S8E15: The Resident and Medical Student Dynamic

Lilly: So I don't know if you guys grew up ever using the samples that come in . . . Oh my gosh, this is going to age me probably. But those samples of perfumes and stuff in magazines, and you rub them on your body to get a free sample. I'm getting lost looks.

Austen: No, I am right there with you, Lilly.

Sanila: I am lost.

Lilly: I got myself some skincare, and it came with a bunch of samples, so I've been using all of them. Anyway, today I look like a grease ball from this new moisturizer, so please excuse that. Luckily, no one else besides us can see me.

Austen: No, you are magnificent. No grease ball in sight.

Lilly: Thank you so much. I'm so excited to have both of you on for this episode. Welcome back all of the Bundlers who are listening in on your commute, at home, wherever you podcast. This is Lilly, one of your co-hosts for "Bundle of Hers." And I'm so excited to be here with Austen and Sanila, both also co-hosts on "Bundles."

And today, we're going to be talking about the relationship between residents and medical students, specifically the residents that you work with very closely and intimately, which are typically the first-year or second-year residents that are seeing the patients with you, helping you coordinate plans, but then aren't typically always the ones who are necessarily giving you feedback, like attendings or supervising doctors are, and what that relationship looks like.

And from our experiences, what we've seen that's been a really successful, positive relationship, and then also times where we've seen things that could be better improved. And really just have that conversation with all of you as you are either preparing to do your rotations, as you're shadowing, as you're seeing all the different dynamics within these teams in the hospitals. I just thought it'd be a really interesting conversation to have.

Austen: I feel like the resident/med student relationship is one of the most important relationships that you'll have during your medical training, especially for the med students. I feel like sometimes, as a med student, you feel kind of like a burden to the resident, because I'm sure that I am messing up the workflow and moving at a tenth of the pace as the resident could on their own.

But I feel like looking back on all of the residents I've worked with, I've learned so much from each of them and I feel like I am kind of an amalgamation of who they are and the positive traits I see in them. So I think it's amazing that we're having this discussion. I love it.

Sanila: I, for one, would love to know your perspective of someone who's relatively new in their career and who probably remembers a little too closely what it was like to be a medical student.

Similarly to Austen, I find myself trying to figure out the balance between being a member of the team, but then also being in my role as a student, and what that relationship looks like and how it changes from team to team or person to person. So I'm excited to talk about this.

Lilly: Yeah, it's really such an interesting dynamic.

And before we dive in any further, I just want to give the disclaimer that we always give in our episodes, which is that all the opinions and perspectives that we share are those of our own. They don't represent any of our employers or institutions that we work for. So please just keep that in mind as you listen in.

But really, what triggered this conversation topic in my mind is I was a part of something called Gold Humanism Society during my last year of medical school. And we were trying to think of a way that we could give back to residents when we were MS4s.

I wrote a letter that we ended up emailing to all the departments, and we posted on our social media page, and things like that. It was "Dear Resident," and it was just a few paragraphs talking about how special our residents are to us and thanking them for a lot of the work that they do.

From my perspective as a medical student, I just felt like . . . Especially when you have a really good resident, they really look out for you. They make sure that you shine on your rotation. They help guide you to a diagnosis, a treatment plan. They do chalk talks with you. They let you go home early when there's nothing happening for the day. And they give you really good feedback that helps you grow as a future physician.

And a lot of times, they don't always get all of the positive feedback from the rest of the team because it's just so busy. They're doing a lot of the grunt work that kind of goes unnoticed. And they are, I feel like, the glue to the team, realistically.

But we got a really positive response from that letter and a lot of departments sent it out to their residents, and some of them sent out an email blurb from their administration, thanking their residents again. So I thought it was kind of this nice ripple effect of just recognizing the work that they do.

Then I completely forgot about that letter. Over a year went by, and I just happened upon that letter again. And I was reading through it. I just thought it was so interesting reading that letter now as a resident and thinking of all the things that I appreciated as a med student that now as a resident, I'm like, "Oh, yeah, I don't realize how much I do until I look back at it."

So I just thought it was a really weird dynamic now that I'm on the other side of things and seeing what it's like to be doing that work.

Austen: It's like you wrote a letter to yourself. You know how people write a letter to themselves five years down the road? I feel like, in a lot of ways, everything that you described the residents that you worked with doing, those are things that you're doing now for the med students, right?

As you talked about residents being the glue of the team, I think that's so incredibly true. So many of the teams that we're on would not function without residents, simply would not function. Residents have so many responsibilities, they wear so many hats, and they seem to do it all fairly effortlessly, honestly.

