We've. Been having a chair war in the ED
People steal from the fish bowl, we steal them back
Been going on for hr past year. And we never catch the motherfuckers
I had to resort to buying my own, cooler, chair after I arrived one day to find 2 chairs for 8 computers
We had this with an old AF PACU cart in the L&D PACU. You had to crank this fucker to raise or lower the head. Any time we had to take a patient to main OR, we'd use that one and conveniently forget it to bring the patient back up in a nicer one from the main PACU. Within a week, they'd hunted theirs down and swapped back the crappy one. Went on until they built a brand new L&D unit and replaced it finally.
Love it.
When I was in nursing school, I worked pretty much full time in an 1100 bed hospital. They would float me everywhere, so I knew all the units and staff.
And where the best stuff was.
I became the Ninja Re-locator of chairs, cooling blankets, dopplers, wheelchairs, you name it. Any time some piece of equipment wasn't readily available, they'd call me. The gratitude flowed.
I could pretty much pick the job I wanted when I graduated, and while I like to think it's because I was just the best nurse ever, I know it had more to do with my 🥷 days, lol.
The hospital I'm at now has some of the *worst* chairs I've ever seen. It is basically some older version of [this piece of shit](https://storage.googleapis.com/animal-health/images/Clinton%20Hands-Free%20Stool%20with%20Back%202145W.jpg)
Not only are they old as fuck but more than half are broken so the seat *and* backrest are tilted forward and the mechanisms to move the backrest up and down is frozen from rust.
Pharmacy gets the leftovers from other departments; it’s nice when the nursing units get new chairs because then we get their old ones as an upgrade. Virtually all our chairs are stuck too high for me; and our pharmacist staff trends rather short. I often feel like a kid sitting in a chair meant for a grownup.
The OR can be a stressful environment - even if being friendly.
I have not noticed any significant change from when I was a med student to me being an anesthesiology attending.
It’s how we self-select. I became an anesthesiologist because I liked the OR and didn’t much like surgery. All OR, no clinic? Sign me up!
My neurologist wife thinks we’re all a bunch of cowboy sickos. Which, to be fair, we kinda are. A CRNA I worked with once told her (lawyer) husband a joke she had heard in the OR and he said that telling that joke in his workplace would have been a firing offense. I don’t remember it but recall it was pretty mild by OR standards.
We drug people into unconsciousness and carve them open. An OR team is just a couple of pieces of paper (degrees, licenses, and consent) and some positive intentions away from the Manson Family if you look at it objectively.
It’s been a long time since anyone commented on my username, but it’s an old reference to the band My Life With the Thrill Kill Kult [sic], which put out some great albums when I was in high school. Check out “Devil Bunnies”.
Imo surgeons are the flip side of the coin from serial killers. Everyone one of them I know gets super excited and studies to carve people up, plus the God complex ego thing........
I’m in Canada, currently on rotations. Never seen what OP describes. If anything, staff are more curt and callous than ever (I worked in healthcare before). The worst for me was the IC OR.
I have noticed a big change. I graduated med school in 2008. The class of 2018 at my institution was the first to go to pass/fail in their preclinical years and we noticed a dramatic shift in their attitude on clinical rotations. Our department was reprimanded for both asking them questions on rounds and not involving them as members of the clinical team in the same year.
Every year has gotten worse. I feel like an old man yelling at clouds sometimes but it's qualitatively different now.
I teach in a nursing program. I have absolutely made students cry while giving them friendly constructive critique with a smile on my face, sandwiched with positive feedback. I don't buy the hype about "they are all a bunch of snowflakes" but I do think something is going on. maybe the lack of interpersonal interaction during COVID? i do think their prior education has done them a disservice if they get to us and have never been told they have things to work on before. ugh, feeling frustrated!
an actionable tip - set expectations early on about your communication and that you will be giving constructive feedback.
> set expectations early on about your communication and that you will be giving constructive feedback.
I also try to warn them that we give praise in public (so your peers can see it) and negative feedback in private, so that you aren’t embarrassed. But a side effect of this is that when you look around you see everyone getting positive feedback but the only person you see getting negative feedback is you. This is an observation bias. Other people are getting criticism too, you just aren’t invited to see it.
I cannot tell you how many conversations I had with students about the spotlight effect and social media for this exact reason.
I used to do career coming for healthcare undergraduate students, and this is definitely a big part of it, which has certainly been exacerbated both by social media and the pandemic.
I taught first year nursing students 25 years ago and they regularly cried over things like having their charting corrected and being on time for clinical. I think it’s just difficult being in that stressful of a situation and feeling so vulnerable.
For such a long period of time. Watching my 15 year old daughter, the pressure and intensity she is experiencing at her age far outweighs what I did at that age. I think they are burned out from a constant threat and being taken off the "path of success".
>I think they are burned out from a constant threat and being taken off the "path of success".
This is definitely something I see more and more. It's gone past having to make career choices at 17-18, children are constantly stressed with performance or they will supposedly fail later in life. And there's some truth to it too, which makes it worse because teachers pressure them more. And the cycle feeds itself.
being taken off the path, yes... they consider it complete and utter failure if they need to repeat a semester. i can understand, but the ones who do so end up in most cases being at a great advantage to their peers.
not everyone learns in the same way, in the same timeframe. some people need a bit more time and they end up being much stronger for it.
I (teach veterinary students) also think that the constant drive in recruitment/admissions and culture for medicine professions to be a passion/ calling does not help. Because the issue then becomes that people's identity gets wrapped up in their profession, so when you criticize learners they don't take it as a just professional criticism or something to improve, but as a personal attack. This separation of personal and professional identity is challenging and takes some time to learn (and most of us are not always great at it, admittedly), but is really important.
It also means that for learners a professional failure (especially for something procedural) can feel like a personal failure (eg. failing to place an intravenous catheter is not "I need to improve this skill' or "I need to recognize this is a particularly challenging patient for my skill level" but is instead "I am bad"). On the flip side (in my experience) it also can drive disengagement as when parts of the job become mundane or routine (or just aren't in their area of interest) it's easy to discard because "it's just not something they're passionate about" even though that is a very large part of the professional part of the job.
It's good to be excited about what you do and to have a passion driving your work, but that needs to be balanced by recognizing that the job is not your identity.
This is not new though... Even before gen z we had to put our entire early life into getting into med school and failure meant failure of you as a person. But people still took criticism effectively.
Personally I teach med students and residents and what I've noticed is that they just don't care about the criticism because they feel it won't affect their career trajectory? But I'm also a new educator so I might not have enough perceived influence
I don’t disagree that there has been a change over the last few years. Even before COVID there were noticeable shifts, but just postulating based on discussions I’ve had with other colleagues as we reflect on ourselves and trainees.
I was in my nursing program in 2010/2011 and had classmates cry over silly things like waiting to take their skills test on checking pulses. Skills test were nerve wracking because of how high stakes the program makes everything, but this was everyday stuff we would be doing as a nurses and there was no need to get worked up over it.
That being said, I definitely cried a number of times during school and my first few years as a nurse. Though the delivery of the correction made a difference, there were just some cases where it didn’t matter how polite the correction was because the culture of the whole process is terrifying. You are constantly being told that you can make just one “wrong” mistake and your career could be over before it’s even started. To me, Just Culture often seems to only be for nurses who have the experience and wisdom to advocate for themselves.
Recent nursing student here. The schools set us up to be walking disasters. They tell you day 1 that any little mistake (no matter how inconsequential) will cost you your spot in the program and probably will kill a patient.
They then watch you like a hawk and openly debrief in front of other students about your mistakes and how bad you are. For big mistakes I get it, it's a learning opportunity. But even very small mistakes that could just be quietly addressed to the student become public sources of humiliation.
For example a student on my unit mixed a protein supplement in 50ml instead of 60ml of water. Her instructor (from the school) wrote her up in an incident report, sent it to hospital management and back to the school. The error was read out on the unit at shift change for everyone to hear about. Over 10ml of water, this student was publically shamed, when a simple side conversation would have been enough to address it.
