Kickin' @%...

Come early, stay late. Take initiative in your learning and in the care of your patients. KNOW THE ANATOMY FOR CASES. Always make your upper levels look good. Never say die. Make it appear as though you are never tired, hungry, thirsty, bored, angry, or overworked.
Realize that for thirty days there is nothing but ortho and that you'll get every second of rest you'll need when you die.

"Never show weakness, never show weakness! The only pain that matters is the pain you inflict!" -Coach Kilmer, Varsity Blues

Get it done.

Good luck.

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...and may I add that if there is someone on the team whose personality you don't like, don't let it be known, just suck it up.

while you're "sucking it up" try not to suck up too much. People see right through it. It is a very fine art to walk the fine line between being so eager that you get in the way and not being eager enough. Best of luck. I'm glad I don't have to do it anymore.

Agree with the comments above. It's tough to know what to do as a med student rotator. Being a new intern on ortho service right now, for the first time I have some "inside" info that I didn't have when I was a student just last year. We had a few med students on our service last month and a couple stand out over the others for a few reasons. I know it's tough taking call and not getting sleep, but you have to suck it up. The best students are the ones who never tire out. Some students are present in person, but they have a look on their face like they wish they could be sleeping or somewhere else. Everyone feels this way including all the residents who are on call, but look interested and be willing to help. Let your actions speak louder than words. Work your butt off, but don't ask questions when residents are really busy. Remember that the point is to get the job done as fast as possible. If a resident has 20 things that need to be done, don't add to the load by asking them questions that they have to take time to answer. That doesn't show interest, it shows lack of timing. There are times that are appropriate for questions when things are slow and residents are caught up with work. But at 2 a.m. with 4 trauma's in the ED, don't ask questions! Come to think of it, after 10 p.m on call, don't ask questions!! Just get the work done! Write the note, grab plaster/webrolls, be ready to hold an arm or leg, grab the xray...do anything that needs to be done to get the job done. And do it quickly and without complaining or looking like someone is beating you with a stick to do it. We had one student last month who was an absolute star in everyone's eyes. He was eager and worked his butt off when he was on call. It's easy to work hard at 10 a.m. when you've slept 8 hours the night before. The ultimate test is when you're dead tired, haven't slept for 30 hours, haven't eaten for a day...that's when it counts. The stars rise to the occasion at these times and are noticed! It's a lot to expect of someone, but it's reality -- that's when residents look at you and see what you're made of. We had one student who worked real hard, but after midnight in the ED, he looked like he was p@#$ed off to be awake at this hour. Residents love to have a student to help out, but they don't want a student who looks like he doesn't want to be there, even if he's there in person and going through the motions. At 4 a.m. in the ED or OR, LOOK eager, don't say a word unless you're talked to, run to grab stuff, write notes quickly, hold a leg like a stud, and don't comment on how busy it is. When on call, assume you won't be sleeping all night...if you do get an hour of sleep, consider it a gift.

More "tips":

-- nothing p@#$es off a resident more than a student trying to show him up. If you know something your resident doesn't, keep your mouth shut! Don't overstep your boundaries, or you'll get burned. Ask yourself, how would I like it if a 3rd year med student acted like he knew more than I do?

-- on morning rounds, BE ACTIVE! Have gloves on you and get dirty in the trenches! Be in there and ready to help the resident but don't step on his toes. Do all the dirty work.

-- If a resident tells you to go home (or to sleep or get something to eat) more than once, LEAVE!! Ask him "Well is there anything that needs to be done that I can do?" or something like that. If the answer is no, then go do your own thing. But have your pager ON SO HE CAN REACH YOU. AND ALWAYS ANSWER YOUR PAGES!!! Don't sleep through a page! That's just about the kiss of death!

We had one student last month who was a superstar. He never complained, was pleasant to be around, helped out tremendously on morning rounds, was just as active postcall as he was precall, had more energy than I did at 3 a.m., didn't step on anyone's toes, was quick to respond to pages, and was an all-around good guy. I know that I was pretty happy to find out he was taking call with me. And in the end, that's the ultimate measuring stick for a med student and how you want your residents to view you. You want to be known as an animal who gets things done and is hard-as-nails no matter how tough it gets. If your residents are happy that you're the one who's taking call with them, consider yourself a superstar.

Let your actions do the talking for you. You don't fool anyone by slacking on call with the intern or Pgy2, but then trying to "shine" when the attending or the chief is around. Remember that all the residents you work with have been med students and they know what it's like. Be consistent and honest in your work ethic, whether you're with the attending or with the lowly intern. Granted you have more leeway in joking around with the intern, but show respect to everyone, not just the guys at the top.

I know it's tough but prepare yourself for it. It's not reasonable to expect such things of a person, but that's the nature of this business, and unreasonable expectations are the norm.