I feel like I'm interested to see what residency looks like next year for me, because I look at where I'm at as a med student, and I look at where the residents are at, and I'm like, "How am I going to get there? How can I actually get there?" Because I recognize just how much the residents do and have done for me personally.

And so I think it's so sweet, it's so serendipitous that you were part of spearheading writing this letter to residents to thank them for everything that they've done, and then you get to stumble upon this letter as a resident and be reminded, "Even on a hard day when I'm overwhelmed or whatever, look at all the things that I'm doing."

As a med student, I was able to recognize this, and hopefully, as a resident, you're also able to recognize all the good that you're doing.

Sanila: Yeah, how cool is it that you have that letter to look back on and be like, "Here are all the things that I felt grateful for that helped me stay afloat when I was drowning as a student," and now as a resident, you get to continue those and kind of pay it forward? Which I think is how you kind of begin to shift the culture of medicine sometimes when people say it's a little difficult or toxic. So I think that's a wonderful thing.

And I agree with Austen. I think residents definitely are the glue of the team. They're kind of the bridge between the medical student and attending, oftentimes. I feel like even when you feel overwhelmed, and you're just trying to help your patient and stay afloat, I feel like you do a lot of good for students as well. And I think that's important.

Lilly: Yeah. And I'm so curious to hear from you what that good looks like. Now that I'm on the other side, I've heard this saying that when you go from being a medical student to a resident and when you go from being a resident to attending, those are the biggest changes in your roles and that's the hardest time that you acclimate to those roles, because it's almost like overnight, the expectations shift.

I remember finishing my last rotation as a med student and thinking, "Oh, wow, in two months, I'm going to be back in the hospital, but this time I'm going to have my name listed as the first call. I will be getting all the pages. I will be signing all of the orders, and people will come to me when my patient is crashing."

And suddenly, I went from being a fourth-year medical student who could leave and nothing was going to fall apart without them to suddenly you're the bones of the operation.

You really didn't change at all. It's just been two months, and you're probably on vacation not doing medicine during that time, if you're doing it right. So it's interesting how so quickly that dynamic can shift when you feel like you're the same person.

And from my perspective, not only was I leaving being a medical student, but I was doing a whole different specialty than what I wanted to do in the sense that I had to do my medicine year before entering neurology. So it was suddenly becoming an expert on the heart, and the lungs, and the kidneys when I had spent the last year kind of cultivating myself to be a brain doctor.

So, as a resident, I kind of felt like my first few months I almost acted like a medical student. I was always asking my senior questions. I was always running by order sets with them before I signed them, double-checking the EKG with my senior to make sure I wasn't missing something. And it was a lot of cross-checking things.

I think I definitely felt like I was making my workload a little heavier. And then I also realized sometimes you have medical students on your services who want to pick up a patient with you. And I remember being absolutely terrified in my first few months when I'd have a medical student.

Initially, I think I didn't do a very good job of teaching my medical students or helping them with plans. I'd kind of be like, "I don't really know. Maybe we should ask so and so, or maybe we should look it up." And we would kind of try and figure it out together, and we'd go through stuff together.

It was interesting at first to try and figure out where I fit in, in the course of their education, especially because, as interns, we don't evaluate medical students. We don't fill out your feedback forms. We don't have anything to contribute to your MSPEs, or whatever they call them now, where they give you your evaluations and things like that.

So I really tried not to focus so much on the feedback, but rather the, "Let's have a great day today, and let's get through things, and let's get you out on time." That was my number one goal of my med students, was, "You're going to go home on time." And I think sometimes that went well, and then sometimes they would be stuck there late, and I'd feel really bad.

Sanila: Oh, gosh, Lilly. I mean, it sounds like a very intense transition because not only are you experiencing this big shift in level of responsibility, but you're also going from the role of a learner to now being a teacher, and your knowledge is really put to the test.

And I feel like even now, Austen and I are about three months out from graduating. And even when we do simulations, or I get pimped on things on rounds, I feel like attendings are like, "Oh, we don't really expect you to know doses or anything like that. That's intern level. You'll learn that later." And I'm like, "That's going to be me in three months. What do you mean? I need to know it right now."

So it does feel like a pretty scary switch, but to your point about just kind of making your students feel like you're a part of the same team and then helping them get through the day and kind of involving them, getting them out early, those are all wonderful things.

