S4E9: Perception Awareness

Margaux: Leen, how do you do night shifts? I'm so tired.

Leen: I love night shifts.

Margaux: That's true. You have always been a night owl/vampire. Do you want to introduce Part 3?

Leen: Yeah, this is Part 3. Let's start. Go.

Harjit: Who? Me?

Margaux: Yeah, you.

Harjit: Oh, me. Okay. Hi, y'all. This is Harjit.

Margaux: Hey, hey.

Harjit: Just kidding. I think I was too excited. Hi, everybody. This Harjit. Welcome to "Bundle Of Hers." Today, we have in the studio, virtual studio, Margaux and Leen. I hope you all checked out Part 1 and Part 2 of Shattering Perspectives. Welcome to Part 3.

Today we thought it'd be great to discuss how our views on medical students and being a medical student, but also seeing medical students now as interns, how that has shifted and changed.

Margaux: Okay. I will say the biggest shift in my perspective as a resident now working with med students is realizing how . . . I don't want to say unimportant, but how not critical your role as a med student is compared to how critical you feel like it is as a med student.

As an intern so busy, I kind of ignore . . . or not ignore. I pay attention and I want to teach them and stuff, but if it's really busy, whatever the med student is doing, I'm not paying attention to. Whereas I feel like as a med student, you feel like your every little move is being watched. But as an intern, I literally am just typing and seeing patients and . . .

Leen: You're not that much under a glass as you feel you are.

Margaux: Exactly. So that has changed.

Harjit: Oh, definitely. And I think this is maybe even great for anyone who's going to be a third- or fourth-year medical student. This is a great episode for that, so please share with your friends. I think we'll be dropping a lot of knowledge right now.

I think the biggest thing that I remember is what kind of actions are super helpful and what kind of actions are not super helpful. I didn't have that awareness when I was a third-year med student. I just was doing stuff, learning things.

I want to backtrack. I think I did have that awareness. I will say my strength has been in the clinical setting. I've already discussed how I really am very, very, very bad at tests, but my strength lies in the clinical setting because I think I was . . . I had a little bit of that awareness.

But just as you said, Margaux, what we do isn't under such a magnifying glass when you're a med student as you think. You think the whole world revolves around what you're doing.

Margaux: Totally, but it doesn't.

Leen: No, it doesn't. But I want to emphasize how, like you said, Harjit, there are some actions that are way more helpful than other actions. As a med student, you don't really see that I feel, at least when I was a med student. But now that I'm an intern and I'm trying to manage working with a med student as well as getting a team and everything, the stupid things that we thought as med students that really helped . . .

For instance, in the trauma always being like, "Someone call the CT scan," or, "Someone else call X-ray." And I used to think as a med student, "That's not helpful," but then I realized it's those things off my mind in that moment and it's really helpful.

Harjit: So helpful. It's so helpful if the med student helps facilitate something or has a conversation. You have so many other things to do, that if someone could send this fax or get this paperwork done or find out this information from an outside hospital, it's so helpful.

Leen: And I can tell you that honestly, if in that moment, when I'm thinking, "Okay, now we have to go to CT scan," or, "Is a CT scanner ready?" and then they'll be like, "No, no one called," that moment actually frustrates me way more than any other moment because it's like, "Oh, shoot. It was so simple. I should have just done it myself."

Harjit: It's not having the perfect presentation that always matters. Even for attendings, I think, yes, the perfect presentation is nice but attendings notice when you're doing small little things like that. You don't need the perfect presentation. You don't need all the perfect, "Twenty percent of this is showing. This article shows this." It's the small little things that really . . . that awareness of situation and awareness that someone might need my help, if I can just go grab that ultrasound really quick for that doctor. That is super helpful.

Margaux: And I will say I feel like the med students who have been really engaged and asking questions and thinking about other patients that aren't even assigned to them are the ones that stand out in a positive way. But when I think back as a medical student, I think I felt like I was being annoying or I was afraid if I was being annoying by asking so many questions or being engaged or asking to help.

But now as a resident, my perspective has changed in that that student is the one that stands out in a good light to me, who's engaged and wanting to learn, versus the med student who maybe in their mind is like, "Oh, I'm just going to stand back and not be in the way." But they seem, from my perspective as a resident, totally uninterested and therefore kind of like drags the vibe down of the team. So that's something to think about.

Whereas maybe your perspective as a med student is like, "I'm not interested in peds, so I'm not going to engage and I'll just sit here in the corner and be out of the way." I still notice it because it brings the energy down in the room, versus the student who's asking questions and at appropriate time. Obviously, if it's busy, don't be asking a million questions.

Leen: There's also something called too much engagement.

Harjit: Like being overeager?

Leen: You can be overeager, but I think what's even better is to have a better environmental awareness.

Harjit: Oh, definitely. That's what I was just saying, Leen. That's it. The awareness of situation. But go on.

Leen: I've worked with students who are super engaged with their patients, know everything about them, but then I split them into two categories in that sense. One category is one who just constantly asks me questions all the time. When I'm in there talking to family, they're the ones who are trying to interrupt and be in charge, or when I'm in the middle of writing this note or doing a consult or something, then they'll come and ask me questions.

Versus the other student who's like . . . if I ask a question out of nowhere, I'll be like, "Oh, does anyone remember what this is?" and, "Who's is this?" And I'll be like, "Oh, dang." They're chart-checking on their own.

I guess as a med student I always felt like they're probably ignoring me or something, but it's weird being on the other end.

Also, the students who have a more humanitarian perspective to them and know when to use it not to show off their benefit, but really for the benefit of the patient, those are the ones I really notice a lot more and I really enjoy working with those students.

