MikeGinnyGOLD Member
HOP Mad Doctor
13,923 posts
Location: San Francisco, CA, USA


Posted:
So we got this new medical student on our service yesterday. He's a student at an Israeli medical school, but doing most of his clinical rotations in the U.S. because he wants to come here for residency. He's fresh out of his pre-clinical years, he's brand-new, he's never done anything clinical, and he's signed up for a subinternship, which is usually something you've done after one year of clinical rotations.

So that's fine with me. I just immediately lowered my expectations to zero and I'm fully prepared to teach him *everything* he needs to know about the nuts-and-bolts of clinical medicine. That's my job. I can have that done in a month, which is how much time I have.

The problem is that the poor kid is a nervous wreck. Today I was home all day because I'd been on call at night. Now he's staying near me and I'm going to drive him to work every morning so that he doesn't have to wake up at 4:30 to take the train into work, so he called me to make sure we had the time. I've assigned him one patient, a 6mo girl with pneumonia. So I'm lying in bed, I call him to confirm the time I'll pick him up tomorrow, explain his duties before rounds start and tell him I'll do them with him the first day, and then ask him how the baby is doing...

...and the kid launches into: "Well, by systems: Respiratory, she is breathing in the 60's still. Cardiovascularly, she has no issues...yadda yadda..." and tries to truck on into a full systems-wise presentation of the patient while I'm lying in bed at home. I just wanted a "better!"

He's a nervous wreck and I'm afraid that unchecked, it's going to negatively affect his performance and his grade.

How do I help him to relax?

(And this is serious, folks, so easy on the pervy comments. wink)

-Mike

Certified Mad Doctor and HoP High Priest of Nutella



A buckuht n a hooze! -Valura


AnonymousPLATINUM Member


Posted:
Have you thought about approaching him about his nervousness?

I find bringing it to someones attention may help them open up and calm down.

At the same time, give the kid a beer.

ElectricBlueGOLD Member
Now with extra strawberries
810 posts
Location: Canberra, Australia


Posted:
That sounds like a tricky situation. Do you thin after a little time seeing how every one else works and getting a few things right he might calm down a bit?

I second the idea of sitting him down and talking about it with him. It will proably help alot Maybe also remind him that you are always there if he needs help and that sort of thing? The style of teaching may have been quite differnt where he came from.

Good luck though, i hope it all goes well

I {Heart} hand me downs and spinning in the snow.<br /><br />


BrennPLATINUM Member
Will carpal your tunnel in a minute.
3,286 posts
Location: Melbourne, Australia


Posted:
You mentioned that he was a student from a foreign medical school. Is it possible that there is a lot more riding on his mind than doing a good job at his placement?

There could be underlying family pressures to over-achieve, which may be why he has gone straight to a sub internship and skipping rotations etc. All of which will be negatively impacting on him.

Just a thought. Hope things improve for you and him! hug

&#2384;

Owner of burningoftheclavey smile
Owned by Lost83spy


GnorBRONZE Member
Carpal \'Tunnel
5,814 posts
Location: Perth, Australia


Posted:
How many days have you had him with you so far? Is he relaxing after a time? What is he doing to destress when not at work (not your responsibilty but if he isnt having down time he wont refresh himself)

I imagine (and hope) that once he knows his way around and who to ask stuff of his comfort zone will settle and he will cope. I make lists in new jobs of what I can potentially be doing, when to do them and peoples names.
Can you help there like you did on HOP here for newbies. Give him a set of crash notes of duties and expectations
(You absoloutely gorgoeus over whelming darling that the new guy is trying to impress.)

Is it the Truth?
Is it Fair to all concerned?
Will it build Goodwill and Better Friendships?
Will it be Beneficial to all concerned?

Im in a lonely battle with the world with a fish to match the chip on my shoulder. Gnu in Binnu in a cnu


MikeGinnyGOLD Member
HOP Mad Doctor
13,923 posts
Location: San Francisco, CA, USA


Posted:
Well my plan is to spend the day with him and basically do all of his duties with him. Walk him through each and every step, give him a set of crash notes on how to write daily notes, have him practice a blood draw and putting in an IV, all that stuff.

And we'll see how it goes.

-Mike

Certified Mad Doctor and HoP High Priest of Nutella



A buckuht n a hooze! -Valura


Kathain_BowenGood Ol' Yarn For Hair
422 posts
Location: Atlanta, GA, USA


Posted:
 Written by: Doc Lightning

How do I help him to relax?

(And this is serious, folks, so easy on the pervy comments. wink)



Had him a set of poi? weavesmiley

(well, you asked for not-pervy!)