And I'm sure Austin can attest to it, but especially as we get closer to graduating, I'm like, "Yeah, I still kind of want to enjoy my day and learn as much as I can before I go to sell my soul and then start working on the wards."

Austen: Just like Sanila said, when you were talking about the things that you do for your med students, I feel like that is part of what makes you a good resident. And then all of the personal growth that you're experiencing is the other component, right?

Being a good resident is so much more than just looking out for your med students. It's also making sure that you are prepared in the ways that you need to be.

I've worked with residents in the past where, yeah, they're looking for opportunities for me to learn or they're looking for opportunities for me to leave early, but when they also had moments of potential growth, they still kind of prioritized those so that the next time they could be a source of fairly certain knowledge. They could be prepared to stand in whatever truth or knowledge that they learned and share that with their whole chest. And I think that's also important.

Sometimes when we talk about being a mentee or being an educator within the medical system, it feels very self-sacrificial. And I think in some ways it can be. But thinking back on some of the best residents I've worked with, they're people who, yes, prioritize my learning, but they also put themselves in the position to be the best teachers possible.

And I think that's something that I've appreciated as well, because we're all learning together, right? Your car may be 10 exits ahead of mine, but we're all traveling in the same direction.

And so I like the idea of you being able to drive ahead and then radio back and be like, "So this is what's coming up. Now I know what it looks like. This is what you need to be aware of."

Honestly, hearing you talk about things, I'm like, "I wish I could have worked with Lilly. She sounds like a dream resident."

Sanila: Truly.

And much like Austen said, I'm trying to reflect on what experiences with residents I've had that I felt like were particularly meaningful. I often look to residents as kind of the next role that I will someday fill. And now it's ever so barreling towards me really fast, and it's scary.

But one resident can remind me that medicine is very humanistic, and that they're also people who are trying to figure it out. And just because they are an intern or an R2, maybe they don't know everything, and it's okay to still figure things out with your team and rely on the people around you.

I think that's also been a really important reminder, and then also just helpful to have that modeled from someone who is ahead of me in terms of career.

So not only just teaching but also being like, "Hey, it's okay. Medicine is going to be hard regardless of where you're at in your career. And as you go further, you accumulate more knowledge, and maybe you'll have more experience, but there are some things that are still going to be difficult because, at the end of the day, you're a person and that's okay to kind of navigate with a team."

Lilly: Exactly.

Austen: It takes some of the pressure off. I think it takes some of the pressure off, I would imagine, as the resident who's the teacher, but then also as the med student. It's like, "If I don't know this yet, and my resident doesn't know this yet, it's okay. There's room to grow."

There's not this expectation that we're going to be perfect medical robots. Just like Sanila said, we're humans, and there's kind of this more human, mortal side of medicine. We have to learn and grow together. I love that.

Lilly: Yeah, I agree with what you both said.

I really think the trickiest thing is when someone genuinely believes that they know everything. I think that's where you get into a very dangerous place in medicine.

As soon as you think that you're the expert in the field, you can just start making decisions without clarifying it with your pharmacist, or with your physical therapist, or with your attending, or your supervising resident. I feel like that's when mistakes are made. That's when things are missed. That's when differential diagnoses are narrowed down to a very finite, "I know for sure this is what it is," that you miss other things. I think that kind of tunnel vision can be harmful to patients.

And so that's one of the things I like about neurology, is almost everything under the sun could be a differential diagnosis that we think of. There are so many things that can happen to you that really makes the differential a little bit more interesting, but also a lot more challenging.

And I think as I've transitioned from intern year to PGY2 year where now I'm a little bit more comfortable in mentoring my medical students, I'm trying to figure out ways that I can teach them that's still within my capacity of comfort and I'm not leading them astray.

I think some of those small things really, when I take a step back, blow my mind that now I'm trying to teach others how to do this, because a few months ago, I was horrified to do it alone.

I guess specific to neurology . . . which I always feel bad when I get too detailed about neuro because some people who really are not interested in neurology might be like, "I really don't care about this." So I'm sorry, but these are my experiences.

For example, neurology residents need to know how to do a lumbar puncture. That's an expected procedure that you need to be able to do. And I'm sure there are specific things in OB-GYN, like Pap smears and cervical exams. It's a procedure that you're expected to know, and you're expected to be competent in doing.

And as an intern, I missed my first LPs that I did, and I was so stressed out. I was like, "I'm not a real neurologist. This is absolutely mortifying. I've let down my attending." And it would really, really get to me.

