6 Tips For Disappearing on Rotations

As I progressed into my third year and especially my fourth, I would often brainstorm creative ways to disappear or otherwise leave rotations early. Here are some of the best strategies and tips for being the “absent” medical student while still achieving a passing grade.

1. Set The Bar Low
   The best thing you can do if you’re shooting for a month-long vacation is to never really make yourself visible that much from day one. Your first few days on a rotation can really set a precedence as to how much your residents expect to have you around. If you spend the first week of the rotation fully visible at all times and then mysteriously disappear, a few red flags will be raised. You do need to “feel out” the rotation to see just how much you can get away with, but don’t sit around the resident’s room in your downtime as this will increase your visibility.
2. Learn The Schedule
   Find out when the attending or your chief resident likes to round, since you’ll likely have to base your disappearances around these times. It may take a few days to learn the schedule, but often the attending will just come out and state that he or she wants to round at a specific time. If you’re taken by surprise, remember you’re just a page away.
3. Build Inconsistency
   Starting early on, you’ll need to build inconsistency with your team. What this means is that they will really never know what to expect out of you. To do this, you’ll want to disappear unannounced for half an hour or so during the first day or two of the rotation. Get lost at completely random times and random intervals, and then miraculously return. As the first week of the rotation progresses, increase the duration of your disappearance. Before you know it, you’ll be gone 2-3 hours at a time and no one will expect anything any different.
4. Study In The Library
   If you like to study in your downtime, always let it be known that you prefer to study in the library for minimal distractions. This gets you away from rotations and you’ll be less likely to be called on for scut. If the residents or attendings object, reinforce the fact that you’ll be available via page and that you are on campus. No argument against you studying in the library can hold much water, so you’ve just got to do it.
5. Map Your Exit Strategy
   Always know your route of escape for each rotation. A good rule of thumb is to never, ever take the elevator on your way out. You’ll inevitably run into an attending or someone that’s going to squeal. Even if you’re on the 11th floor, the stairs are your best friend. Once you’re in the stairwell you are generally home free.
6. Never Carry A Backpack
   Having your backpack on while walking down the hall is a sure-fire sign that you’re leaving. You should always carry just what you need in your white coat. By doing this, you never look like you’re leaving. While you want to create inconsistency with your presence, you’ll want to maintain a consistent appearance. If you plan to study in the library, simply leave everything in your car and then swing by and pick it up.

All Joking Aside

Even though this post is partly in fun, I did actually put these tips to use while on some of my rotations. Obviously, you’re going to have to use some common sense and feel out the residents to see if ducking out for any length of time is feasible. There were certain rotations where I would be absent 3-4 hours out of every day and left early without permission, while others would check up on the students so often that it just wasn’t possible to slip away.

Also, you guys are smart enough to know that if you employ these stealth tactics, you most likely won’t be honoring these rotations. If you get nailed or somebody has a sit-down with you, it’s best just to play the game and ride out the rest of the rotation without being gone too much.

The idea is to achieve the maximum amount of time away from the rotation while still receiving a passing score. In order to do this, sometimes you’ll need to balance a fine line.

Volunteering is Overrated

My previous post on needle sticks and exposures was awarded a shiny new post over at SDN. Some questions for me were posed in the discussion, and I wanted to expand on the topic a bit more than simply posting a reply to the thread. Before I go much further, I wanna give bronx43 props for watching my back.

Druggernaught states:

I’m curious how much clinical exposure the guy who runs MedSchoolHell had before he applied to medical school. I’m guessing not nearly enough. Do any of his regular readers know, or is he willing to share that with us here? It doesn’t take long to realize that you’ll be dealing with people who aren’t willing to put in the time for a little common sense preventative care for themselves, who will simultaneously hate you for doing your job and yet demand that you give them the care they need, and that you’re going to have to put yourself at some risk from time to time.

It’s a bit off topic, but looking over that website and some of the posts here, I really wish that medical schools posted some sort of requirements as far as real clinical exposure to avoid the 4.0, 40 MCAT applicant who very quickly realizes he’s made a mistake but is too far in debt and has committed too much time to turn around now.

I had roughly 8 months of volunteer experience, ranging from shadowing in the ER during college to volunteering in private pediatric and family medicine practices in my hometown. This was across three years of college, so roughly 2.5 months out of those college years I was volunteering somewhere. I loaded my volunteer experiences during the last three years of college, and didn’t do much of anything other than school-related stuff during my freshman year. These gigs were the typical “volunteer” positions, so they were probably 1-2 days per week at 3-4 hours each day. Nothing excessive, by a long shot.