I would definitely have a friendly, non-threatening chat with the fellow if I were you, preferably on comfortable, neutral grounds. Perhaps have a cup of coffee with him, or invite him to come with you for a cup of coffee one morning before shift. I know, you're a teacher, so that could be overstepping bounds, but it might help.

It could be that he's nervous about having a lot to live up to, or it could be that he has a false impression of you being a hard ass, a perfectionist, or just a teacher looking down on his student (all of which could cause a knee-jerk reaction to over do work). Look back at what you wrote about immediately lowering your standards for him- he could feel like you were patronizing him and developed this "nervousness" as a result.

I'm not saying that you did something wrong. hug

At any rate, chatting with the fellow in a friendly manner can never really hurt. Hopefully, it will help you figure out what's going on and how to help him relax a bit. Maybe it's the work hours, maybe it's fellow staff, maybe it's even the fear of failing these, his first hands on patients (I'd imagine, for your first on hands experience, I'd be intimidated by it- hell, you should have seen me just taking care of a large fishroom for the first time by myself!) At the very least, it could very well just loosen the fellow up a bit. At the worst, he tells you he hates his job, the hospital, you, the little girl, but you'll know where he stands.



If all else fails.... I seriously think you should just let him have a set of practice poi. Sometimes, people just need to go and beat things out in a physical manner to destress. Docs have one of the most stressful jobs out there. Maybe he just hasn't found a way to zone out and just decompress from a day at work. I mean, look at the Decompression and Regression Days at different colleges. Look at Caltech's Decompression alone! Sometimes, you just need to let loose and turn off that work-mode of your brain, and I can think of no better way to do so. ubbrollsmile

"So long and thanks for all the fish."


Rouge DragonBRONZE Member
Insert Champagne Here
13,215 posts
Location: without class distinction, Australia


Posted:
I agree that there is probably a lot of pressure coming from his home/family as well therefore (and I don't know how you'd do this without prying too personal) maybe you need to somehow show him that family love transcends success?

i would have changed ***** to phallus, and claire to petey Petey

Rougie: but that's what I'm doing here
Arnwyn: what letting me adjust myself in your room?..don't you dare quote that on HoP...


whyBRONZE Member
not _Y_
720 posts
Location: Scotland


Posted:
 Written by: Doc Lightning


Well my plan is to spend the day with him and basically do all of his duties with him. Walk him through each and every step, give him a set of crash notes on how to write daily notes, have him practice a blood draw and putting in an IV, all that stuff.

And we'll see how it goes.

sounds fairly a robust plan...

Nerves may start to fade a bit if he feels like he has an idea what he's meant to be doing

You see things; and you say, 'Why?' But I dream things that never were; and I say, "Why not?" George Bernard Shaw


BirgitBRONZE Member
had her carpal tunnel surgery already thanks v much
4,145 posts
Location: Edinburgh, Scotland (UK)


Posted:
It's difficult to overcome nervousness if you're starting an important placement in a different country (and dealing with saving kids' lives won't help). As for your last example, he couldn't have possibly known what you meant by "how's the kid doing" - another doctor might have ripped his little student head off for saying "better" and not giving some data, and he probably wanted to prove that he understands what he's on about, so that to me doesn't qualify as a nervous wreck that needs checking, just a new person who needs the rules set down.

Make sure that he knows what you expect from him, is my recommendation. Otherwise he'll be (necessarily) trying to guess and go wrong a lot of the time.

"vices are like genitals - most are ugly to behold, and yet we find that our own are dear to us."
(G.W. Dahlquist)

Owner of Dragosani's left half


MikeGinnyGOLD Member
HOP Mad Doctor
13,923 posts
Location: San Francisco, CA, USA


Posted:
He did better today.

It's just a slow process of learning.

-Mike

Certified Mad Doctor and HoP High Priest of Nutella



A buckuht n a hooze! -Valura


jarleGOLD Member
Lv15 Ranger
1,489 posts
Location: Melbourne, Australia


Posted:
The chat idea would really be good, it adds a social aspect to an otherwise very formal relationship (or so it seems to be). Don't pressure him into doing so, shy people don't ever like that, and make it one on one and if possible on a regular basis.

During the chat, find out as much as you can without interrogating him. Things like his background/culture for example, or hobbies and interests. Shared common ground is always good and can help him overcome his nervousness at least in your direction.

Birgit also has a good point with the expectations; I'm sure each individual doctor would have a different method of formality (they want information in this format, during this time, yadda yadda yadda). Setting out what you expect him to do will go a long way to help him with that.

