For the video version of this post, click here. Whenever I have a new med student on a rotation with me, I tell them the same thing. Your med student rotations will be the worst experience in your medical training. OK, so I might not be the best preceptor.
But I mean it. No one on the team is as scrutinized as the med student. No one gets asked as many medical trivia questions. The interns and residents, overwhelmed with the workload, get a pass. But the med students, following 1 to 2 patients, man, they better know every last detail. And of course, they’re being graded on this performance, and that grade will dictate whether they become a highly paid orthopedic surgeon, or, I don’t know, a nephrologist with a blog.
But the worst part, I think, is their feeling of impotence. They know what they want to do for the patient, but they can’t really do it. If they write an order, it has to be cosigned. If they write a note, it has to be reviewed. This is, of course, a necessary part of training, but I feel for them. And I remember personally how liberated I felt when I could finally be an intern, and really care for patients on my own.
Med students routinely stress about the impact they are having on the team. Are they helping things, or just slowing them down? Well, a study appearing in the Journal of the American Medical Association gives us some hard numbers, at least in one big urban emergency room. At UPenn, my old stomping grounds, the ED is staffed by med students 3 out of 4 weeks a month, providing a nice little pseudo-randomized trial. What differences occur in med student weeks compared to med-student-free weeks?
The researchers looked at about 15 years of data comprising almost 1 and a half million ER admissions. The patient characteristics were all pretty similar regardless of what week of the month it was – about 20% would end up getting admitted, 70% discharged, and 4% left without being seen.
The primary outcome the researchers were interested in was length of stay. Turns out, having a med student around increased the length of stay by about 4 and a half minutes. With a median length of stay of 3 and a half hours, this statistically significant result likely doesn’t matter that much clinically.
Of course, length of stay is just one factor of importance in an ER stay, and the authors don’t tell us things like the number of times a zebra diagnosis like Whipple’s disease gets caught or missed.
In the end, this study should give med students some reassurance. No, your presence on the wards doesn’t slow us down. Or, when it does, we’re happy to do it. Because, even a bad preceptor like me loves medical students for what they bring to us in those four extra minutes: enthusiasm, heart, and a reminder why we started doing this crazy job in the first place.
Well, I just took 150 seconds of your time. I hope you can forgive me. And remember, the next time you see a med student, give them a kind word and a pat on the back. They’re going through a lot.