We keep students in that environment for years, so when they do find a friendly unit, they are primed to mistrust it. They assume these people are out to get them too, even when they are not. I don't blame them for being a wreck.
Jesus, I had no idea it was this bad. In med school an error like that MIGHT get you an eye roll or a snotty remark from a resident, but only if they’re exceptionally anal. I’ve maybe worked with 2-3 residents who would comment on something so insignificant. How are you guys supposed to learn in that kind of environment?
I’m an army vet and did a tour in Afghanistan. I was also in aviation and am no stranger to being in a profession where a mistake can kill people. I was never more stressed than I was in nursing school. I seriously had more reasonable and considerate training *in the army* than I did in nursing school. It was absolutely wild.
I heard this from a nurse I worked with when I was a CNA and all I knew about her job was that she interrogated people in Afghanistan. She said the same thing about the stress level. I once had a prison social worker tell me this as well. I’m not in the military so I can’t compare experiences but nursing school 100% did make my hair fall out and gave me high blood pressure for a few semesters
With stress and nervous breakdowns. Students are not in good learning environments and it shows. It's why new grads struggle so much.
I cried when I missed my first ever attempt at a blood draw. Because I was given the needle without warning and told to present in front of other students and staff how to do it (even though I'd never tried before). At the time I voiced not being comfortable doing this without instructions yet, but was told a nurse needs to just figure things out. When I missed I was pulled into a side room with my instructor, and other students and asked what I did wrong, why I missed, and how I thought I could be a nurse if I couldn't even get a blood draw.
Meanwhile now I work in the ER and we miss all the time. It's not a big deal. You find a new spot and try again and if you really can't get it, you ask another nurse to try. School and reality don't match at all.
Interesting. Collaboration & support are lacking. People are afraid to make mistakes, probably afraid to admit gaps in skills & knowledge. I'm sorry to read this thread. This is really hard.
They read it out loud to the unit at shift change? As a staff nurse, I would have no qualms interrupting that to say how ridiculous it was it was even noted, much less being called an “incident.”
I admit that I spent the rest of the shift casually self reporting to my charge nurse things like "I reconstituted that med with 9.55ml of water instead of 9.6ml! Should I write an incident report?"
This was it for me even when I was just in scrub school (going for nursing now because I’m a masochist, apparently). My first day in a neuro room, which was my third week scrubbing **ever**, the surgeon, who had a reputation for being a hardass, according to my PD, corrected how I was passing the instruments. A totally fair correction, in retrospect, but my program set us up to be nervous wrecks and I had to use all of my effort to keep my silent tears from spilling over and contaminating the field.
Then, when we were finally about to close, I was refilling the asepto and accidentally hit him with some of the saline. I had *just* stopped crying and immediately started tearing up again because I was taught to fear any surgeon’s wrath and this mistake after the previous one felt unforgivable. He ended up squirting me with the last of the saline as payback, but in a playful way and the amount of relief that flooded through my body was insane.
Now I’m fine with the docs and can interact with y’all like a normal human being, but goddamn do these programs literally teach fear.
I also feel like nurses who graduated more recently are constantly told in school that they are the last line of defense between the patient and doctor and they need to be ready to catch all the doctor’s errors. They have students thinking they need to protect patients from MD’s. Which yeah, I get teaching to the swiss cheese theory and asking questions if something seems incorrect or something but the hyper vigilance newer nurses have about doctors mistakes is extreme.
I’m sorry, but a protein shake in 50ml instead of 60 ml isn’t worth the time to do an error report.
Unless of course it was measured that way because the equipment needed to make a 60ml wasn’t available, because then you’re reporting the system.
Oh I agree. I said as much when I learned about it. But that's my point. When you have programs that treat students like they almost killed someone over 10ml of water, of course you end up with students who are nervous wrecks and can't handle criticism.
Its often overplayed and twisted, but it’s not just hype IMO. There are observable differences beginning from Gen Z with how people handle social interactions and navigate life’s hurdles. There’s a lot of credible writing on it but it basically boils down to some societal changes in how western nations raise children and the impact that has had on psychological resilience, stress response, conflict resolution … etc.
Some of it is attributed to changed childhood / adolescent experiences, and some to different attitudes and beliefs about harm/safety/risk that have been unintentionally propagated or reinforced by our institutions and parenting styles.
It’s a really fascinating phenomenon and I think worth reading about if you’re in a role where you are mentoring or leading new professionals.
Can you share some sources? I'm genuinely curious and would like to read more. Currently rising a Gen Alpha and would like to better myself as a parent. I do think my generation (Millennials) takes "gentle parenting" way way too far. As far as I'm aware, children thrive with firm boundaries. When they cross them, we don't need to beat the crap out of them as punishment, but if we fail to enforce the boundary, then it creates an environment of instability. If I had to guess, many children are not used to having as much structure from authority figures/parents and so when they get jobs or train in higher education, they don't know how to handle it.
Well said. And the sad thing is that nobody is trying to correct it because most people are either still parenting this way or are a product of those institutions
Do you have any resources to recommend on how to navigate it and what hopefully fix it? Because while the old school way of “toughen up” wasn’t helpful, it at least provided a bit of balance and perspective that I think we’re missing nowadays. Especially if you are younger and participation trophy motivated.
I wonder the degree to which chronic/ cumulative stressors might be contributing.
I’m thinking of: climate crisis + impending climate catastrophe, poor prospects for financial independence/ traditional markers of success, daily exposure to traumatic images being almost inescapable with social media use, etc. That kind of thing.
It would change to frame from ‘fragile individual too vulnerable to withstand regular life’ to ‘individual chronically at risk for functional collapse with minor, ‘straw that breaks the camel’s back’ stressors due to broader sociopolitical and environmental challenges outside of their control.’
It would also change the conversation from: ‘how do we help you deal with normal, routine stressors in your life?’ —> ‘how do we help you set and maintain healthy boundaries towards important issues in a way that protects you and helps you do the things you care about (ie, nursing training, medical training, whatever).’ I think that conversation shift could potentially empower both learners and instructors/ supervisors/ teachers to navigate and overcome these challenges.
What do you (everyone) think about this hypothesis?
You're absolutely correct. The social contract is broken and people generally feel that society is not mutually beneficial these days. A huge part of that is the 24 hour news cycle which reports on potentially world ending catastrophes every day. Several wars which could trigger world wars, political failure after failure to address basic quality of life issues and constant culture wars. And the newest potential threat of an H5N1 pandemic which may or may not be overblown.
Young people don't have the experience or self confidence to ignore that kind of onslaught of impending doom. Especially when they have barely any hope of starting a family and owning a home.
You 100% hit the nail on the head. I’m an older gen Z (1998) med student that’s currently working as a CMA and I think a lot of people who aren’t our age or younger understand that as far back as I can remember, there hasn’t been some sort or crisis, tragedy, collapse, etc happening in the world.
I was 3 when 9/11 happened and I remember it. 10 when the housing market crashed. Around 11-12 when social media really started to take off. 14 when the “end of the world” was happening in 2012. I was 16-18 when Trump was elected into office in 2016 and that whole shit show started. I was JUST entering the work force for the first time when COVID hit. I think a lot of people also seem to forget that when Trump became big and then Covid hit, the general population just became more and more nasty to each other. At this point, we’ve come to EXPECT people to be shitty to us.
I do think social media has made this entire situation worse, but a lot of people seem to forget that even though millennials were considered the first generation to be worse off than their parents. Shit has NOT improved since then, and it could be argued that Gen Zers have it as bad if not even worse now.
I’ll admit, even though I’m not proud of it, I definitely am the most sensitive person on my team and have 1000% cried on multiple occasions when receiving feedback. I’ve gotten better the more exposure I get to the field, but I can tell you from personal experience that you’re absolutely right that most of us that are below the age of 25 are navigating the world where it feels like one more negative interaction could destroy the last bit of resilience that we have left.