Then once I became a second-year resident, there are so many LPs that are happening all the time. We always have at least one or two during our service for all the different things that we're considering in our differential, and you're forced to start doing it a little bit more, getting out of your comfort zone.

And I remember the first few I did, I wanted my senior resident to literally hold my hand, hand over hand, put the needle in with me, pull it out with me, and just be there to give me comfort like a blanket. And they would do it. They would stand there. They would help guide me. They would also go through the whole procedure with me, give me all their tips and tricks. And I would try to absorb that as much as possible because I knew this was something I was going to have to do on my own one day.

Now, just thinking in the last month when I've been on service, I've had to do a couple of LPs, and I've had medical students with me. It's a really interesting change to be like, "I'm the resident by myself in this room, and I've got two to three learners in the room watching every single movement. And then I'm also trying to explain to them every single movement."

I think when you're able to teach it to others in a way that they understand the methodology is when you really have a good understanding of it yourself. And these are small things that happen over time that you don't even realize until you're doing it.

So I'm sure you all, in a few months, will be in a case or be in some kind of patient care experience, and you're going to almost not even realize that you're doing something that would have blown your mind five months ago that you're allowed to do by yourself.

And I think that's the beautiful part of medicine, is you're ingesting so much knowledge and skills so much throughout the shifts and rotations that you're on, that some of these things become second nature that once were so overwhelming. So you really do grow over time.

And I think the biggest thing that helps you build that confidence is the fact that you do it over and over and over again, and that repetition and becoming that expert in that subspecialty is what will make you more comfortable.

Sometimes I'm a little bit hard on myself because I feel like, "Oh, that med student, I really didn't get to teach them much," or, "I kind of explained something in a confusing way for them." But we're also learning, and I think over time, the more you practice, the more of that knowledge you have to share.

Sanila: Lilly, it makes me so happy to hear that you get to do the things that you enjoy after much a bated breath.

It's always so nice when I get taught things, honestly. When people care about my learning, they involve me in learning opportunities, and when people explain the whys of medicine, I find it really helpful.

Sometimes, as a medical student, I feel like I'm playing catch-up of, "Let me just look at the order history," and, "Oh, why was this medication ordered?" or, "Why are they getting this sort of imaging?" And sometimes it's hard to know when it's appropriate to ask questions.

I think some personalities don't want you to ask a lot of questions at certain times and people tell you to read the room, but it's easier said than done, I think.

And to your point that there are so many technical skills too that happen in medicine and that interns need to learn on the job, I've been kind of curious as to if there's ever such a thing as being too eager for a medical student to learn something.

Lilly: From my perspective as a medical student, you want to show the team that you're interested in what you're learning about, you're interested in your patient's case. You want to show that you want to be as involved as possible without overstepping.

And now that I'm a resident, I think the number one thing that really makes me invested in a medical student is when they show me that they really care about the patient.

I know people are like, "But everyone cares about their patients. We're all in healthcare because we care about other people," and that's totally valid. But you all have a lot of other things that you're stressed about in medical school. You're studying for shelf exams, you're applying to residency, you're studying for your OSCEs, you have your own life responsibilities.

And maybe you're on this rotation, but you've already committed to something else that you know is your passion and your lifetime dream. You never want to do a lumbar puncture, and you don't really care about a neurological exam because you plan on being a radiologist or you're wanting to be a pathologist or something where you're never going to be doing this in the future.

I think that's really valid, right? If you know you're not going to be doing it, you don't need to put yourself in an uncomfortable situation where now suddenly you're poking a needle in someone's back and you really didn't feel comfortable doing that.

So I don't think you need to volunteer yourself for every single thing if it's not within that expertise or wheel that you're trying to build in your knowledge.

But I do think if you've picked up a patient as a medical student and you're following them, I always tell my med students, "That is your patient. I am going to take a step back. That is your patient, and I'm here to help you, but I want you to feel ownership over your patient.

"I want you to feel like you know the most about your patient. I want you to feel comfortable calling consults on your patient. I want you to feel comfortable updating family when we're in the room, talking to the patients, telling them what the plan is, asking if they have questions, going back in the room later in the day, and reviewing their imaging if they have questions about it. This is your patient."

And I think that's the best way to kind of build confidence in medical students so that when you do become a sub-I, you've had that experience. So now when you have four to six patients on your roster, you still feel that sense of ownership over them because you know the details of their history, and their meds, and their plan.

Then I also think when it comes to procedures . . . It's always interesting because I always ask my med students, "Oh, have you seen a lumbar puncture? Are you interested in doing one?" And I don't think everyone always asks, especially when you're going into a surgical subspecialty and things like that, or critical care.