Harjit: I think that as an intern or even a resident, I feel like I was a pretty aware medical student too. I also give medical students the benefit of the doubt because I was there and I try to understand their perspective.

So what my go-to has always been is every single med student I work with, I actually give them verbal feedback every single day. And giving them small bits of encouragement . . . just help them out a little bit. Then they actually really appreciate it and they'll actually help you out, so it's a win-win situation.

Margaux: Give them the benefit of the doubt. Don't assume they're not doing something because they don't want to or they're not interested. Maybe they just don't know or aren't aware or familiar with the system. So many of us have never been on a peds rotation. Like you said, Harjit, give them the little pointers. And I think that as residents, that's something . . . as a med student, I really appreciated it when residents did that for me, and so trying to pass that forward.

Leen: The mindset I notice the most, even if they know they're not doing emergency medicine, they know that they can learn something from the moment. That makes me more encouraged to say, "Hey, you want to come do this with me? You want to come do this with me?"

Harjit: I think that's so right, Leen. And again, I will say . . . I feel like I'm just complimenting myself, but I'm on a high right now. So I used to do that all the time and that's why for me, in clinical years, I felt like I did pretty well, because I would do everything. I want to do that even though I knew I was never going to be a surgeon. In total, I'd maybe done like 10 procedures that I'm never going to do in my life again. But I'm excited and I'm like, "This is cool. I want to learn. I want to try." And you never know. You might actually like something.

Margaux: So I would say yes, always, like you guys are talking about, go into it . . . even if it scares you, do a procedure. Do whatever opportunities are in front of you because you have so much safety net and support at that moment.

But also, I would say don't lie about what your interest is. We can tell. Don't say, "Oh, I think I want to do peds," when you really know you want to do surgery and have no interest in peds, because we can tell. And nobody is going to judge you if you say, "I want to do surgery," but you're interested in taking every learning opportunity from that rotation. I think towards the end of your clinical years and you have an idea, don't lie about it. We can tell.

Leen: Being a clinician should not be limited by a specialty you choose. You're always going to be a clinician. You've learned this stuff. You can look up the most up-to-date information. We are clinicians, we can be adaptable. And I think that's something . . . if I was a med student, if I went back to being a med student, that's something I would definitely be more aware of.

Harjit: I think that's the main point. A lot of us go into third- and fourth-year thinking, "Oh, I need to do presentations like this. I need to present myself like this." But a lot of it is just being curious, just learning, just gathering information.

My presentations sucked third- and fourth-year. And honestly, they kind of still do now, but they're better than they were before. You'll grow and you'll learn.

And I think when I was a third-year, I'm like, "Oh my god, I'm so bad. I'm never going to be good at this." But then you look back and you're like, "Wow, I've grown a lot." And you don't see that growth in the future, but you do grow a lot.

Margaux: I would also say that I feel like your presentation is something that's easy for an attending to critique because it's there in the moment and it's a good way to give feedback. So don't take it personally if that's something that you're always getting feedback on, because that's something that's just common for attendings to do.

But what I noticed that was so funny is going from a fourth-year medical student to an intern, I stopped being critiqued on my presentations even though I feel like I didn't really improve. And when I listen to a med student who's giving a way more concise presentation than I just did and the attending is critiquing them, I'm like, "Oh, okay."

So in a way, you're sort of immune as a resident from presentation critiques, but I think the attendings really try to give you feedback in that moment. So don't take it personally.

Harjit: I feel like a lot of us just put so much weight on the way we're being graded and not so much on what we should be learning. I think that's really the shift. And once people make that shift, you'll be so much happier.

Anyway, if you need any advice on how to do third-year, please ask me. I know I'm on a high horse, but I know when I'm good at something, because that was the only thing I was good at.

Leen: Yeah, girl.

Harjit: Because I suck at tests really bad.

Leen: Do you guys get called Doctor? I guess we do.

Margaux: Oh, yeah. I always introduce myself as Dr. Miller to patients just because I feel like . . . just because of sexism, I think.

Harjit: That transition has been very interesting. I'll come into the room and I'll be like, "Harjit," and then I'll be like, "Oh, actually Dr. Kaur." And then I've had patients laugh. They're like, "Okay, Dr. Kaur." I'm like, "Like apple core."

But I think that just in thinking about shattering perspectives, this topic that we've been talking about has been really important because our mindsets are constantly shifting. The way we think about things and view things is constantly changing.

When I think of what it means to shatter my perspective, it also means that I'm growing in some sense, and that's exciting. As an intern, it's been a year of a lot of reflection, a lot of growth, and how I see the world and how I want to navigate this part of my training and hopefully what I want to be as an attending.

And I think that thinking about all these scenarios like we always do really helps us shape who we want to be. I'm really excited that we were able to have this conversation today, and last week, and the week before.

Margaux: I love that you bring up the growth mindset too, Harjit, and that we're talking about this, because I think each stage of whatever process you're in, you talk about how your perspectives have changed and shattered. That can also help medical students coming up in this system to have open conversations. And it would be interesting to hear this conversation from an attending's perspective of how their perspectives have shifted from residency to attending-ship. And so keeping the conversation going is always super important.

Leen: We'll do this episode when we become attendings.

Margaux: Totally.

Harjit: Heck yes.

Margaux: That was a beautiful transition, by the way, Harjit, and summary of the whole topic.

Harjit: Oh, thanks.

Leen: And with that, thank you so much to all our listeners who joined us for this conversation. We absolutely appreciate you bundlers all listening to us. If you have any input, comments, concerns, questions, whatever, please share with us. You can reach us at our Instagram page @bundleofhers or at bundleofhers.com where you can find all our links to all our social media platforms and where we have our podcast available.

With that, thank you so much. Bye.

Harjit: Bye.

Margaux: Bye.