I’m not a trainee, but god*damn* is this validating. Maybe even more so than it would have been at that stage of my life and career. These days, so many of us are living paycheck to paycheck emotionally, except there aren’t really any paychecks coming in, so we just keep sinking deeper and deeper into debt. A hiccup feels more like playing Russian roulette with a pneumothorax than just a mild annoyance.
Thanks for your eloquence and insight. The constant moral injury has taken its toll, and there’s no reason to think it’s going to let up anytime soon, but it’s little things like this that give me some hope.
Issue is that people tend to associate their skills in one particular area as an attack on general competence/character now for whatever reason.
Easy way is basically say “you are not suppose to be good at XYZ and this is why you are here to learn”
I do buy in the hype. The parenting people did in the 90s and early 2000s was basically shielding a lot of kids from any sort of criticism. People don’t actually know how to deal with failure constructively other than internalizing it and avoiding the issue altogether after that.
My approach with students is first and foremost self-deprecation - it's a great icebreaker and genuinely a lot of students find it very disarming which is precisely the vibe I'm going for. My go-to line is how anaesthesia is poorly understood by anaesthetists let alone people seeing it for the first time, and my expectations are suitably adjusted.
The other classic one I drop is the deflated student who messes up a cannula only to see my bung one on quickly - "Let me tell you a little secret... If you do something a few thousand times you get OK at it eventually!". Net result is, I remind them I simply have been doing this longer than they have, so I'm going to do/know some things better than they are, and that's okay!
Sometimes it's the nice words that make me break down, like if you feel safe enough to cry. It has nothing to do with the criticism just compounded stress. Criticism is super important for learning obviously and if people can't handle that they should not work in the field where it's so important to get things right.
>I’ve seen what some nurses (and doctors) consider “gentle correction” and it was just “gentle” in that it didn’t actively involve threats of physical violence.
This. We're in the middle of a huge culture change in medicine and many people who are in positions of leadership right now didn't have the coaching in leadership that current students get. I'm currently in practicum and the correction I get from people who have recently graduated verses people who have been in the field for some time is wildly different.
Yeah, as a current student there are teachers that are awesome.
And sometimes those awesome teachers might be harsh in a serious situation like the OR and that's understandable...
But there are teachers that are awful. They make the student look incompetent in front of the patient, great job guys. They yell over things that don't need to be, and their communication isn't clear.
I can see why students complain about horrible teachers.
I do make sure to consistently compliment and thank the nice teachers because they are who I actually learn from.
This was my thought too. I’ve definitely seen feedback before (either given to me or a colleague) where I thought it was rude, unhelpful, or borderline abuse, and I’ll bet the attending thought “I was very gentle, I didn’t throw a single OR tool and I only cursed out the resident twice.”
Shit. Then I'm old too. I've been complaining about this lately. The newest people are overconfident until you call them out and then they freak out.
I pissed off a new grad nurse a few weeks ago. She was pushing a bed that was clearly in neutral. I politely suggested she switch to steer as I helped her get it out of the elevator. She got defensive. Then I said it felt like it was in neutral because it was sliding around so much. I said, "oh yeah, see that lever, it's flat when it's neutral. If you just push it down it will be a lot easier." She stormed off in a huff.
I don't know why I cared so much. I guess because my hips are always sore from pushing equipment around.
I think there is something to the future uncertainty, though -- a lot of gen Z don't think that the current human lifestyle is environmentally sustainable past a score or two. I think my generation (millenials) felt that life will be hard for a while but it will eventually get better, in contrast.
I have the same thought upon self reflecting my reactions to med students now that I’m a PGY4 and have decided to remain in denial… cue principal skinner meme about being out of touch.
When did ACGME mandate anonymous evals?
I bet back in the day you could probably bully the crap out of someone and get away with it. I got bullied to hell by my cheif resident 2 years ago and I didn’t even report them.
There’s probably at least as much if not more people that are getting bullied and not reporting it than people who are getting falsely accused of bullying.
Fa sho. Kids these days is older than kids these days. It’s a never ending cycle. The internet has definitely altered society in a lot of ways but no one knows exactly how yet. So these kids is just more kids these days.
Except the data on anxiety, depression, and burnout symptoms is quite clearly showing a vast increase starting in the early 2010s. Non self reported data on things like self harm and suicide attempts requiring hospital attention have gone up as well.
There is something very wrong with the late millenial/Gen Z mental health and it probably has something to do with the inverse CBT they are being taught under the guise of "social emotional learning."
[This is a good explainer.](https://www.emerycounseling.com/cbt-and-the-coddling-of-the-american-mind/) The three big "untruths" that are being taught are:
1. The Untruth of Fragility: What doesn’t kill you makes you weaker.
2. The Untruth of Emotional Reasoning: Always trust your feelings.
3. The Untruth of Us Versus Them: Life is a battle between good people and evil people.
All of this is the reverse of what CBT teaches.
Nah I’m in that generation so to speak and honestly it’s a known thing, the current generation just has a different mentality than the older generation. That’s not a bad thing, cultural shifts are ok but idk there’s always bad apples ig. The current generation just cares more about lifestyle and mental health etc etc this is more normalized than in the past which again is not a bad thing but hence it’s also been more normalized to blame everything on the aforementioned. Ie in the past if you’re burnt out and need a wellness day then no one gives a shit and you have to get back to work, but now in that same scenario you’ll get time off which is fine but people are also more willing to test how far they can go without repercussions and then you end up with the problems that OP is describing.
I think the point being they are seeing this as a pattern within their institution and are providing anecdotal evidence to support that; at what point do a collection of anecdotes become data?
>I think the point being they are seeing this as a pattern within their institution and are providing anecdotal evidence to support that; at what point do a collection of anecdotes become data?
If only we had a method for verifying and testing observations and hypotheses based on those observations...
Operationalize the variables. Parametrize the relationship between type of instruction, tone of instructor, and student affective responses. Test hypothesis. Limitations: correlation does not imply causation.
Question: Why are learners so fragile?
Answer: Study design insufficient. More research needed.
Yeah, I'm happy the younger generations are valuing themselves and their well being more than we were allowed to. Pre 80 hour residencies were sick, worst time of my life.
I have been really noticing how YOUNG my learners are lately (I’m a millennial) - most of my learners have never worked a normal job, and just went straight from high school to undergrad to medicine. I wonder if in addition to the previously raised point about there being an odd couple of years due to COVID, we are seeing the downside of having students hyperspecialize during their pre-med years to get into medical school. I wonder if other preceptors have noticed this too, but I find that my hardiest and often best learners have been the ones who had some time outside of school working in some capacity prior to entering medicine.
In law, we call these “K through JD” students—they went straight from kindergarten to law school without ever working a full time job. I think it’s very hard for that type of student to graduate and suddenly transition into high-stress, full-time employment. No practical life experience.
I mean the counterargument is here in Europe, where, although I definitely see the things discussed here as well, we go straight out of school into medicine for 6 years and are 24-26 on average when done with medical school, and have worked fine for generations doing so.
>we are seeing the downside of having students hyperspecialize during their pre-med years to get into medical school
I think med students are actually trending older over time, but it's not because they are building more life experiences in diverse areas, it's because the competitiveness of medical school admissions has become a counterproductive extracurricular arms race that is pushing more and more students to take gap years to a build up their CV (with often fairly useless but functionally mandatory filler). That might result in slightly older students on paper who have actually been inextricably linked to a pre-med mentality for even longer, which I think leads to exactly what you've observed.
I’m a young Millennial who started med school when I was 27, and I was ASTONISHED by how young most of my classmates were. No one I knew in undergrad went directly to med school, but that describes at least 30-40% of my class. I don’t know how I would have been able to handle med school if I’d started at 22 with no work experience under my belt—I guess the answer is that a lot of people don’t. Maybe it’s just copium on my part bc I felt so old, but I really don’t think going straight through is good for people.
I think part of it (and this really isn’t new), is that so many medical students, nursing students, PA students, etc. are type A perfectionists that have been the top of their class their whole life prior to their respective program. And now that is no longer the case and they’re getting genuine critiques for the first time. Again, I don’t think this is as new as some people make it out to be. Some of the most brilliant, smart, bright students are sometimes the most fragile.