There's a certain number of procedures that residents and fellows need to get, so sometimes I feel like it's harder to get that opportunity to do a procedure or do something more technical.

But I think it's always worth asking because, worst case, they're going to say, "Oh, this patient has complicated anatomy. They might not be the best case for you to try on," or, "We're really crunched on time. Let me just knock this one out." But they'll at least know that now you're interested.

And if you're working with them for the rest of the week, then the next one that comes by . . . There's that saying of "see one, do one, teach one." You've seen one now, so maybe you could try and do one.

Especially later on in the year when residents have hopefully been able to do a couple of procedures on their own, hopefully they're willing to share with their medical students so that they can also get that experience.

I think that the times where reading the room and responding appropriately is more like social norms almost . . . Sometimes we'll have medical students who will interrupt the attending, or they'll try and answer the questions . . . which I am totally guilty of this. I have also done this because I want to answer the question, I know the answer, or I want them to know that I'm thinking about these things.

But I think just being mindful to wait until the attending is done asking their question or finished doing whatever their teaching point is before you respond.

Or if you're in a patient's room, kind of seeing what the culture of that attending is. Some attendings do not want anyone to speak in the patient's room besides them. They give the plan, they answer the questions, and that's it. If you have anything you want to say, you'll say it outside of the room.

Other attendings are very relaxed, and maybe they'll give an update, but then they want you to give some updates. Or maybe they have you give the whole update in the room, and they just stand in the back wall in the corner. Nobody even knows that they're the supervising attending, and they think that you're their doctor because you are.

So I think it's all about trying to figure out what the attending really wants. And I think the best way to navigate that is to talk to your resident and just tell your resident, "Hey, this is a new attending. I haven't worked with them before. What is their style? Do they like to talk in the rooms? Do they like us to talk in the rooms? How do they like to round?" and that kind of stuff so that you can get prepped.

Again, as your resident, we don't evaluate you. So you should ask us all of the "dumb questions" you have because we're going to answer them because we're also learning with you, versus when you ask the fellow or the attending who's going to be filling out your feedback forms, they might remember that you asked some of these questions that they think are more simple or something like that, which I think is still silly. You should be allowed to ask any question you have.

Austen: You always hear about people who are doing the most and saying crazy stuff, and I think you just get worried that you're going to misstep because you want to help or because you're so excited about learning.

I had a little breakfast meeting with an OB here at The U who I love. Shout-out . . . I don't know if we can give shout-outs.

Lilly: I give shout-outs.

Austen: Okay. Shout-out, Dr. Kaiser. And this wasn't necessarily about being over-eager on rotations. It was actually about crying. I was worried that I was going to cry too much as a provider.

But I was like, "When something serious is happening, how do you deal with it? When there's a terrible outcome and it's weighing really heavily on you, how do you deal with that? I'm worried that I'll end up crying in the patient room."

And her response to me was, "There is a benefit in sharing with other people. But as soon as you start to make the situation about yourself, that's when things go wrong. That's when you're stepping out of line, as you're no longer fulfilling your role as a provider."

And I think, similarly, it can be applied to being a med student. In our roles as learners, if we are working as a team and if we're sharing in the energy and we're contributing to the group, that's great. But as soon as we take a learning opportunity that's supposed to be shared and we make it about ourselves, I think that's when we kind of run into trouble.

When we feel like, "Now's a great time for me to show off or to show the group I've really been reading up about hypertension," I think that's when we kind of run into issues because we're no longer approaching this as a team sport. It's now, "How can I show off my growth? How can I learn more? How can I do whatever?"

And while personal growth is important in medicine . . . I've said this before. Medicine is a team sport. You don't succeed by stealing opportunities from others. You don't succeed by shining alone. It's about, "How can we as a group improve so that we can all then be more prepared to take care of the patients that we have on our list?"

Even though that advice is about crying because of what's going on, I think it's been a good reminder to me that as a learner, yes, I should be excited to learn, I should be excited to grow, but I am growing within a shared space. I am growing within a group. And sometimes that means that we grow together as opposed to me stealing all the sunlight so that I can grow alone.

Lilly: Yeah, I think that also brings up a good point of the group dynamic, because as a medical student, you do want to shine. You want the provider, the attending, to remember who you are in case you want to ask them for a letter of recommendation in the future or to be your mentor in whatever field that may be.