I never fully enjoyed any of my volunteer positions. I saw them as a necessary evil in order to boost my chances of getting into medical school. Everybody else was doing it, so I should too. I should have listened to my heart way back then, but I brushed it off as “not liking specialty X.” I thought I’d surely like something in medicine, just not whatever I was volunteering in at the time. Since I didn’t volunteer in every conceivable medical specialty, I rationalized that I would find something that would fit my personality.

The Volunteering Conundrum

The problem with volunteering is that you’re not really going to see what it’s all about short of becoming a full-fledged employee where you actually get to do stuff. You follow some doc around for a few hours and then go home — rinse and repeat while your pre-med mind thinks it’s going to be cool to be like that doc one day. Most volunteer gigs won’t let you do anything remotely close to what you’re going to be doing as a medical student on the wards due to insurance and litigation issues.

What volunteering won’t show you are the long hours, after-hours calls, sleeping in some crappy call room overnight, unruly patients, staying after “office hours” to complete paperwork, aggravated family members, social work involved with “patient care”, and the terrible insurance crisis and low reimbursement to physicians. The only way you’re going to learn about this stuff is to pull a regular job in a clinical setting, and even then experiencing some of these things might be iffy at best. Some of my pre-med buddies were doing stuff like phlebotomy, full-time ER nursing, or even full-time EMTs. Were these people more prepared going into medical school as far as knowing more about what they were getting themselves into? I think that without a doubt they were.

That being said, most students (myself included) have no idea what the practice of medicine is really going to be like prior to medical school matriculation. That’s the nature of the beast, especially when you do the standard volunteer gigs. By the time you get on the wards and decide that it really sucks, you’ve already thrown away two years so you might as well finish it.

That’s what I did, anyway. By the time I decided I really hated medicine, I had already taken and passed Step 1 and thrown away two years worth of tuition and time studying. I still believe this was the best decision for me, as talked about in my post about when to get out of medicine if you’re unhappy. Your mileage will vary, but had I not had student-loan debt incurred during the first two years of medical school, I would’ve probably cut my losses a lot earlier.

UberVolunteer (or Work) More

If I had one piece of advice to give, it would be that you need to really dig down and come as close as possible to finding out what medicine is really going to be like before you waste your energy applying. If this means getting a full-time job working 12-hour shifts doing blood draws, you need to do it. If you can shadow a 1st or 2nd year OB/GYN resident and work every hour that they are at the hospital including calls, that experience will give you a much better idea of what this whole medicine thing is going to be like than pushing patients to their car or bringing down food trays to the emergency room. This isn’t volunteering, this is being an UberVolunteer. I’ll be the first to admit that I didn’t really know what I was getting myself into, but I at least partly chalk that up to the fucked up volunteering system in place. If I had to work 12 hour shifts doing blood draws or follow some poor OB/GYN resident around the hospital while he or she got their asses burned, I would’ve given medicine the finger long before I even matriculated.

Paramediclizard states that I should “learn something from a real physician and student of life.”

Being compassionate, being concerned for your fellow man, doing everything you can to help people—that’s the kind of religion I have, and it’s a comforting religion.

Sorry DeBakey, that stuff just doesn’t float my boat. For me, medicine was just a job prospect. For you, it was a lifestyle and religion. I’m really not that concerned for the welfare of sick people I don’t know. Sorry.

Plus, I like more than 4-5 hours of sleep every night and retirement before my 90th birthday. Hey, that counts for something, right?

Needle Sticks and Exposures – One Reason I Hated Medicine

I stayed away from procedures. I never, ever volunteered to do anything and would always do the bare minimum to pass on every single rotation. If the procedure was to be done on a patient with a known STD or blood-borne illness, I refused to do it.

You see, it honestly wasn’t worth it for me to risk a needle stick while performing an invasive procedure on a HIV/HepC+ patient. I don’t care how low the reported risk is — the honest truth is that there is still a risk. The risk of contracting HIV from a needle stick is higher than people winning the lottery, and people win the lottery nearly every day.

I’m sure most of you guys have seen something like the following:

A 42 year old HIV+/HepC+ male with chronic alcoholism and a history of current IV drug abuse.

• Point 1: If it wasn’t for his or her poor lifestyle decisions, they probably wouldn’t be here in the first place.
• Point 2: If I wanted to take the risk of contracting whatever it is that the patient has, I sure wouldn’t do it working 14 hour days and being abused in some shitty hospital.