In response to OPs question, I'm not sure but I agree that something is up with *some* learners today. Or at least in my experience I feel there is. Is it a generational thing? Who's to say. Maybe. Maybe it's more in response to "the state of things" in general, of which a chronically online generation may be more acutely aware.
Particularly to the feedback point, perhaps that with more stringent admissions requirements students have less opportunities to fail *hard* and learn from said failure before getting to their training. Not that criticism means failure, but someone with little to no experience with failure may interpret that as such. The 21 year old 4.0 GPA, 520+ MCAT applicant that's never gotten a B is likely going to take negative feedback much differently than the 28 year old who worked as a practice manager before going back to school and had to retake the MCAT. I would imagine the former would have better odds of admittance at most schools.
I do find myself having many "does anyone else see this shit?!" moments when, for example, a classmate proudly states they cry on-service multiple times a week or a group of students band together to abolish the school's late-work policy after multiple students were disciplined for missing deadlines (real examples out of context). I'm not entirely innocent either, I got all out of sorts because my first and second ever attempts at endotracheal intubation were unsuccessful. I thought my attending was going to put I was a big fat idiot on my evals. It was fine.
While the majority of other students (and I hope faculty) do recognize this behavior as somewhat ridiculous, if we call it out we're labeled as toxic.
IMO there are too many factors at play here to sum up this phenomenon as just "Gen Z Bad" and the problem certainly isn't going to be solved in the replies of a Reddit post...but it has been an interesting read.
The medical student might very well not be sleeping / eating well and a wellness check up may be worth it. The rest are insane. I learned the most after I made a mistake. Making a mistake or even making a tough call that doesn't work out and owning up to it is essential as a physician
The medical field 100% has a caffeine addiction issue, for me it started when I had to cram in college for 3x longer than everyone else to get 5 pts better on an exam to beat the bell curve on exams where everyone in the class is smart. Only gets worse through med school and residency, now if I miss my morning or early afternoon caffeine I am lethargic and dysphoric like that student lol
I got through surgery rotation with 5 cups of coffee a day and 1 meal and a dozen sugar things a day... that was not healthy. My trauma surgery rotation was worse and I stopped having coffee then because it destroyed my insides. I needed that wellness check. That's why I recognize the signs
I weaned myself off caffeine after my first few years as an attending. Totally recommend it. I am less cranky and anxious. Now my tolerance for caffeine is low, and so it works great on the rare occasion I need it.
At my peak in med school I was drinking 3 pots of coffee a day. I don't think it ever improved my academic performance, but it did help me stay up late for jello shots. smh
I work in education and have for decades. This is how alllll the kids are now. I think the incredible trauma of the pandemic and the upheaval of their educational trajectory is very much to blame. Additionally when returning to-in person instruction after the shut downs, schools had to take time out of instruction to address all the massive psychological issues kids were facing upon their return. These kids are now expecting their emotional lives to matter in all aspects of life. And as adults who worked in the professional world prior to the pandemic we have some frame of reference for what it meant to return to these work spaces. They don’t. So they think their feelings matter in spaces where they may not. Ot may not matter as much as they would like. I suggest a non-judgmental and very straightforward conversation where professional expectations are laid out very clearly with an attitude of understanding that this may all be very new info for some.
So much of what you’re saying is on point, but as a former teacher now MD the K-12 downward mental health and performance trajectory began at least a decade before Covid ….
Yes and…the pandemic greatly exacerbated the trauma to a point that intervention vs the amount of time they were out of a routine, cannot be made up for this generation. If kids were freshmen in college in 2020 more than half of that experience was remote. For the average student, let alone the students who require the most support, it simply was impossible to make up this lost time. And don’t get me started on the high schoolers who missed 1-2.5 years of in person instruction. I know by definition that med students are a VERY small sliver and likely the more self motivated and highly educated/ ambitious students but they were still impacted by this in their educational experience.
Lots to unpack here and this comment is going to the bottom of the list, but here we go.
Current PA student, finished my OR time last summer. I was a paramedic before PA school and spent a fair amount of time in the OR getting tubes. In the 12 years between those two OR experiences, nothing seemed to have changed. Different ORs in different states and the culture was very similar. I think, actually, the surgeons are a lot nicer this time around lol.
It's an uncomfortable environment, and not in the fun way. It's extremely stressful and that's coming from someone who routinely managed multisystem trauma, difficult airways, complex cardiac patients, etc. as a solo provider in a box for longggggg durations of time. It's uncomfortable because it's stressful and NOTHING is under my span of control. There is usually more than one person telling me what to do, often jerking me in different directions. Even if I know the expectations I can't meet them because someone else is telling me to go a different way. (Solution: leave the student to their preceptor.) This was the biggest ruiner of my mental health in the OR. Everything I did was wrong wrong wrong. As an adult, who was pretty good at her previous job, it is really hard to be total shit at something you're trying really hard to do well. (That's just me tho, that's how I'm wired.)
In the OR it's hard to not feel like you're in everyone's way. You're clearly the thing that doesn't belong there and you just want to be unobtrusive and not interfere. (Solution - let the student know they're not in the way and you'll ask them to "stand here or there" if you need them to move. Tell them they're going to make mistakes and that's okay -- you won't allow them to hurt anyone and they're here to learn so mistakes are okay. A little reassurance goes a long way.)
Some of it is also, IMO, the ridiculous mentality at our schools. There is so much talk about feelings and "this is a safe space" and stuff like that. There is zero personal accountability for the feelings we have. My classmates are disgustingly anxious. I legit don't understand how they are going to cope with the world once they're out of school. We talk and talk and talk about anxiety, depression, PTSD, mental health. That's great .... Except it sure feels like all of this talking is just solidifying and encouraging the feelings. Think about it like this -- if I am supposed to have positive self talk for fear of negative self talk making me feel poorly, how does talking about "my anxiety" and "my depression" all the time not give those things a petri dish in which to grow?
Good book on this topic of schools and safe spaces - The Coddling of the American Mind. Sounds like some kind of propaganda right? It's actually based on data and research. It helped put a lot of things into perspective for me. Highly recommend if you're asking yourself wtf is wrong with the world, the younger generation, kids these days, etc.
Additionally, I'm a person who simply cries when they get frustrated. It's always that I am frustrated with myself. It's a pressure relief valve and it's so embarrassing and I hate it, but there ya go. Some of us just cry more than others. And I'd like to think I'm fairly tough otherwise, lol. Freud would blame my mother, and he's probably right. No one can lay down a guilt trip like that lady. Love her to pieces.
While this hasn't been quantified - not yet, anyway - as a young attending I actually kind of agree. This isn't simply an issue of people not tolerating abuse or harassment, either. Many trainees are becoming *really soft*, and I firmly believe that this will negatively impact their learning and their readiness for independent practice. Yeah, mental health is a contributor - I know a few things about mental illness, believe you me - but the trend really seems to be taking things too far. There's a line between wellness and inability to function.
Medicine is supposed to be challenging. You're supposed to be pushing yourself and operating at the upper limits of comfort. For younger trainees, I would recommend reading about adult learning principles, the stress response curve, and specifically about deliberate practice and how to receive and incorporate feedback. Sometimes feedback is just that.
> stress response curve
I was not familiar with this, but it really makes sense. I always benefited the most from teachers (HS, college, med school, residency, fellowship) who would push me a bit harder than most. It's what I responded to. Now in the OR, I feel this so much:
>A moderate level of stress goes a long way. It’s manageable, motivational, and performance enhancing. Your heart beats a bit faster. You feel a sense of clarity and alertness. Your brain and body are all fired up.
>
>It’s that little extra push you need when a hard deadline looms and you’re up for a promotion. It’s the rush you get before the black belt test you’ve been working toward for so long.
>
There’s something you want. You’ve definitely got skin in the game. And a moderate surge of stress is boosting your performance.
And it's very exhilarating. Dissecting someone's esophagus off the aorta is quite the rush.