I hope this helps.

I agree with all that Sharptool said. It's the nature of the beast. Those who decide to go down the ortho path must be willing to endure the pain with a smile on their faces.

This grasshopper thanks you once again...and maybe one day I will be able to grab the stone from your palm...
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And be a "cool" guy. don't kiss the hiney, but just be a "cool" guy. That means different things at different programs.

Another rotator no-no:

Don't take food out of the hungry intern's mouth. This doesn't refer to OR time. Med students should be scrubbed. I'm talking about on-call things. Try not to take call with the intern, but if you do, don't expect to do any of the hands on stuff. I had a student on call try to sponge in multiple times and ask the junior if they could throw on the splint or reduce the fracture!!!! If I were an upper level, that would be fine. But we interns need all the hands on experience that we can get (or at least I do). Your time will come. Understand that if you take call with an intern, or try to take calls with a junior if you want to get your hands dirty with that stuff.

Bonejock is absolutely right.

Bonedock and Sharptool are right on. Also, dont be a student that tells the resident how to do things. For instance, times where a intern is writing orders and a med student is beside you watching, dont advise the resident on how he should write the orders, Believe me, nothing gets on the nerves of a resident more than when a med student tells him what the right thing to do is. Also, keep your mouth shut in the OR unless spoken to. I am not talking about a couple of appropriate questions, I am talking about not trying to shoot the @$%& with the attending that you dont even know. Find the balance between being helpful and enthusiastic and getting in the way. Most students do the latter and it takes a strong one to know the difference. It is tough being a med student during an Ortho AI. Just be yourself and work hard. Be cool and laid back at smaller, more casual programs, and be more on your guard at academic programs where you will tend to do more skut. The best thing that can happen to you after your AI is not to be remembered till interview time. The students that are remembered at the end of the month are the annoying ones that will never match at that program. Also, get along with the other students in your group. We do pay attention to this, not only because it tells us how you will get along with your peers, but because when I was a med student, I couldnt stand pricks who tried to shine by attempting to make the other students look bad. For instance, if you want to show hard work ethic and see patients before the normal time residents round, talk to the other students about it. The last thing you want is to be the sole gunner and see patients when the other students show up and the normal time. It would be MUCH better if all the students saw patients prior to the residents. BUT, in reality, we residents dont really care if you see patients beforehand, so just chill and come when the residents come in. That was just a situation. Another situation I experienced is when a particular med student tried to hog as much OR time as possible without consulting the other students about it. All the other students want to get in and get as much face time with attendings, so talk amongst yourselves and work out a system, dont be the hog, is wil be noticed. Dont think you are the @$%& coming out of a big ortho program rotating at a place with other students. NO program wants a @#$%y SOB, so keep humble, even if you arent, which most are not, fake it for a month and fight every urge. In the OR, yes it is nice when students can write the op note or orders, but do this before the case is done and dont rush to get it while the resident or intern is going towards the chart to write it. I had some situations after the case, the student and I help put the patient onto the stretcher and I go towards the chart to write the notes and the student races me and nearly runs me over or snatches the sheet from my hand and insists on writing it. Dudes, just CHILL. IF we are intending to write it, it is not big deal and we will not hold it against you if you didnt write it. Another piece of common sense is, I am an intern, if a second year is asked a question in conference that he doesnt know, than if I am asked that same question by the upper level or attending and I know the answer, I still respond with " I dont know". Many will disagree with this, but as a student, if an intern is asked something and he doesnt know, dont be the student that interjects and answers the question for him also if you the student is asked the same question, take my advice and say I dont know, believe me, it is to your advantage that you dont p@#$ off the intern vs. thinking answering that one question is going to make you look sharp, most will think you are a idiot for correcting the intern. Just my two cents
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In total agreement with all the above (sharptool, bonejock, trackshun, et. al)...it's amazing that I just went through this last year but as a student you don't really see how other students behave in the OR or on call. Some of the things I've seen students do last month have been eye-openers. Trackshun and sharptool are right about keeping your trap shut when it comes to correcting interns and pgy2's. Last month we had this one student who at times felt like he knew more than I did (I'm an intern)...one time I was trying to reduce a hip and it was a tough one, so the idiot has the nerve to tap me on the shoulder and say, "alright that's enough". Last week my chief asked me what i thought of the students and what type of work they did and I couldn't help but shoot this guy down and his chances of coming here are practically nil...simply because when I was a student I kept my mouth shut and never even came close to stepping on the toes of a resident. Like it or not, this is a hierarchical system. I defer to my pgy2 under all circumstances but the line is a bit finer within residents than between students and residents. As a student, you shoot yourself in the foot if you try to act like you know more than your upper year. Read sharptool and trackshun's posts over and over again throughout your A.I.!!!!

