How attendings actually see medical students…
What I Wish I Knew: How attendings actually see medical students during clerkships
Last updated: Dec 2024
The Family Medicine Attending’s Perspective by Dr. Shieva Khayam-Bashi, UCSF Clinical Professor, Dept of Family and Community Medicine
Key Takeaways:
Most attendings are too busy/preoccupied thinking about their own tasks, to-dos, and patient needs and do not have much bandwidth to be scrutinizing the medical student’s behavior
Attendings generally are not comparing students in their head
Third-year evaluations for students (and even sub-Is) generally end up being positive as long as the student was not mean or irresponsible
Enjoy the learning experience of rotations! Attendings don’t expect third-year medical students to really know much apart from have a good attitude and willingness to learn
When attendings ask medical students questions, generally speaking they are not looking to evaluate how much you know but rather figure out what level of detail to teach to
Third-Year Students:
Attending physicians understand this is a period of adjustment and we focus on your energy and enthusiasm for learning and for service to patients and to teammates (fellow students, residents)
We see you as “new”-- we want you to be eager learners with a foundation in medical science, but we KNOW you have very little clinical experience.
We do not expect you to know much, especially in the first few months of 3rd year.
We do expect you to have (& develop) basic clinical skills like history taking, physical examinations, and documentation of your notes.
Fourth-Year Students:
We see you as more experienced, and you are expected to have a better handle of Assessments and Plans for your patients, and to take initiative in patient care under supervision.
We think you should demonstrate stronger clinical reasoning and problem-solving skills by 4th year (because you have really learned a great deal in 3rd year, just by getting through it!)
Attending physicians look for professionalism, responsibility, and a commitment to patient advocacy.
Common Student Misconceptions:
Thinking Your Attendings Expect Perfection:
Reality: Attending physicians understand medical students are still learning. Mistakes are seen as opportunities for growth, not failures, as long as the student learns from them.
Fear of Being Judged Harshly:
Reality: The focus is on the learning process and a willingness to take initiative.
Attending physicians appreciate students who ask questions and actively participate in patient care.
Attendings really are so involved themselves and their own concerns in the challenges of each patient’s care, and the busy activities of each day, that we really are not remembering that you made a mistake in a vital sign or lab result or did not give a perfect presentation. We are all moving fast, and focused on just getting the right things done for the patient.
Thinking You Need to Know Everything:
Reality: It's impossible to know everything in medicine.
What matters most is a strong foundation, critical thinking skills, and the ability to learn efficiently. Asking questions is a sign of your desire to learn and grow.
Feeling Like a Burden:
Reality: Attending physicians see students as valuable members of the healthcare team.
Students contribute by performing history and physicals, assisting with procedures, and offering fresh perspectives. You know more about your patient than anyone else does, and you have more time to learn and read and offer fresh ideas. You are not at all a burden, but rather an asset.
Overall, attending physicians want students to succeed. They appreciate your positive attitude, willingness to learn, and commitment to patient care, and your helping your residents and classmates when possible. Don't be afraid to ask questions, make mistakes, and learn from them.
Here are some tips for medical students on the wards:
Be Prepared: Review patient charts beforehand and come to rounds with questions ready. Read up on your patient’s condition in Up-To-Date, etc.
Be Proactive: Offer to take on tasks and participate actively in discussions.
Be Professional: Dress appropriately, be punctual, maintain good communication skills, and treat everyone with respect.
Be a Team Player: Collaborate with residents, nurses, and other healthcare professionals. Learn from everyone and help support everyone.
Be Enthusiastic: Show your passion for learning and patient care.
Try to see this entire experience as potentially FUN and MEANINGFUL learning and growing
Learn from everyone— even the negative role-models are teaching you something about how not-to-be :)
The Surgery Attending’s Perspective by Dr. Jess Gosnell, Professor of Surgery, Associate Director of UCSF Surgery Clerkship Program
What are your expectations of MS3 clerkship students on the surgical rotation?
The expectations are actually very low. F2 is very different than a Sub-I. Sub-Is have a huge role on the team. As an F2 student, you still play a role in the team, but you’re mostly there to understand how inpatient hospital systems work, how patients are cared for in complex clinical environments, how to be part of a team, how to move into the clinical learning environment–you’re just there to learn.