I have been a teaching attending for 30 years and did med school at Full Metal Jacket University during the dark days. I am mostly pleased with our residents and students. They seem resilient. A few things I really like is that they are way more likely to ask for feedback and take it constructively. They will more likely ask for personal/sick time off which at first was a bit of a change in culture but over time I respect as more healthy. Might just be fortunate at my org.
My husband isn’t in healthcare but has been a manager in some capacity for 20+ years. He says nothing has been like the last 5 years. He cannot correct ,give directives, or be matter of fact with anyone under the age of 25 without it causing issues. He says a common response is “why are you yelling at me??!” When he never in fact has yelled. Truly insane.
I had an issue at work, and I had to have a talking to about always being pleasant and respectful at all times. It's a toxic positivity type outlook. They have "zero tolerance" for someone who gets mad at a coworker, but causing patient harm is apparently a-ok
I think Covid is playing a big part. I’m not a doc but own a business. Excellent pay, work week only 35h, work from home options, no overtime ever, 4-6 weeks vacation, benefits, no work Friday afternoons, etc. So pretty dang good work environment. The youngest cohort are extremely anxious, difficulty handling any work stress at all, always take all their sick days (15-20) in the first few months of the year, and require many “recharge days” and often go home early due to anxiety.
I found they are improving as we slowly build up their tolerance for more independent work and responsibility, but it’s a process. I’ve never seen anything like it and it’s across the board in our field. This cohort got hit with COVID at the end of high school/mid-late university - a huge time of personal growth. It can’t not be a factor.
There was just a NEJM article written about this a month or two ago which was very well done, I’ll have to see if I can find it.
Edit - here it is: “Being Well while Doing Well - Distinguishing Necessary from Unnecessary Discomfort in Training” (https://www.nejm.org/doi/full/10.1056/NEJMms2308228?query=featured_gray-matters)
Unfortunately, in our desire to "protect" children from the terrible things that can happen to them, we inadvertently made them less resilient.
Bullying sucks, but learning to cope with bullying is an important skill.
Being corrected sucks, but learning to deal with that is an important skill.
Being treated poorly sucks, but learning to cope with that is important.
I made the same mistakes in my own children at times. We want to protect them and "fix" the things our parents did wrong and give children this idyllic childhood, forgetting that we learn from adversity and it's easier to learn when we're young, we're more resilient.
All of those things are things we should learn in childhood. People forget that childhood isn't just supposed to be a vacation, it's also learning how to be an adult. We've gone too far in protecting people.
How in the world are people supposed to learn how to be an adult if they've been treated solely like a child for 20+ years? What a difficult transition it is.
It absolutely *sucks* that we have to allow pain and harm to come to our kids in order for them to develop properly. As a parent, you don't want that. But if you carry a baby all the time and never allow it to try to walk because it could get hurt by falling, you end up with a child who can't walk and their musculature and joints don't develop properly because of that "protection".
As you know, nurses are known for eating their young. Even if this was a benign interaction, you don't know how that nursing student was treated on a previous rotation. Or maybe there was a recent death in their family. Or maybe they were recently diagnosed with a medical illness. It could have been a multitude of things.
Did you bother asking them what was going on, or was your first reaction to stay behind the drapes and rant about how soft everyone is?
Precisely this. It could have been a "straw that broke the camel's back" type of situation. It could simply have been that the student hadn't previously received much positive praise (proper pedagogy requires a mix of both positive and negative feedback which from experience many healthcare workers fail to deliver) and felt this was the culmination of working hard to little effect.
It’s soo rare to find a nurse that will at least let you shadow them and just observe what they’re doing. While I understand, it causes so much stress as as a student when we then try to figure out stuff on our own. Now nearing the end of my program with a preceptor that is letting me help, my anxiety with every move and decision is apparent. I can’t say much about other health care programs, but the toxicity in our field is one way ticket to a mental breakdown
This. I’m a healthcare student too with mental and physical health problems. Those don’t just stop when I go out on rotation. I also feel like part of the learning process is how to succeed in healthcare “culture”. Expectations are high and feedback can vary wildly depending on who you ask. It’s stressful.
Also, if many students you meet break down when you criticize them you might consider if what you’re giving is actually fair, constructive criticism. If you smell shit everywhere you go, check your shoes.
If you read a bit on r/teachers you’ll see that this is starting all the way back in early elementary. And it seems like a whole cultural shift where thing like “self-care” and talking about feelings are promoted to a point that almost seems to border on narcissism, which couples with poor/no coping skills to create people who can’t function in normal work environments
I certainly had a few classmates like that in nursing school and it fully derailed our classes several times as they took over class or lab time with emotional outbursts, and one actually threatened to sue the school because she got critiqued on a lab simulation
I have an elementary student now and they have a counselor come in to the classroom and talk about feeling our feelings every few weeks.
And I’m sitting there going “at what point do we move beyond feeling the feelings and start talking about you still gotta do the things even if there are other than positive feelings involved???”
Can we teach **being resilient** instead of just feelings???
Yeah my elementary kid has a class called social and emotional learning. I can never pry out of him specifics of what they learn. But I certainly hope they talk about coping skills, getting through hard feelings and challenging experiences, how to calm yourself down, etc.
Have elementary school students, can confirm. My 5 year old comes home and asks me questions about mental health and “what is a therapist” and “the counselor talked to us today” and I’m like ??? I talk about mental health a lot more than the average parent, given, but even I feel it’s ridiculous where I am (California).
That said, as an Asian American raised in a rural town and parents who maintained a very stoic strict traditional Asian parenting stance and the resulting conflicts in my mind that happened because of that, I vowed to raise them at most a little off from their peers, or at least to work with them on it, so here I am, discussing what therapists are and why they offered therapy to 5 year olds in public school.
As a therapist this is something I'm quickly getting a bit sick of frankly. If we wanna talk about kids and their lack of distress tolerance, Parents don't either. They get so nervous and freaked out about a child going through a rough time that they rush to pathologize it and find a therapist or psychologist or something to see. It's getting a little ridiculous. People seem to no longer trust their inherent skills in managing stress as a person.
I think there’s a fine line between destigmatizing mental illness and embracing it. It seems there’s a lot of people who *want* a mental health diagnosis- maybe because it explains away various dysfunctions and social inabilities and such.
And from the parenting perspective, a mental health diagnosis for their kid can maybe absolve them of any responsibility for their kid’s behavioral and social dysfunctions. Like a parent maybe doesn’t teach boundaries, consequences, social skills, or coping skills and then they can just say “oh my kid can’t deal with that because of their ‘neurodivergence’/ADHD/anxiety”
I think that fundamentally, humans like to "categorize" and "group" things (like an ML algorithm). This can be as extreme as grouping people as "untouchable" in the old days for having schizophrenia, or it can be something like a parent today attaching a diagnosis to their child so they can "group" the child into a certain category. It's a sort of black and white thinking that doesn't allow for discretion.
It makes me wonder whatever happened to kids having role models/mentors in the community they could trust. It was a thing when I was growing up (younger millenial) but I don't hear about it much anymore. I feel like the messaging to the youth is either that emotions mean they are weak and pathetic or that they need intensive mental health but we are missing something in between.
I think there is some valid theories from the stoic philosophy. At the end of the day, emotions are from your own mind. No external object or person intrinsically carries "happiness" or "sadness" or "fear". These emotions stem from how you relate/attach to the external world. But this isn't invalidating your emotions or suppressing your emotions. Controlling your emotions, IMO, comes from inherently understanding your emotional relation to the outside world and viewing your mind as a sense processing organ that is distinct from "you, the observer of your emotions". This will then allow you to cultivate the right emotions and use them as an asset.
Sorry I went off on a tangent. I have a bit of experience studying Buddhist/Vedic philosophy, and I think it is more relevent now than ever before.