Also agree about not talking in the OR unless absolutely necessary. Don't be a phoney, just keep quiet and answer the anatomy pimp questions and that's all you need to do. We don't want you to be our best buddy by the end of your month. Be genuine and don't force conversations or try to become buddy-buddy with the residents. This same kid would try to strike up a conversation with the attending and residents during a case, he'd start talking about boats/trips and the attending's latest vacation spot...but then when asked where the gluteus medius attaches to he'd be so quiet you would think he was in church. I suggest you do the opposite. Keep quiet and then look like a stud when you're pimped.

Also, when doing a splint, your job is to hold the limb, period!! Don't ever grab web roll and start wrapping! That's the resident's job. You'll get to practice putting on splints when you're an intern too. Right now, your job is to hold the limb and watch the resident wrap. I know it sucks but hey, that's all I did last year and we all endured what you're going through.

Doing ortho rotations as a student is very difficult and I remember not knowing what to do to impress people. I was not perfect and no one is, but one thing i never did was act like i knew more than my upper year or tell my upper year what to do.

My $0.02....I think there is a big difference between stepping in and telling an intern how to do his job, such as the "that's enough" example from Micky, and answerring a question when asked. I think a 4th year should be able to answer a question honestly when asked. If it will make the intern feel like more of a man, maybe phrase it "I think...", or "I am not sure, but I think I read this..."

I agree 100% that you shouldn't jump in and tell you intern how to reduce a fracture or wrap a splint. I also agree that you shouldn't try to answer a question your intern or resident missed without being asked, but I am not going to dumb myself down to spare someone's feelings. I graduated high school ten years ago and I am not about to start playing those games again.

I really don't want to work with a group of guys that are going to get offended that easily, so I guess I will use my willingness to answer questions as my weed-out factor. If they rank me low because I answered a question, then I will be fortunate not to spend five years worrying about who I will offend.

You have a valid point Ortho 2003, and Ortho thank God is not like G surg, but remember, it is still a hierarchy system. There were a few times were residents were asked a question that they answered wrong then the attending asked me the question. I did know the answer, but answered I dont know. This situation only happened twice since they usually go from the bottom up. All I am saying is that you will have plenty of opportunities to answer questions right or wrong later, dont try to outshine the residents. I was very conscious as a med student where in the pole I stood. It meant that I kept shut often, you may think this is childish, but it is the system and if you dont like it, good luck succeeding in it. I would be interested in how other residents feel about this. Believe me, I am a very laid back person in a very laid back program, so dont get the impression I am in a malignant program, but this stuff is universal rules anywhere you go. Have I been following the wrong rule book?
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Maybe I am fortunate to be in a great program where people really don't care about that stuff. I have never dumbed myself down when asked a question and I have answered several questions correct after residents (usually interns) missed the question. Don't get me wrong, I never jump in and answer unless I am asked first (I don't jump in on other students either) and I may use the "Uh, I am not sure, but I think..." line, but I don't pretend not to know the answer.

I have even taken this approach with attendings in correcting them when they mis-state something and not once has it come back to burn me. I have received glowing reviews from my residents and attendings on every rotation.

I do agree that it is important to avoid competing or trying to show up fellow classmates and house staff, because I don't want to be around people that are going to do that. My feelings aren't hurt when another student answers a question correctly that I miss (I guarantee I won't miss that same question again though) and I don't think an intern's feelings (ego) should be hurt if a student answers a question that he/she missed. It isn't like they have to worry about anything...they already have their spot.

Ortho 2003,
Man, you have some balls correcting attendings. I guess I never had the moxy to do that. Your mind is pretty set and I am not here to advise you since nothing I say will make you want to do otherwise. Those attendings may seem to not care when you correct them, but you will be surprised what is said in the sidelines when students arent around. You think you are getting great recs, but you havent read the letters from your ortho attendings who you supposedly correct. Just be careful, that is all I have to say about that and you and I will end this discussion, but I am interested in what other RESIDENTS think of this issue.

I am at a primary care school that tries to keep competition to a minimum. Maybe that plays a role in my experience. I haven't done an ortho rotation yet, so maybe I am in for a rude awakening and will be forced to change my stance a bit. Only time will tell.

I agree with 2003 in everything he said about answering questions when asked. If the residents are going to get ticked-off becuase some student knew the answer, perhaps they should recognize that the attending was the one who asked the question to the student in the first place. I wouldn't expect a med student student to lose his of her integrity by lying to the attending just to save the feelings of someone else. Again, this is only when a students gets asked the question after an intern missed. We are not talking about volunteering an answer w/o being asked. The latter is just pure arrogance.
About correcting attendings, I think there is a place for that, too. You do it in private (may be go to his/her office) and bring up the issue as a question "Dr. Bones, I didn't quite get it when you said that...my understanding was that...perhaps I am missing something" I think just by the fact that you are not doing this in front of the whole team he or she would appreciate and accept the comments.

