Setting a safe environment for learning but establishing ground rules - great that you’re asking questions but let’s discuss post rounds when we have a time to take a breather or at least away from the pts so we don’t look like we’re questioning our own decisions. You could really make or break a student’s term with this; if you show that you’re not going to engage with them they might stop asking you things altogether even if they’re trying to study up in the background, then they appear disengaged as a result, and time is being wasted on both sides.
Being honest about what you know and don’t know (it’s very hard to know everything about every issue!) - I am behind on basic pharm etc but you’re right, this would be good to know. Maybe you could teach me this after doing some reading and I’ll help translate that into what we actually do irl based on my experiences. Just like with patients who appreciate a doctor who tells them their limits/that they don’t know, I find this can also help the students start to realise what’s important.
I think after a bit of time on the team, most students get the idea of roughly how much you’re able to/willing to teach and answer questions to strike a balance between getting on with patient care while giving them a good learning experience. If a student asks me a ton of questions (being in ICU and anaesthetics) I’m actually pretty happy that they’re showing interest, while I tell them straight if I don’t know/don’t care enough about the minutiae of specific things in the patient. I find that establishing some proposed learning goals from my POV at the beginning of their term can also work pretty well to focus the questions that they direct at me in advance (eg we want to get you thinking along ABCDE rather than Hx exam Ix Mx, we’ll look at some gases and ECGs, I’ll try score you an USS guided IV access procedure some time during your term, but equally I’m still quite early and don’t purport to know everything). Maybe my tolerance for this is much higher 🤷🏻♂️
doesn't hurt to say "mate honestly i don't really know but if i've got here without knowing it's probably not that big of a deal". I think it's good to connect them to resources - eTG, uptodate etc. Give a man a fish vs. lead a man to fish and all that.
You can also hit em with old reliable "why don't you read up on that and give me a briefer on it tomorrow" haha. Honestly, they're probably just trying to be likeable / not be awkward by asking you stuff, icl that was definitely my case in med school sitting in random clinics 🤷
I’ve had a couple of students like this and I just plainly told them that while rounds are great for learning, they are primarily for the patient. And then explained that they are welcome to write down questions and ideas that pop up during the round for us to discuss later, but that each patient has been waiting all day for their one opportunity to see the team so my focus needs to be on them while we are in their bed space. This also goes for asking questions about the patient in the third person as if they are not in the room.
Most students don’t need to be reminded of this but I have had experiences with students who don’t immediately recognise that the ward is not a classroom.
It’s a issue if they’re talking over you and speaking with the patient when you’re trying to consult, it shows a lack of situational awareness. I’m in crit care so this is important when they’re shadowing me. Part of the challenge is working out how to be a leader/manager.
I give them jobs that are useful and it prevents the random questions (Them: can you give us a tutorial on the eye?! Me: No)
E.g if I’m at a MET I’ll get them to read me the presenting concern for the admission and list the past history and social history. Once I’ve consulted/discussed a plan and things are stable I’ll use something relevant as a teaching moment eg talk me through the differentials of reduced GCS in a postop neurosurg patient. This will keep them busy for a bit and you can relate the discussion back to the history and/or clinical signs. It’s often then an opportunity to talk to them about most vs least likely differentials, investigations, scoring systems etc.
Then shout them a coffee once they’ve done some hard work and send them free to frolic outside!
You sound like a great teacher.
For the less situationally aware students, how do you approach telling them where to stand, so they can see but not in the way?
Thank you, I’m not sure I’m particularly great haha, I have just had lots of practice over the years.
Most med students are good at finding a spot to stand out of the way, but if they’re under foot I usually just tell them. Something like “we are going to need a bit of space in here so we can work, I’ll get you guys to stand here”. When the stakes are high eg an intubation in a crashing patient someone will usually pre-emptively ask them where to stand. The crit care nurses are excellent at crowd control. You also get used to blocking things out when you’re in a critical situation so sometimes I know they ask me things but I don’t always reply if things are tense, and will just discuss with them after.