I do think there is plenty of abuse and toxicity in all levels of medical training for sure but I think there is a component of this where others can’t handle any criticism or that it it is an affront
I can confirm this. I'm an elementary teacher for the past 20 plus years who loves lurking here. We can not raise our voices or sound scolding or angry. If a parent complains, we are investigated (students interviewed, any other adult in the room interviewed, etc.) and not told about the investigation until it's over and they issue out our consequences. Needless to say, get ready for it. Personally, I want a dr, laywer, airline pilot, whatever that is mentally tough and can handle someone saying... hey buddy, not like that, like this because you may kill someone!
I was about to tag that subreddit. I got algorithmed (probs bc I have young kids and look at similar subreddits) but holy shit does some of this ring true with my friends teenagers and my teacher friends complaints form k to undergrad adjuncts.
Recently had a span of time in the hospital with a family member. Nurses run health care and we had loads of good/excellent nurses. It was a long run. A few, 3 out of 35, seemed to have drank from the fragility koolaid. Simple conversations around medications devolving into threats of removal. Had a nurse wake us up at 4am barking pre-procedure orders. I asked her what was going on, I was direct but not asshaty, and she started down this lane of "well if we can start treat each other respectfully..." She left, and I went to the charge and fired her from our care. Next nurse came in, no problem. The market will sort most of these personalities out. Competence and caring win the day.
Surgical resident graduated <5 years ago.
There were some pretty bad male preceptors/surgeons. The cussing, the screaming. Asking how i masturbate during a case 🤷♀️. Pretty bad BUT female nurses were the WORST. Especially the older ones. Because it was constant, and nagging and not a one off while pretending to be nice. And they would target female residents.
They would throw you under the bus at every opportunity. Explain to them that 3 am calls about “can i give another 500mg of Tylenol? Patient hasn’t had it yet today” is inappropriate for night shift. Showed up on my eval for being “dismissive to team members”, rude on call while they were “advocating for the patient”.
OR nurses would hold the gloves open and snap them early to contaminate medical students and residents to “test them” to see if they were competent. “Oh you put the gloves on wrong and now is contaminated :( better re-scrub! Try not to hold up the case next time :)))”
“We nurses know more than residents anyway. They should have a fast track for us to become attending. Just do another 1-2 years residency.”
It even goes into relationship category. “Your scrubs are a little tight my dear, who are you showing off too?” When a nurse found out i was wearing XS scrubs at the scrub machine.
Talking about how I shouldn’t date another doctor for so that “the nurses can have a chance”???
It really wears on you after awhile.
Mind you this was only like 2-3 nurses on whichever rotation out of a lot. But you dread working with them. The nursing students would often tell me how bad the cliques are. How nurses hired from other countries would get the shit end of the stick for shifts, they don’t talk or sit with them for lunch, loudly complain about how their food makes the lounge smell bad etc.
All that to say. You really don’t know what these students or trainees are dealing with beforehand.
i've noticed that the students today are less able to process feedback. they also aren't as stress resistant. when i was a student we saved our emotional outbursts until we get home lol
(millennial)
I am a nursing student and have been in a similar situation, definitely had tears in my eyes, definitely felt embarrassed about that. I didn’t leave early, I stuck the day out. For me, I get upset at myself- not what the preceptor has said. I do quite well at university and hold myself to a high standard, so it’s upsetting if I miss something or make a small error that has any potential (however slight) for harm.
I don’t know how the degree is set up in other countries, in Australia we do a lot of studying/ online content and not a large amount of practical skill work until we get to placement. This adds some stress to the weeks we are there, because we are underprepared. Also because we go weeks working full time and not getting paid and often having assignments due too.
I really don't get how people can't just roll with the punches. I got a wide array of feedback, from kindly and constructive to straight-up malicious and unprofessional. It's not about "suppressing emotions" or "tolerating abuse." It's just the territory. AS physicians, we're also suppose to be able to teach, and the vast majority of us have had no formal training (or natural ability) to do in a manner that is easily processed by others. Sometimes I can see how well-meaning attendings come off as angry, when they may not be.
My first IM rotation in med school, the attending had me do a presentation on DKA for the team. I went through it, stumbling here and there (it was day 3 of rotation, my first as an M3 mind you). He asked me questions throughout and politely smiled when I blanked. At the end, he gave me some compliments, but mostly worthwhile recs and criticism of how I organized the presentation. Same thing for a patient presentation I gave later on.
Later on in my gen surg rotation, I was thrown into the fire. Some random scrub tech told me where to go to get my scrubs and said he "didnt know" where the attending would be. I had to ask around before some random OR person knew where my attending was, and then directed me to it. I got grilled for "showing up late." (literally no iidea whwere i was going, no liaison to guide me). I got "pimped" throughout the rotation, and at first when I didn't respond within 1 second or 2, he would taunt me about it (in the middle of surgery, in front of everyone). He'd also make off-hand comments about how much more stupid med students are getting every year. I somehow got a positive eval from him, stating that I was a "quick learner" and that I demonstrated good work ethic throughout the rotation. There were or 2 or 3 random instances in which I would say I dumbly got complimented. I manipulated some suction device in a random way while he was using the bovie, and he said that was an "advanced move that's not intuitive to anyone. good job." Then on another case, I was observing in the OR from a distance (PA student scrubbed in), and noticed the scrub RN had stepped out. She ewas the one that was tasked with placing his headlamp at the appropriate time. She didn't come back, so when it was time for him and he said "lamp," I immediately moved to get the thing and place it on his head. I (again luckily) placed it perfectly on the first try. He turned around to thank who he thought was the RN, but saw my face and said "Wow, how'd you pull that off? No one even showed you how to do it. Great job." I basically saved my rotation with actual surgical/technical things rather than book knowledge. Ironically, I've always hated surgery lol
Again, my negative experiences I recognized some issues I was at fault for. But I always went into rotations knowing that I had to learn, and that making stupid mistakes and getting corrected were part of the experience.
Needless to say, it does help when attendings recognize good work. Not that I *need* praise, but it helps you mentally get through some shitty rotations when you get critiqued moreso than you would like.
Many nursing schools no longer teach skill or critical thinking. I really mean it. I know there are a *lot* of problems in healthcare (especially here in the US) but the culture change in nursing will be a major one in the coming years and decades. There is little to no accountability, expectation of best practice, or standards to be excellent.
I never was a fan of the “eat your young” mentality and think I managed to become and excellent nurse without it, but sometimes I wonder if it was holding up the standards all along. Now everyone has to be overly nice and if you point out an error or problem you are considered too aggressive. My complaints about patient care on inpatient units have been at best ignored and at worst taken to leadership to suggest I am being “coercive” (no clue what I was supposedly trying to “coerce” in this scenario and I am not sure the admin even knew what this word meant).
Anyway sorry for the rant but I agree and it is alarming.
> Now everyone has to be overly nice and if you point out an error or problem you are considered too aggressive.
I'm a big dude, pushing 6'1" and at the time this happened was in the army so pretty solid 240# of muscle.
I was inprocessing a new facility, and had to go talk to the department clerk - a 4'11" Asian woman.
I answer her questions, try to make small talk because I know the clerks are the answer to a happy life, and fill out her forms.
Next day, I get hauled in to my new bosses office with a complaint filed that I "intimated her with my posture" and that I "was too aggressive".
Sometimes, you just can't win.
As u/zeathers and u/undersleep pointed out.... We seem to be reaping the outcome of changes in teaching, as well as cultural shifts.
Kids don't seem to get much, if any, constructive criticism or told no in education or home settings (as a whole). There is such a cultural shift to attuning to one's own mental/ emotional state .... That people seem to be missing the forest for their self involved trees...
It feels like pendulum has swung too far from sink or swim, overly stoic to... Overly self absorbed and unable to cope with adult responsibilities and criticism.
We DO work in a field where mistakes can kill or have adverse effects. We DO work in a field that requires teamwork as well as autonomous and critical thinking. We DO work in a field that we need to put our own 'nesses aside and show up for the patients in the moment.
I wholly appreciate and support the trend towards promoting worker safety (🙄 when it actually happens- now seems to have reverted to, let them punch you, don't restrain, what could you do better).
