A Fresh Start

Ah, July.

Start of the academic year for the US/Canadian medical systems. Where when one was a medstudent previously, is now an intern.

And what it means for consultants like us, is fresh blood (spoken with a Transylvian accent, followed by a sardonic laugh)! New 4th year med students and fresh-faced anxious interns. Which means new entertainment for us (just kidding. Kinda).

It's always interesting seeing the fresh faces this time of the year. Whether it's a fresh 4th year medstudent. Or a fresh intern. Or a fresh fellow (person having completed residency and starting off in subspecialty training).

You see all kinds of characters. Some you like. Some you'd love to work with. Some you'd hate.

• There's the very nervous kids. The ones who are trembling so bad when they're examining the patients that you'd think they had a lesion in their basal ganglia (hah, you thought an endo would forget his neuroanatomy, didn't you?). These medstudents/interns tend to be a slight shade of bile green, and look like they were at a funeral. Liable to puke if you pimped them a bit too much with questions on adrenocortical physiology. I tend to buy the medstudents on rotation with me Starbucks; but with these students, I have to be careful about buying them any caffeinated drinks.


• And then there's the arrogant SOBs. The ones who act like they know it all, just because they scored a 99 on the USMLE step 1 (which by they way does not predict how good a doctor you'd be). These are the ones who tell you on Day 1: "I'm going to be a neurosurgeon/interventional cardiologist/[insert high-paying subspecialty]". These are the ones I sometimes (shame on me) enjoy watching fumble when I throw out my customary teaching-round questions. Eventually they wisen up and realize that they may need a letter of reference from you, and stop acting like they own the ground you walk on.


• Ah, and let's not forget the Beauty Queens/Studmuffins. All medschools have 'em, students who look like they should be modelling for a career instead. Admittedly, some eye candy on rounds, especially when you have a long census, makes work more bearable. And it's always amusing to me (a tinge of envy, perhaps?) to watch the George Clooneys of the medschools schmooch the nurses. "Oh, don't you worry. I'll get the patient chart and bring it to you. And oh, there's some donuts in the nurses' breakroom too; go help yourself.." Oh, if only I was like that in medschool.


• There's also the walking dictionaries. The students who know every single factoid listed in every published medical textbook. And they'd be happy to recite it to you too, whenever the need may arise. I have to say, I've found these students very helpful- they're often also very keen on explaining the pathophysiology of things to the patients. And so, when things get busy, I sometimes have my students spend some time after rounds to again go over what is hyperthyroidism, or adrenal insufficiency.


• Of course, we next have the eager beavers. Usually medstudents who are aiming for a very competitive residency, and need to get good letters of references. The ones who volunteer to see the next consult, and the next, and the next. Something the other students are only more than happy to oblige. These students tend to carry the most patients. To their credit, often their work is exemplary (for a fourth-year) as well. They'd bring you the charts even before you asked for it. Notes all written in detail. Heck, they'd probably give me a shoeshine and back massage too if I asked for it!


• And on the other end of the spectrum, we have the uninterested. Students who couldn't be bothered, and are not hiding the fact that they're bored. They're yawning when you're talking to the patients. They're texting or surfing the next on their smartphones when you're teaching. They don't complete the reading assignments you gave them. I see two subgroups of these students; very unambitious people aiming for residencies even a tadpole could get into, or students late in the academic year after they've matched, and are suffering from a bad case of 'senioritis'. These are the most painful students to work with, and while I've not yet failed anyone yet, one young lady got close to it. When she yet again did not read up on the topic I had assigned her, her excuse which became classic in her medschool after I wrote that on her evaluation, was "It was Mardi Gras yesterday..."

Despite these many personalities though, the best students are probably the ones with a good mix of the above with the exception of the last. And working with these different personalities certainly makes work a lot more interesting. More so when you're now looking at things from the other angle of being a consultant, and not a student anymore.

(And for the record, I was the anxious kid in internship. Especially in the first few weeks of my ICU rotation. I was so uptight that my anal sphincter probably could have crushed beercans. And I had palpitations and insomnia going into call each time).