And I think one of the things that they really pick up on is how you work in a group, how you treat the other medical students on service with you, how you interact with the nursing staff, how you interact with the patient and their family. All of those things don't go unnoticed.

And those are things that we think about when we're providing feedback, is, "Were you respectful to the nurses when they came in and gave you an update about your patient? Did you engage with them on rounds, ask them if they had any questions? When your co-medical student is answering questions, do you jump in to answer their questions, or do you let them have an opportunity to also shine?"

All of those things are really considered when we look at how you work in your group dynamic, because ultimately when you become an attending, you're going to be working in a group environment, whether it's in academics, whether you work with a private group. You're still going to have co-workers and colleagues. You're going to share patients. You're going to be transferring cares and consulting one another, and it's really all about how you interact with one another.

And sometimes I think that gets forgotten about when you think it's this dog-eat-dog, "I need to shine so they remember me and I get the honors on this rotation," and things like that. I think that sometimes people put themselves into a hole when they try and sell themselves that way.

Salina: And it's so true, too, Lilly. I think as a student, I never know what is going to be noticed of the things that I do and what isn't going to be noticed. And I feel like all I can really do is show up and try to be the best student that I want to be and try and learn the most that I want to, regardless of the situation I'm in or the team dynamic I'm in. It is really helpful to feel part of the team.

I've had residents, when the attending is pimping me, they'll mouth the answer to me. Little do they know that I don't know how to read lips and then I'm just like, "Uh." But that always makes me feel a little bit cared for in terms of like, "Oh, this person wants me to succeed, and it's okay for me to both not know answers and then also to show off if I get pimped."

I think it's a matter of knowing what settings it's appropriate to do so in and then also just remembering, like what Austen said, that this is a team sport and you need the people around you to kind of bring you up and allow you to have those opportunities.

And I feel like I've had the best time on teams that when I show up on Day 1, they assume the best of me to begin with, until I prove them otherwise. So they assume that I care enough for my learning, that I want to be there, that I want to improve, that I want to receive feedback, and that I have a shared goal of making sure that patients receive good healthcare and are taken care of.

When people assume those things of me, I feel like they become more true as time goes on as well, because it makes me feel like my presence there is valued and I'm not wasting my time, wasting anyone else's time.

And in those cases, I really don't mind being at the hospital for long hours. If I feel like I can be useful or I'm learning and I'm not just getting in the way of people, which sometimes it's kind of hard to figure out what role to slink into so that you're not doing that, I think that's where I've enjoyed my time the most and then felt like that time was the most meaningful for myself.

Lilly: I hear that so commonly of medical students saying, "I just don't want to get in the way," or, "I don't want to slow you down. I don't want to hold the team back." And I think it's so interesting because you all are the ones who are paying to be there. This is a part of your education.

We are at the point in our careers where we get paid to do the work that we're doing, and we do work longer hours. Ideally, you all are leaving before we are, and things like that. So while you're there, the whole point is that you get exposed to as much as you possibly can. And I think it really creates more of a put-together picture of the patient's care that you don't get if you're watching from the sidelines.

When, as a medical student, you're invested in your patient's care and you want to take that extra step of building that rapport, staying a little bit later, trying to do the procedure, reading into their case, getting that additional history . . . I can't tell you how many times a medical student has gotten a history from the patient that none of us knew that changed the course of their care.

And you really play an instrumental part of their care because you have that privilege of time. Especially our MS2s who are newly into their rotations, you're usually carrying one or two patients at a time, where you can really dive into their charts.

I'm so impressed with my medical students who are like, "I found their ultrasound from 2022 in Montana, and this was what they had at that time." And I'm like, "Wow, how did you find that? I did not have time to do that when I'm carrying eight patients."

And so I really think that you get the most when you invest into your patients. And then we see that from our perspective, that you really do genuinely care about your patients.

I love that you said that we should just assume that, because I think sometimes when residents are really burnt out . . . And this kind of goes back to my perspective as a medical student when I did have seniors and residents who were really burnt out. They kind of lose that excitement to teach, be around medical students, explain things to them, take a little bit of extra time to help me piece together little parts of why we're doing what we're doing or why we ask the questions that we do.

And when you get in that situation where you can tell that your resident is really burnt out and tired, it can be kind of discouraging. You feel like your learning is being hindered now because they're being overworked by a system that's not set up to help them succeed.

It's tricky because I think as a resident, sometimes we just really want to finish our work on time so that we can go home because we're going to be back in five hours and we're really, really tired. And it's a hard balance. But I think that others poured into us, and so it's important that we pour into others because you're the future of medicine.