It just wasn’t procedures, either. I absolutely detested the OR. I hated it with every fiber of my being. My hate stemmed not only from the asshole residents and attendings that I had to spend hours with, but also from the fact that blood was most likely going to be shooting and splattering about the fucking place at some point. For example, we once had a HepC+ guy on the vascular service who needed a femoral popliteal bypass done. He was a chronic alcoholic with near end-stage liver disease, and by the looks of him had lived quite the “exciting life” at the ripe old age of somewhere in his mid-40s. I hoped to God he would leave AMA before we had to take him to the OR.

I’m just not built to take care of people who don’t take care of themselves — and those were exactly the kinds of patients seen at training institutions that take care of the indigent population.

I’m glad I got out when I did. Fuck Hippocrates, let Darwin sort ‘em out. It’s survival of the fittest.

What You Can Learn From Medical Conferences

I disliked medical conferences in general. I wasn’t interested in the topics and they were typically only a short break from my work on the wards. While they often put me to sleep, I did take something away from conferences that was not blatantly obvious while I was attending them.

To be proficient in medicine requires a huge time commitment. Think for a minute at the number of conferences you attend on a weekly (if not daily) basis:

• Grand Rounds
• Morning Report
• M&M
• Noon Conference
• Guest speakers
• Program-specific conferences (i.e. unknowns in Pathology)
• Tumor Board

I don’t know about you guys, but I attended at least three conferences mentioned above every week during my 3rd year. I’m sure the residents probably attended even more. I particularly disliked noon conference, because I wanted to use my lunch as time to hang out with fellow classmates and talk about something, anything, other than medicine. Most of the other students didn’t see it that way, and I usually went up to the cafeteria or an outside picnic table to eat (pending I was fortunate enough to have a lunch break to begin with) while they listened about treating hypertension for the 50th time.

Now combine the above conferences with your workload on the wards and the outside reading and studying that you probably do. Guess what?

You’re eating, breathing, sleeping and shitting medicine.

If you aren’t passionate about it, however, you’re simply wasting your time. Those are hours down the drain, never to return. You better damn well make the most of them.

If you would put in even a fraction of the amount of time and effort that medical training requires and apply that effort to alternatives outside of medicine that you are truly passionate about, you guys would absolutely kill it. I wrote about medicine developing my work ethic in an earlier post, and this idea is a spin off of that broad concept.

While I never learned shit about a new drug or the latest treatment regimen for pulmonary hypertension, medical conferences taught me that I could be more successful, more profitable, happier, and have more free time with a smaller time commitment while still following the “daily learning” equation that medical education subscribes to. I just had to apply that equation in other industries.

Thanks again, medicine. I owe ya one.

Slacker Stories and How You Can Get Away With More Than You Think

Radiology rotations at my school were known for being extremely laid-back. With that in mind, most students at my school took a radiology elective at some point during their senior year.

Not to pass up on the good times (who really wants to be doing a SICU rotation instead of a radiology elective, anyway?), I promptly scheduled myself for a general radiology rotation about midway through my fourth year. Here was my schedule:

Day 1: Hung out with residents and got a read of just how much I could get away with.

Monday-Friday: Came into the hospital around 10:00 am, signed a paper to validate that I was present, left the hospital at 10:15 am and went back home.

Saturday-Sunday: Off.

Repeat for four weeks.

Seriously, that was my rotation.

Am I competent to read films? Nope.
Do I care? Not at all.

I had no plans to even practice medicine, much less read a damn radiology study. I thought “why not make the most of this rotation?” And that’s exactly what I did.

How You Can Get Away With More Than You Think

I was supposed to be hanging out with the radiology residents from around 8am-5pm Monday-Friday. That’s what the other students did, anyway. What most students don’t realize is that you can get away with far more than you think you can on rotations. Of course, it’s rotation-specific. For example, I couldn’t have done this on Surgery or IM. You have to just read the residents.

I saw on day one that there were quite a few students rotating with me and that the residents and attendings weren’t keeping detailed logs of attendance. The only attendance log was one that stayed up for the entire week that I signed myself. That’s an early Christmas present for you because it essentially means that nobody really knows who you are or where you’re supposed to be. This was all I really needed in order to pull the schedule out of my ass for the month.

For evaluations, I simply picked a few random residents that were on the service. They didn’t know who I was anyway, so they just filled out the evaluation and gave me pretty good comments.

My final grade on the rotation: A

The key is to simply keep your ear to the ground always looking for opportunities to exploit. Just like in business, you need to find market inefficiencies and then take advantage of those inefficiencies in order to create a profit.

Do You Have Any “Slacker” Stories?

It’d be cool to hear about any slacker stories that you guys may have while on rotations. Perhaps you “beat the system” and got a little payback for the long hours and abuse you had to put up with during your third year. If so, I’d love to hear about it.