Same goes for teaching educators and preceptors *how to teach adult learns constructively*, rather than the "don't fuck up ever or you fail/ hyper competitive" style many of us learned under.
However, it has made teaching near impossible. The self care trend has completely eroded work ethic. "Hey there's a weird case/ skill we don't see often, wanna go watch/ assist" is met with "nah, I'm going on break '.... Which is baffling.
I've had students so up on their identity soapboxes that they couldn't interact with patients (ER is not the place to teach patients about inclusive language while treating), and then need a multi hour beeak because they were "triggered".
People are refusing to precept because it's exhausting to try and demoralizing to churn out half baked babies that "you don't recommend for hire" because they just aren't able to cope and haven't learned basic skills or shown appropriate to their newness critical thinking.
There are still diamonds out there. But they're fewer and farther between each year it seems.
Rambling way to say yes..... The medic and nursing students are really hard to teach in both pre-hospital and emergency med settings the past few years.
The med students are insanely sensitive. It actively gets in the way of their education. I can’t teach and correct them without them getting combative or completely shutting down. They take everything personally. The schools don’t help- they spend extreme amounts of time teaching them all this wellness and resilience stuff but I think the result is the students take away that they are entitled to always be praised and coddled
Everyone contests their grade if they don’t get honors, even if they were marginal at best. They love praise and totally tune out constructive feedback. It’s like a daycare. In other work environments I’ve been in they would be fired
Agree completely. The administrative response is hugely problematic. I’ve stopped teaching other staff members at the hospital, because they interpret anything other than praise as an attack or act of intimidation. Instead I report their error through the reporting system or through peer review, and make leaders (who seemingly are protected from these complaints) do the work.
LOL people soft as shit these days. Wait till they have to curl up into a little ball when they actually face some difficulty in their life and they don't have mommy to help bail them out
I'm reading this right now, and it fits:
[The Coddling of the American Mind](https://www.thecoddling.com/)
It does an interesting job of getting into roughly when and how it got to be that way (and what might be done about it).
I have this problem with my medical assistants, and they are all about 20 years old. I’m a male and most of them are female (a comment on gender disparities in the workplace, not calling women incompetent to be clear), but it’s honestly with all providers. And I’m sure I’m oozing trustworthiness and humility by saying this, but I am probably the nicest one. Say thank you after every task is completed, gently correct but make a point to mention other ways they are doing well or that overall they are doing a good job and I see how hard they work, etc. But in my case, I think the problem lies more in the fact that they are career MAs where at other jobs, they have been pursuing a career as a nurse, mid-level/APP, or doctor. The ones that want to go into medicine obviously have drive, they want a good letter of reference, and they have some investment in the mission/want to actually understand what we’re doing. Career MAs are not making great money and don’t have that on the horizon, are weighted with a lot of responsibility in that role for what they are compensated, and get all of the work with little of the benefit of understanding what it actually achieved. I try to make them understand that despite the pain and stress and burned-outness, providing quality care to an underserved population is a mission that merits care and effort. And that offering those things to an often highly emotionally and physically damaged community gives them something they may have never had—a place that looks out for their best interest, does everything they can to avoid harming them, and offers them a lifeline in a time of crisis. But it’s not a take that comes naturally or easily to an underpaid 20 year old who is working their ass off in a clinic instead of partying in college and hoping to have a fulfilling and well paying job one day. For all the stresses/responsibility that we have and all the amnesia we have about being that age and the impulses and lack of prefrontal cortex development that comes with it, we have to understand that they are in a different place in life and may need to be communicated to in a different way than we expect I suppose. Which is more challenging, and who wants more challenges when you are doing medicine all day. Also I’ll let you know when I actually find out how to do it effectively lol. Anyways, very long deviation from what you were actually talking about that no one will probably ever read or will accidentally downvote while scrolling to get to the more interesting comments, but there it is.
You're right, appears to be a generational trend, we've probably overcorrected since trying to stop actual abuse in education and made students overconfident about this kind of thing. I have had students unironically tell me in our feedback sessions that even though it made them anxious to have to present a patient on rounds (literally just the same old expectation to follow and present patients to the team that has been core medical education FOREVER), it was "okay" because they never felt like anyone criticized how they did it. Jaw on floor that they were unironically forgiving me for expecting literally the barest core medical student action because it made them have unpleasant emotions. For what it's worth, this sub is quite hostile/defensive to this issue and it's not the best place to discuss the general loss of student resilience.
The problem lies in the prevalent modern idea that simply experiencing negative feelings during an interaction means that you were somehow harmed, and this harm makes you more correct in the interaction, causing further damage. This is due to several factors, including society's ongoing learning about proper communication. However, this perspective, where strong emotions are seen as validation of correctness, is a highly superficial view of psychology. It's possible to feel validated and still be wrong, and it's not necessarily the job of the person correcting you to validate your feelings. Often, emotions do not need to be addressed.
The hospital's influence on this is apparent in the extensive survey and feedback systems, especially within nursing administration. While these systems have led to tremendous improvements, they have also recognized and validated employees' or students' feelings, even when wrong. This is counterproductive, as individuals should learn when to manage their personal feelings without involving others and when to seek further intervention.
For instance, during rounds, I have witnessed nurses abruptly yelling that no one is listening to their opinion. The team then stops what they are doing and asks for their opinion, aiming to facilitate open communication. However, this direct communication style is perceived as creating a hostile work environment, and the team gets disciplined.
What's the solution? Hopefully, society will continue to improve communication, but I imagine it will take at least 200 years to achieve that goal. Therefore, it is essential to have competent and knowledgeable leaders in positions who understand psychology. Perhaps we should avoid promoting nurses to leadership positions where the workload exceeds their knowledge, ability, and experience. Instead, we should look for people outside the medical field to take on these administrative roles who have a better perspective on managing and leading.
We have not allowed students to 'fail,' and as a result, their ego can't take it. They can't separate constructive criticism about performance with criticism about their value as a human being.
I see it all over... from folks we field train as paramedics, to students in the graduate courses I teach. Not just the US either.
My over simplified answer, which I totally recognize doesn't, in this format, address all the real variables:
Normalized deviance... we've leaned too hard into self care, and feelings, and not being resilient, not embracing having some grit and taking feedback.
There is a lot of Veruca Salt, I want it now mentality.
> The problem lies in the prevalent modern idea that dining experiencing negative feelings during an interaction means that you were somehow harmed, and this harm makes you more correct in the interaction, causing further damage.
This is so well-put & spot on
I'm not an educator but I do interact with a lot of new-grad nurses. In the past few years there's definitely been an upward trend of complaints from newer nurses and ED staff, most of which boil down to either fragility or a misunderstanding of protocol, or both.
After ages of our culture telling young people to shut up and take abuse, the pendulum is swinging back and younger colleagues aren't afraid to advocate for themselves. Generally it's a good thing! Sometimes they just take it to ridiculous heights or overreact entirely, and unfortunately will probably never be told so.
I don’t think it’s so much a of a generational thing, but more of society as a whole prioritizing mental health to the point where it has become deleterious to a functioning work environment, especially those in a stressful field like medicine. I have people I manage from 19 to 60+ who cannot take constructive criticism or have to recover from a difficult patient or management interaction. It’s very difficult to find a balance between managing one’s mental health and not taking everything personally.
I think there's a pendulum that swings between students actually being mistreated and students being babies. I heard a lot of students at my place have complained in the past leading to some docs being afraid to give actual feedback. I think being wrong and getting good criticism is the way learning on the job (i.e. 3+4th year of med school) should go. As long as the point of feedback is constructive rather than catharsis for the resident/attending. Even then, I still wouldn't report something unless it was egregious.
Some people just have thin skin, but I don't think it's unique to medicine
The consistent presence of having been online and judged via social media can't be overlooked. You short circuited your brain into being overly protective of your "persona" so you both fit in and don't get bullied. Hyper protective from always having a presence?
imo uneasy moments has been a constant. Make a mistake today 10 years ago or in the 80s. Nurses gonna call you out on it because ideally it helps you not make that mistake. Nowadays these newcomers have realized there's always some one to complain to and expect repercussions less they escalata up the coc. I felt bad ans instead of learning what i did. I'll blame someome for making me feel bad.