I just love that idea that I taught you something that you'll teach someone else one day, and I think that that's a really important skill to have. But I also think it's okay to give that feedback.

I remember I had a resident who told me that my patient was no longer a good learning case and that they wanted me to pick someone else up that was more bread and butter. And I remember being really disappointed because I loved that patient. I had built such good rapport with them. I knew their case in and out. I wanted to see what was going to happen. I wanted to be involved in the palliative talks and the conversations, and understand what end-of-life care looked like. And I felt like that was ripped away from my learning because they felt like it wasn't important to my learning.

At the end of my rotation, hopefully they're always asking you, "Do you have any feedback? What could we have done to make your experience better or helped you learn a little bit more?" And I usually say, "No, everything was wonderful and amazing, and thank you so much. I'm so honored to be around you," because you just don't really know what else to say, and you don't want to be super negative.

But in this case, I was like, "If I'm being honest . . ." Which was terrifying, obviously, because you never know how it's going to go. But I was like, "If I'm being honest, I really feel like I could have learned a lot from that patient I was following. And I wish that you would have allowed me to keep following them. I would have been happy to pick up another patient, but I hate just letting go of my patients when I haven't closed out their case and seen what happens to them."

I think that they took that feedback really well. And they were like, "Yeah, I think it's fair for me moving forward to ask a medical student if they want to pick up a different patient or if they want to continue following that patient."

I think that that's important to give you the autonomy to do that because who knows, maybe one day you're going to end up being a palliative care doc because of that experience you had with that patient.

And so sometimes I think it's okay to push back, which is scary, because especially when we're running behind on rounds and we're trying to finish, someone says, "Why?" And then it goes into this whole tangent for 10 minutes and you're like, "Good lord, we're never going to finish rounds." But I'm trying to push myself to just be like, "Why?"

And I always think of it in the sense that, "Well, what would I do if I was on in the middle of the night by myself and I get this case and I don't want to miss the diagnosis?" I need to know the why. That's a part of making me a better doctor.

And so I'm trying to push myself to do that more with my attendings, and I hope that as medical students, you all feel that empowerment too. Ultimately, the only person that's hurt from not doing that is yourself, because you miss out on that learning opportunity.

Austen: I like this idea of advocacy, like self-advocacy. That's something that is found within both a good medical student and a good resident. Someone who's willing to say, "Hey, I need help. I need clarification. Can you provide that to me?" Like you said, the person who loses out . . . Is that a real word? The person who . . .

Lilly: It sounds real to me.

Austen: I'm in the middle of refreshing my Spanish and so everything sounds fake to me.

But the person who loses out the most is going to be you, and potentially patients who then are affected by this kind of gap in knowledge, right? And so not only should we feel empowered to do so as residents, like you pointed out, but as med students. It has to start somewhere.

Just kind of how you were talking about having this drastic change in scope of practice where you go from being a med student, kind of being in the back seat watching people do medicine, to then being responsible, I think learning is the same way. At some point, we have to go from being a passive learner to more of an active participant in our own learning.

And I think it should happen as early as possible because it's just going to help us, whether we are residents, or med students, or attendings, right? There's always going to be someone who knows more than you who can help you along the way.

And so I like this idea of not viewing my gap of knowledge as a hindrance to the team, but as something that could potentially benefit the team later down the line or benefit my patient later down the line. It's an opportunity to grow and to be better prepared.

Salina: I feel like medicine is such a top-down system, and we really have to reach down and pull the people that might be earlier in their career or in years below us . . . I don't know how to phrase that better. But we have to reach down and pull them up so that they can learn.

I really think you can't learn all of medicine in the walls of a classroom. I think a lot of learning happens in the hospital when you're discussing on rounds about a patient or figuring out what the next best steps are or you're talking to family.

And I love what you said earlier when you talked about your story about being disappointed of picking up a new patient because your resident was like, "Oh, this might not be the best learning case for a student."

I truly think that there's something to learn from every patient encounter, even the patients you've been following for a while, whether that's learning how to update a family on what's happening, or explain your reasoning, or remembering that you need to contact family, if not every day, pretty frequently and update them.

I think those are all life skills, maybe some soft skills that you just kind of learn with time and with repetition. I think those are just as important. And I think the knowledge-based stuff will also happen with time, too.

I've also found that residents who really advocate for my learning when I'm unable to advocate for myself, or because I'm with a scary attending and I don't really want to step on anyone's toes . . . A lot of OB residents, they've been so great at being like, "Oh, Sanila should try and do this skill," or, "She should try and run the list because these are skills that she's going to have to know. This is what she's going into."