You don’t need to do anything extraordinary or demonstrate a huge fund of knowledge; you’re there to figure out whether or not you want to be a surgeon. Ask questions, be engaged and interested, rather than focus on “having to do xyz”. There’s no hidden curriculum about staying late.
That being said, if you want to be called in to see interesting things, additional cases, etc., attendings/residents have a lower threshold to call you if you’re in-person rather than if you already went home. We also know you’re busy and don’t want to bother you if you already went home.
Most surgery attendings don’t have a huge list of expectations for students or expectations about students staying late. We also don’t want students to feel overwhelmed but want to see what you want to learn and how we can help
Generally, students will get “graduated responsibility” as the rotation and year progresses.
It helps if you can come in with some goals: e.g. here are my goals for clinic, I would love if you could watch me present or watch me do a physical
Half the time, the team is so focused on patient care and outcome, so students don’t have to worry about being evaluated all the time
How important is my surgical fund of knowledge?
A lot of 3rd year rotations have nothing to do with fund of knowledge. That catches a lot of students by surprise. It’s often more about teamwork, people skills, figuring out the culture of where you’re working. That’s also the hard part, because just when you get the hang of something, you switch rotations.
Focus on understanding the patient's story rather than memorizing anatomy. It’s much more important to know why the patient is having surgery and being familiar with the general indications/goals of the operation rather than just knowing details like “this is the celiac artery.”
Spend even just 5 minutes studying the patient and the procedure before surgery. This little bit of preparation makes a big difference.
It can help to find out what residents are reading (e.g., residents often read super short 3 pages of operative anatomy) that can go a long way.
Engage with the team: Ask questions! Good times to ask questions are at the beginning of the case at the scrub sink or during closing when things are calmer. This shows interest and helps you learn.
How important is it to have good surgical surgical skills?
*Laughs*. Not important
But, is an opportunity to ask questions, get help
It’s still good to practice, but it is extremely rare for an attending to work with a 3rd year and say, “that person was really good” and quite frankly, it doesn’t really matter
How do students do well on their 3rd year surgical clerkship?
Attitude is very important. Be interested, willing to learn, ask questions.
As mentioned above, a little preparation can go a long way
If no one ever sees or talks to you, there is no opportunity for them to give you an evaluation that is not generic. Some attendings need a little encouragement to teach you. It shouldn’t be the case, but it definitely helps.
Sometimes students struggle with “feeling like a burden” or just “don’t want to get in the way”. This is hard, and obviously in emergency situations it’s good to stand back. But overtime, this approach is not a great strategy. Ultimately, you are the only one who can make yourself a good doctor/surgeon. If you’re naturally shy or nervous, it can be challenging to speak up. I encourage you to be a little brave in terms of asking questions and using situational awareness (obviously don’t ask a question if there’s pulsatile bleeding!) If we’re with you and there’s no interaction, we can’t give feedback or give evaluation, and that’s a missed opportunity.
It can be very hard in rotations to understand how you’re seen or how you’re doing. Half-way through any rotation, reach out to someone on the team and get honest appraisal. What’s happening, are there things you can improve on, etc. Many of us get 100% blindsided anytime there is feedback that is remotely negative; you should never be blindsided
Are attendings ranking students/comparing them?
It’s important that your attendings know where you are in the clerkship year. E.g. expectations will be different for sub-Is vs 3rd years. For 3rd years, expectations will also differ depending on whether it is early vs late in the year. Attendings often lose track of when in the academic year it is, so it helps to let them know!
In general, there has definitely been a real push for competency-based evaluations as opposed to comparison to peers. Comparison to another peer is never anything that would be on an evaluation.
Also, your attendings are often not 100% focused on you the whole time. They’re more focused on the patient and the outcome
Attendings can find gunners annoying unless it’s genuine. Be genuine/enthusiastic and not obnoxious. Otherwise, it feels like pandering.
What are red flags on the surgical clerkship?
It sounds like basic stuff, but people can forget under pressure: Honesty is 100% important (with what your knowledge is, with what you’ve done). Because we’re all dependent on talking to each other, your word needs to count.
Punctuality is important as well
If you are sick or need accommodations, please go through official channels so everyone knows. If you handle things on your own and not everyone is aware, that may lead to issues. Talk to DQ, don’t tough it out!
Be respectful to patients. Simple stuff.