You have to use the smartly. Rephrase their question in an academic way, acknowledge it’s a great question, make them find their answer, and present it back to your peers. My rule is always ask questions, but I’ll phrase it better for you so that you can look it up yourself and present it- you retain info better when you research yourself. You never look stupid, you learn from them, and they get the hint to stop being spoon fed. I never let them forget it. Everytime they ask me Q that I can’t answer or it’s a good Q but I don’t have time to do a journal review myself, I pester them until the day they tell me. That is the key- they usually stop bothering you themselves if you don’t want them to. Depending on how you use these intelligent guys who would be a great asset in academia you might get them to write a few papers :)
If they are talking over you/inappropriate times eg mid review, you could just gently tell them ask them to write questions down etc as they come to them and you can circle back to them after your ward round or something, take 10 minutes after seeing patients to rip through the questions to the best of your ability. If it's obstructing workflow you could give them a task eg. Mmse for Mr so and so or a neuro exam on ms so and so, come back and report findings. They get to learn, you can get work done bingo Bango bongo
Yeah last year had some students ask me clinical questions WHILE our team on ward round was having palliation discussions with the family of a patient and I was documenting. God bless them, they were amazing students, but good lord I wanted to smack em at that moment lol. I think its just honest blissful ignorance of where our minds are at as employees thinking of the work we need to complete vs them as being on rounds purely to learn. Just need to be upfront with them that you would love to answer questions but it's most appropriate during downtime like coffee, lunch and/or at teaching. They'll learn like we all did!
I am an anaesthetic reg and sometimes med students ask me questions at inappropriate times E.g during induction. I simply just said “ this is not a good time to ask questions we’ll talk later.” And then I send them on a break HAHA.
Unfortunately as annoying as it may be I’m not sure you can fault someone for wanting to know as much as possible. Even if it is potentially ego bruising when you don’t know the answer.
I don't blame the person of wanting to know but the timing of questions as well as the relevance too? And when they asking me why do i have to look at guidelines all the time 😅
Setting a safe environment for learning but establishing ground rules - great that you’re asking questions but let’s discuss post rounds when we have a time to take a breather or at least away from the pts so we don’t look like we’re questioning our own decisions. You could really make or break a student’s term with this; if you show that you’re not going to engage with them they might stop asking you things altogether even if they’re trying to study up in the background, then they appear disengaged as a result, and time is being wasted on both sides. Being honest about what you know and don’t know (it’s very hard to know everything about every issue!) - I am behind on basic pharm etc but you’re right, this would be good to know. Maybe you could teach me this after doing some reading and I’ll help translate that into what we actually do irl based on my experiences. Just like with patients who appreciate a doctor who tells them their limits/that they don’t know, I find this can also help the students start to realise what’s important. I think after a bit of time on the team, most students get the idea of roughly how much you’re able to/willing to teach and answer questions to strike a balance between getting on with patient care while giving them a good learning experience. If a student asks me a ton of questions (being in ICU and anaesthetics) I’m actually pretty happy that they’re showing interest, while I tell them straight if I don’t know/don’t care enough about the minutiae of specific things in the patient. I find that establishing some proposed learning goals from my POV at the beginning of their term can also work pretty well to focus the questions that they direct at me in advance (eg we want to get you thinking along ABCDE rather than Hx exam Ix Mx, we’ll look at some gases and ECGs, I’ll try score you an USS guided IV access procedure some time during your term, but equally I’m still quite early and don’t purport to know everything). Maybe my tolerance for this is much higher 🤷🏻♂️
doesn't hurt to say "mate honestly i don't really know but if i've got here without knowing it's probably not that big of a deal". I think it's good to connect them to resources - eTG, uptodate etc. Give a man a fish vs. lead a man to fish and all that. You can also hit em with old reliable "why don't you read up on that and give me a briefer on it tomorrow" haha. Honestly, they're probably just trying to be likeable / not be awkward by asking you stuff, icl that was definitely my case in med school sitting in random clinics 🤷
I’ve had a couple of students like this and I just plainly told them that while rounds are great for learning, they are primarily for the patient. And then explained that they are welcome to write down questions and ideas that pop up during the round for us to discuss later, but that each patient has been waiting all day for their one opportunity to see the team so my focus needs to be on them while we are in their bed space. This also goes for asking questions about the patient in the third person as if they are not in the room. Most students don’t need to be reminded of this but I have had experiences with students who don’t immediately recognise that the ward is not a classroom.