I've had pediatric neurology residents where we share patients with the general peds team. My pediatric neurology residents have fought for patients, fought over patients for me, and been like, "They're a neurology case. Our neurology student has to take them."

So it's always been nice to know that people really care about the information that I am learning and absorbing, and they want to make the most of my time.

Lilly: Yeah. And I think that ultimately is what also solidifies your knowledge. You made such a good point, Sanila, when you talked about what we learn from seeing actual patients. Once I've seen a patient with a certain diagnosis, I think of that patient when I'm answering even things like boards questions.

If I'm reading through a question stem and I'm starting to see certain lab results, I'm starting to see certain physical exam findings, they're describing a certain rash to me, alarms will start going off in my head. Not because I remember reading it in a textbook or I had a flashcard on it, but because I'll be like, "Oh, yes, during my internal medicine block, I had a patient with cellulitis. They are describing cellulitis."

And I think it's a lot easier to reconcile those patterns when you've seen them actually in practice. So I think it's really exciting. And I think it's a cool way that medicine is developing where we're getting that firsthand experience and exposures to patients, especially because in a few months you'll be running rapids, you'll be at code blues, you're going to be doing chest compressions on a patient. These are things that are horrifying.

I remember shaking during my first rapid response. The first time I was alone on short call, and a patient was in SVT, and I had to push adenosine, I was like, "How do I even know this? It's scary." But you learn it and you pay attention because you know it's going to happen when you're alone one day.

I'm starting to realize as we talk through this podcast that maybe I'm very fear-driven. I'm so scared of bad outcomes. I'm so scared of something terrible happening that I'm very fear-driven in my knowledge, which is fine. Everyone has their own motivators.

But that's how I've thought about these uncomfortable situations where I really do need to know that knowledge. So I think asking why and trying to get that answer will help you and your resident in understanding what they're doing and why they're doing it.

Sanila: Yeah, I think seeing things in real life really makes them stick so much more. Because I've learned in our first two years of didactics from the legacy curriculum, I feel like I've gotten to a point where I can maybe identify a diagnosis of, "Oh, this is what this is." And then someone's like, "Great. What's the next step?" And I'm like, "I have no idea." So being able to follow a case through, especially in real life, is helpful.

And even now, when I'm trying to think of, "What side of the body is the liver or the spleen on?" I often picture what my cadaver looked like in anatomy lab. I feel like I have that visual representation that I draw on. And it's not something that . . . I don't memorize the textbook. It's something I've seen in real life, and that is just what sticks better for me in my head.

Austen: We love, love, love a text-world connection. That's what my friend group calls it. Whenever we see something in real life that we've heard about . . . Oftentimes it's that we've read in whatever book we're reading, but it could also be applied to medicine, right? A text-world connection is memorable. It's going to help us learn. It's going to help us grow, and solidify that information.

Lilly: I love that. I should start using that phrase now.

Sanila: Also tangential, but my main motivator is spite, I think, is what I'm learning.

Lilly: Whatever works for you. I love it.

Well, I think we chatted about everything I really wanted to hit on, and I just really appreciate you all's . . . oh my gosh, how do I phrase that? I really appreciate y'all's perspectives because, although I feel like I was a medical student yesterday, things have changed, and your experiences really helped to shape how I view my interactions with medical students.

I hope if other residents or medical students are listening to this podcast that they think about ways that they can also help to really flourish that relationship between one another and make sure that your medical students are learning as much as they can and taking as much responsibility over things they can.

And then as residents, we also feel supported and feel like we can ask for additional things or to ask more questions.

Ultimately, this is the most interesting, I feel, relationship in the hospital because we're so close to one another as far as training goes, but the titles are so different. And I think we learn the most from . . . I feel like I learn a lot from my medical students. I hope they learn maybe one thing from me. Who knows? But ultimately, I think we're really the meat and the bones of the team. So I just have a lot of respect for all the residents I work with and all the medical students I work with.

I'm really glad that you guys got to have this conversation with me, and I appreciate all the Bundles who joined us for this conversation. Drop a comment, tell us what you think, the good, the bad, the ugly experiences with your residents, attendings, medical students. I'd love to hear a little bit more about how we all can improve as a system.

And if you haven't already, be sure to subscribe, follow us on Instagram, and visit our website. We'll see you in the next episode. Bye.

Austen: Bye.

Sanila: Ta-ta.