Looking Out for Number One

Let me explain the hierarchy of medical learners within an academic hospital, to give you a context for my rant:

    1. Staff Physician – the know all be all who probably has more years of experience working than you have had living
    2. Fellow – A Physician who has finished their medical training as a resident
    3. Chief Resident: Resident in their last year of training. Basically walking textbooks, knowing not only general medical knowledge, but minute details of obscure diseases you’ve never heard of. They’re on their final year, and are in charge of other residents of their program (whether it be general surgery, plastics, ophthamology, urology, etc.).
    4. R3: 3rd year resident, again more training exclusively in their field of interest.
    5. R2: 2nd year resident, usually start training exclusively in their field of interest
    6. R1: 1st year resident. Freshly minted and completed medical school. Most R1’s from all specialties (e.g. Family Medicine, Obstetrics/Gynecology, etc.) complete the same first year. They rotate through different services within the hospital for several weeks/months. Know the least amount of information compared to their upperclassman.
    7. Clinical Clerk: 3rd or 4th Year Medical Student who spends 4-6 weeks rotating through different medical specialties. Knowledge is minimal in comparison.
    8. Physician Assistant Clerk: Me. I’ve finished one year of medical foundations, and am half way through my clerkship. I’ve done rotations in Family Medicine, Pediatrics, NICU, Emergency, Psychiatry and now am doing General Surgery. Pretty much comparable to a clinical clerk in terms of experience and medical knowledge.

A clinical clerk gave me enlightment about the residents managing our team today in the hospital cafeteria for lunch. He told me this particular facility calls themselves an “academic centre”, but staff are not concerned with student education or learning. “Residents don’t care unless it gets them more OR time. The fellows are concerned about getting OR time, and the physicians don’t care about the clinical clerks.” So us clerks have to look out for ourselves, arrange our own learning sessions, and teach each other – which is the essence of problem based learning.

However, I was at a famous teaching hospital just a few months ago. The one-on-one time I got with physicians and residents was phenonemenal. I got challenged, had docs making me working through my thought process about how to get through a differential. And they had me justifying why I should do certain tests, or what lab work reveals about a patient’s disposition.

Nope, not really any of that here. Rounds consist of scribing for the residents, while they completely manage. Since we are competing with so many learners (fellows, residents and other clinical clerks), we can’t be surgical first assist, or even have the priviledge to “retract” during surgeries.

“Residents look out for number one.” At least at this facility. I hope this experience makes me appreciate teaching that I got, and to be able to hand off learning to medical / physician assistant students in the future. My next rotation is Internal Medicine, from which I hear that the learning experience isn’t that great. Here’s hoping for the best.


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