiology resident at another hospital (i was stupid and did a surgery prelim). guess who showed up to interview at my program? (when he was on my team, he said he wanted to go into ophtho. i didn't actually get to interview him, but everyone who did said he was a massive tool. go figure. by far the WORST student I have ever come across.
24th-Jan-2009 04:26 pm (UTC)
Haha, that is great. I especially like #8. There's always a few people in every class who are total characters.

These med student stories are awesome.
26th-Jan-2009 05:27 pm (UTC)
I had a student doing an EM rotation. He was working with me on a night shift. Now for some background, I'm not very demanding of my students, but this guy was just lazy.

In the kiddle of the shift I look over and see him surfing the net, with three new charts up. When I asked him if he was going to see one of the new patients he replied "Two of them require pelvic exams, and I don't feel like doing one right now. The other is a psych case, and they are boring." When I told him to pick up a chart, he left my area. He eventually came back. Later in the shift he asked what procedures I let my students do. Sometimes I wish I could say exactly what I want to people.
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