Above all, be patient - it may take months or even years for someone to overcome personality traits like that, so don't go yelling at him because he ate the last cupcake or something trivial smile hug

Kupo!


LurchBRONZE Member
old hand
929 posts
Location: Oregon, USA


Posted:
I've had to train people to do some relatively stressful/dangerous/life saving stuff, so I know at least a small part of what you're going through, but not on the same scale at all..

I would say that part of the nervousness is a desire to do right, and make sure not to skip any steps. Perfectionism can be a curse though, and you need to explain that to him. Everyone will make mistakes, especially new people. Usually those mistakes will be fixable, sometimes you will get in trouble, sometimes you wont. Being able to accept that reality is a big step. A big problem, and cautionary note about people seeking to be perfectionists is that often times they will attempt to cover their mistakes, which will only make them worse. He's got to be able to accept and own up to his mistakes first and foremost.


Breathing exercises are a good way to get people to calm down and think before they proceed with whatever they are doing. Even something as simple as a nice deep breath before talking will help sort things out in his head. Get to know him on a more personal level, but remember there is a difference between a trainer, and a mentor.

#homeofpoi -- irc.newnet.net Come talk to us we're bored frown

Warning: Please Do Not Jump On The Seals


natasqiaddict
489 posts
Location: Perth


Posted:
ok, want a medical students P.O.V. then?

smile

Expectatiomns is a large one. So if he's giving you all the obs and changes, tell him "when I want an update, I want to know a, b and c..."

One thing that really relaxed me in a rotation was the surgeon said "this is how we're marking you... " and it was all "relationships with patients, attendance" etc, and nothing on medical knowledge which meant I wasn't streseed, pouring over textbooks in his specialty.

Being really friendly and commending them on good work, making sure someone is available if they don't know what to do etc

I think all your above suggestions are awesome and would love to have you as a clinical mentor smile

I've noticed people from other med schools (Mainly Singapore) that come to Perth have very different expectations... and overseas doctors can also be like that. Perth has completely shirked from the med student=slave mentality... So I don't really feel that much pressure.

SO I hope he feels better now...

MikeGinnyGOLD Member
HOP Mad Doctor
13,923 posts
Location: San Francisco, CA, USA


Posted:
Well on sign-out this morning, he presented his admission from overnight like a pro, and I let him know I thought so.

I think he's starting to relax and he's going to do fine.

And Natasqi, thanks for your perspective. I'm a third-year pediatrics resident, so it hasn't been THAT long since med school, but it's still easy to forget and do all the stupid things that my Seniors did to me, not out of malice, but just out of forgetting that the students are there in the hustle and bustle of the day.

-Mike

Certified Mad Doctor and HoP High Priest of Nutella



A buckuht n a hooze! -Valura


newgabeSILVER Member
what goes around comes around. unless you're into stalls.
4,030 posts
Location: Bali, Australia


Posted:
How's it going now, Doc?

.....Can't juggle balls but I sure as hell can juggle details....


MikeGinnyGOLD Member
HOP Mad Doctor
13,923 posts
Location: San Francisco, CA, USA


Posted:
Better. He's learning...

-Mike

Certified Mad Doctor and HoP High Priest of Nutella



A buckuht n a hooze! -Valura


LurchBRONZE Member
old hand
929 posts
Location: Oregon, USA


Posted:
Feed him donuts it helps the learning process... positive reinforcement wink

#homeofpoi -- irc.newnet.net Come talk to us we're bored frown

Warning: Please Do Not Jump On The Seals


PhaiGOLD Member
member
113 posts
Location: Australia


Posted:
Ask about his previous instructors. One of them might have been a real dragon to him.



Hmmm... only other piece of advice I could suggest would be:



If he's calm/(er)/(ing down) about most of the procedures, but still seems upset or edgy about a particular topic, talk to him about it sitting down. Sitting in a quiet corner, relatively informal but not overly intimate. You can always tell alot about people by their posture and hands when they sit. If you're standing, or reporting, you tend to place your hands in your pockets, or behind your back, or hold something.



Places to talk:



Not your office, since it's your territory, and you hold the powerful position.



Not the cafeteria, if it's crowded or loud or other people are going to accost you.



I dunno. Do you have a time out zone somewhere?



Oh! One of the best things I've found was when instructors gave me tips beginning with something such as: "I've found the best way I could approach this is to etc etc." There's no pressure to conform if I (student) have found a preferable method, it references your experience, it's non-aggressive (not that I can really see you as aggressive) and it's open to commentary.



Tough work huh, training stuff to do stuff? You sound like you're hitting a balance between teacher and buddy. He'll prolly catch on gradually rolleyes
EDITED_BY: Phai (1191549931)


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