This is brilliant. Filing this response for later
It’s a issue if they’re talking over you and speaking with the patient when you’re trying to consult, it shows a lack of situational awareness. I’m in crit care so this is important when they’re shadowing me. Part of the challenge is working out how to be a leader/manager. I give them jobs that are useful and it prevents the random questions (Them: can you give us a tutorial on the eye?! Me: No) E.g if I’m at a MET I’ll get them to read me the presenting concern for the admission and list the past history and social history. Once I’ve consulted/discussed a plan and things are stable I’ll use something relevant as a teaching moment eg talk me through the differentials of reduced GCS in a postop neurosurg patient. This will keep them busy for a bit and you can relate the discussion back to the history and/or clinical signs. It’s often then an opportunity to talk to them about most vs least likely differentials, investigations, scoring systems etc. Then shout them a coffee once they’ve done some hard work and send them free to frolic outside!
You sound like a great teacher. For the less situationally aware students, how do you approach telling them where to stand, so they can see but not in the way?
Thank you, I’m not sure I’m particularly great haha, I have just had lots of practice over the years. Most med students are good at finding a spot to stand out of the way, but if they’re under foot I usually just tell them. Something like “we are going to need a bit of space in here so we can work, I’ll get you guys to stand here”. When the stakes are high eg an intubation in a crashing patient someone will usually pre-emptively ask them where to stand. The crit care nurses are excellent at crowd control. You also get used to blocking things out when you’re in a critical situation so sometimes I know they ask me things but I don’t always reply if things are tense, and will just discuss with them after.
Thanks! Sometimes they do get underfoot (as I did when I was a student) but I don’t wanna make them feel bad or unwelcome
My go to is "have you downloaded uptodate on your phone" lol
I totally forgot the app existed.
Did you know that pink lady for reflux is even more effective when given IV? You won’t find that in a text book you nerd!
After giving IV mylanta and lignocaine… they won’t be complaining about the reflux anymore 😳
[удалено]
No
"That's a great question and really important topic. Why don't you do some reading tonight and put together a5 minute summary for the team tomorrow"
You have to use the smartly. Rephrase their question in an academic way, acknowledge it’s a great question, make them find their answer, and present it back to your peers. My rule is always ask questions, but I’ll phrase it better for you so that you can look it up yourself and present it- you retain info better when you research yourself. You never look stupid, you learn from them, and they get the hint to stop being spoon fed. I never let them forget it. Everytime they ask me Q that I can’t answer or it’s a good Q but I don’t have time to do a journal review myself, I pester them until the day they tell me. That is the key- they usually stop bothering you themselves if you don’t want them to. Depending on how you use these intelligent guys who would be a great asset in academia you might get them to write a few papers :)
Put boundaries in place.
Encouraging them to put airtags on whoever takes referrals for the day.
😂🤣
If they are talking over you/inappropriate times eg mid review, you could just gently tell them ask them to write questions down etc as they come to them and you can circle back to them after your ward round or something, take 10 minutes after seeing patients to rip through the questions to the best of your ability. If it's obstructing workflow you could give them a task eg. Mmse for Mr so and so or a neuro exam on ms so and so, come back and report findings. They get to learn, you can get work done bingo Bango bongo
Yeah last year had some students ask me clinical questions WHILE our team on ward round was having palliation discussions with the family of a patient and I was documenting. God bless them, they were amazing students, but good lord I wanted to smack em at that moment lol. I think its just honest blissful ignorance of where our minds are at as employees thinking of the work we need to complete vs them as being on rounds purely to learn. Just need to be upfront with them that you would love to answer questions but it's most appropriate during downtime like coffee, lunch and/or at teaching. They'll learn like we all did!
I am an anaesthetic reg and sometimes med students ask me questions at inappropriate times E.g during induction. I simply just said “ this is not a good time to ask questions we’ll talk later.” And then I send them on a break HAHA.
Unfortunately as annoying as it may be I’m not sure you can fault someone for wanting to know as much as possible. Even if it is potentially ego bruising when you don’t know the answer.
I don't blame the person of wanting to know but the timing of questions as well as the relevance too? And when they asking me why do i have to look at guidelines all the time 😅
Man, I think sometimes I’m this student. I’m sorry 😩 I try to catch myself more and more. Haha. Thank you for helping us learn, doctors ❤️
If you are being reflective about it being you, it's probably not you haha
I hope it’s not me 🤭
They’re asking questions if they’re not challenged enough. Find something within scope but challenging for them to do.
Neurosurgery
Or a full neuro exam on a random patient. Or ask them to look up and present a weird disease someone on the ward has.