I don't think you should pretend not to know an answer. If you know it, and are asked the question, there's nothing wrong with answering. But be aware of your place in the hierarchy. Some students lose track of it at times when their egos get the best of them. The good ones are always on their guard. Hey let's face it, when I was a student there were plenty of times when I felt like telling one of my residents to step aside and let me handle it because I thought they sucked at whatever it was they were doing. But resist this temptation. Don't correct people above you...But if you're ASKED A QUESTION, answer correctly if you know it, by all mean, regardless of who missed it before the question got to you.

Work as hard as you can, listen 95% of the time, talk 5% of the time. It's all about where your personality fits theirs. If it doesn't, there's nothing you can do to change that. Just work hard and get through the month without p@#$ing anyone off. I did a month at a program last year where I was just miserable. I didn't get along with the residents and had little in common with them. That's just the way it goes sometimes. I just tried to lay low and not get on anyone's bad side. It's hard picking away electives. Many of you will regret your choice of electives come October. I did 2 aways...loved one of them and hated the other. I matched at a place I didn't rotate at so it's it's not the end of the world if you hate your rotation.

Hang in there. There IS an end to this process!!

I'm a 2nd year resident at a university program. Here's some additional advice:

Don't try to be cool to hang out with. If you ARE cool to hang out with, it will be effortless. If you try to be cool, it will be painfully obvious and it will work against you.

If you can manage to get even one thing done on your resident's to-do list daily without having being told to do so, you will be ahead of the game. Many students I've seen wait until told to do something before pitching in. This may apply in cases where your unsure of what to do, but it doesn't apply to things you DO know how to do. For example, if you know how to pull drains and you see a patient on the list who needs a drain pulled, go ahead and do it if you're SURE it needs to be done. If you pay attention closely during card rounds you can be sure of what needs to be done. In that way you can act as an intern. However, if you are ever unsure you should just ask. I can just tell you that if a student is constantly asking me what he or she can do to help, I am constantly saying "nothing" because it takes more time for me to run through the list than to just do it myself. On your rotation you want to balance going to the OR and helping out with scut. Most of the time you schould be in the OR because you'll have the next 5 years to do scut, but any time you're out you should look at your list to get things done.

Being in the way is probably worse than not bending over backwards to help out. If you are trying to help and you see that you are getting in the way you should back off until told what to do.

Never talk smack about fellow students or other residents.

All of the other stuff about not showing up fellow students and residents is true. There's a fine line between not making yourself look unprepared and not making your resident look stupid. We don't want you to show us up simply because it makes us look bad - but students have more time to read than residents and may know certain facts that we won't be able to remember post-call. If you do show up a resident once, just make sure you don't do it again...or forget that program.

The bottom line is that you can try as hard as you want to be the star student and still be black-balled from a program because of personality conflicts. It's not entirely under your control. Just work hard, don't be late, and help get stuff done. If you fit in that program, it will be easy.

Good luck.

I couldn't agree more with Orthogirl. There is nothing more annoying than babysitting a useless and or demanding medical student. No one expects you to have a clue the first few days of a rotation, but if by the second week you are still not somewhat self-sufficient it can make a tired resident irritated. Paperwork is always great to have help with. Example, pay attention to what your residents write for home going instructions on a few cases and then offer to fill them out. Anything that makes the paperwork go faster is a HUGE help. Just don't do something that you aren't sure how to do it and then screw it up. You can virtually forget about a program if a resident has to explain a med student screw up to an attending, which generally means taking responsibility for it.

If you know an answer to a question, fine. That is great. Everyone knows you are working your ass off to try to get into ortho. If your resident doesn't get it right and you do, so be it, just don't gloat about it. And DON'T get @#$%y! There is no better way to get blackballed than to be overly @#$%y. I rounded early on a patient and was writing the note when a med student showed up. He actually had the nerve to ask me how I could write such a detailed note without even seeing the patient? I of course had already seen the patient. Questioning your residents integrity...NOT A GOOD THING!

It probably isn't fair, but you may not even know you p@#$ed someone off. I made a brief comment to the med student about questioning my ethics, but never mentioned it again. As you can tell, I am still hacked about it. The safest bet is to keep your mouth shut as stated above others. If you fit in, it will come naturally. Also kissing ass can be just as annoying as getting in the way. Just help out and don't make more work for you resident and things will go well.

Titanium

All very good points.

as for answering questions after a resident has missed it. Go for yours. Be modest (er, huh I think the answer might be, yada, yada, yada), but answer the question. One fact remains

---

> that resident has his/her residency spot. you don't. you still have to impress. And I'd never be mad if a student new an answer that I didn't.