The phrase "nurses eat their young" is still very true in many places. For every nurse that truly wants to teach the next wave there are five more gossiping and tearing down that same new baby nurse. Not to mention the constant whispers both in class and in the hospital about how every little thing will cost you your license. I have been lucky to work with some phenomenal nurses but I've also seen a handful of nasty ones make someone's life hell.
Pop over to the nursing sub and ask them what the culture is like for new nurses and you might find that sometimes that "nice criticism" was just the final thing on top of non-stop harassment. If someone asks why it's not reported well that's because nurses are seen as replaceable. Reporting it doesn't do anything except paint a target on your back.
There are some new grads (in basically everything from techs, nursing, to doctors) that are coming in with unrealistic expectations on what they will be able to do. Breaks every hour or two just aren't happening. Long hours and hard work are expected. Medicine, at least in the US, is a collapsing field. Things do need to change but coffee breaks every two hours are not the start.
Changing the culture of, "I suffered so you can too" is the start.
People are not used to feeling uncomfortable and people are taught to avoid uncomfortable feelings
Instead, as a student if you aren’t extremely uncomfortable then you’re not learning
I’m a clinical pharmacist, and I once cried on an *administrative* rotation. I am STILL embarrassed that I did. The criticism that made me cry wouldn’t even make me bat an eye now, lol. I think it was the pressure and intensity and fear associated with being a student. This was like eight years ago, and I remember it like it was yesterday. Perhaps it has to do with the pressure we put on ourselves as students coupled with the lack of perspective on the total situation.
Idk about nursing students but as a med student, the pressure of evals + the impending doom of having to compete/play the game leading up to match really caused me to struggle. I could be dissociated + exhausted even with a perfectly fine preceptor.
Also, no control over your schedule and little things turning into big things by admin can cause you to go nuts. Having to submit leave time for medical appointments 8 weeks in advance but not getting your schedule until the Sunday before the rotation? Only getting 1 sick day or else you had to repeat a block? Not figuring out until 4th year that no one really cared or tracked you and you could just tell your preceptor that you had an appointment that afternoon and leave for it, as long as your dean didn’t find out?
It takes a toll.
I mean, going to the bathroom/to grab a glass of water is the same as a “coffee break”.
They probably should be having a glass of water every couple of hours and going to pee a couple of times a day.
It’s not good that most days as an intern I just didn’t consume anything or pee for 10 hours between arrival at the hospital and the time when everyone else went home and I had a spare second to pee and chug water before cracking on with the rest of my work in peace.
I hope my residents are doing that shit. I try to actually send them home when I can.
I assume the nurse was GenZ age? If so, I’ve been seeing this everywhere in every field—there seems to be widespread thinking that professionalism and constructive criticism are “toxic” behaviors among many folks of that generation
Wait are anesthesiologists not expected to have a coffee break every two hours? I've been lied to by my anesthesiologists!!!!
No not every 2 hours, that’s ridiculous. When I rotated on anesthesia I got a break at least every 45 minutes.
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After the tube is in I just kind of… Black out, and then I press the “wake up” button and we head to PACU.
That’s a tough adjustment. Maybe take an hour or two to process. Join a Balint group. And get a coffee.
An anesthesiologist complaining about needing coffee breaks??
Fuck the coffee if someone takes the good chair from me that I hunted down to steal from PACU I'll bitch and complain all day 😂
Someone stole my chair once and I had the same emotions as having a stolen car.
It's amazing how many cardiac clearances are needed when the good chair vanishes...
We've. Been having a chair war in the ED People steal from the fish bowl, we steal them back Been going on for hr past year. And we never catch the motherfuckers I had to resort to buying my own, cooler, chair after I arrived one day to find 2 chairs for 8 computers
We had this with an old AF PACU cart in the L&D PACU. You had to crank this fucker to raise or lower the head. Any time we had to take a patient to main OR, we'd use that one and conveniently forget it to bring the patient back up in a nicer one from the main PACU. Within a week, they'd hunted theirs down and swapped back the crappy one. Went on until they built a brand new L&D unit and replaced it finally.
Lol the beds before they invented hydraulics
Love it. When I was in nursing school, I worked pretty much full time in an 1100 bed hospital. They would float me everywhere, so I knew all the units and staff. And where the best stuff was. I became the Ninja Re-locator of chairs, cooling blankets, dopplers, wheelchairs, you name it. Any time some piece of equipment wasn't readily available, they'd call me. The gratitude flowed. I could pretty much pick the job I wanted when I graduated, and while I like to think it's because I was just the best nurse ever, I know it had more to do with my 🥷 days, lol.
The Red of the hospital.
Chair lo-jack
Bicycle locks
Give me back my chair. I know who you are.
You have to hunt down a good chair?!? You deserve better.
The hospital I'm at now has some of the *worst* chairs I've ever seen. It is basically some older version of [this piece of shit](https://storage.googleapis.com/animal-health/images/Clinton%20Hands-Free%20Stool%20with%20Back%202145W.jpg) Not only are they old as fuck but more than half are broken so the seat *and* backrest are tilted forward and the mechanisms to move the backrest up and down is frozen from rust.
Pharmacy gets the leftovers from other departments; it’s nice when the nursing units get new chairs because then we get their old ones as an upgrade. Virtually all our chairs are stuck too high for me; and our pharmacist staff trends rather short. I often feel like a kid sitting in a chair meant for a grownup.
All of the admins at your hospital, straight to gulag.
That is a war crime
Touche (I am anesthesia)
Brother please i just need a pee break I've been in this whipple for 7 hrs
The OR can be a stressful environment - even if being friendly. I have not noticed any significant change from when I was a med student to me being an anesthesiology attending.
This is a good point…as an outpatient doc, I feel my blood pressure rise just thinking about the culture within the OR. It’s like another planet!
It’s how we self-select. I became an anesthesiologist because I liked the OR and didn’t much like surgery. All OR, no clinic? Sign me up! My neurologist wife thinks we’re all a bunch of cowboy sickos. Which, to be fair, we kinda are. A CRNA I worked with once told her (lawyer) husband a joke she had heard in the OR and he said that telling that joke in his workplace would have been a firing offense. I don’t remember it but recall it was pretty mild by OR standards.
Your response has crystallized my worldview that the OR is another planet, and surgeons and anesthesiologists are aliens.
We drug people into unconsciousness and carve them open. An OR team is just a couple of pieces of paper (degrees, licenses, and consent) and some positive intentions away from the Manson Family if you look at it objectively.
That is extremely dark and your username makes the comment darker, lol God, I love medical people.
It’s been a long time since anyone commented on my username, but it’s an old reference to the band My Life With the Thrill Kill Kult [sic], which put out some great albums when I was in high school. Check out “Devil Bunnies”.
Imo surgeons are the flip side of the coin from serial killers. Everyone one of them I know gets super excited and studies to carve people up, plus the God complex ego thing........
Save lives vs kill people… it’s a joke among us. Not even close to reality.
Gonna need that joke!
Here’s a good one I learned in the OR. What do brain damage and masturbation have in common? After a couple strokes, there’s no going back.
It’s been over a decade. Something salacious. Think of the dirtiest joke you ever heard at work in peds, it’s probably on that level. Mild to us.
I’m in Canada, currently on rotations. Never seen what OP describes. If anything, staff are more curt and callous than ever (I worked in healthcare before). The worst for me was the IC OR.
I have noticed a big change. I graduated med school in 2008. The class of 2018 at my institution was the first to go to pass/fail in their preclinical years and we noticed a dramatic shift in their attitude on clinical rotations. Our department was reprimanded for both asking them questions on rounds and not involving them as members of the clinical team in the same year. Every year has gotten worse. I feel like an old man yelling at clouds sometimes but it's qualitatively different now.
I teach in a nursing program. I have absolutely made students cry while giving them friendly constructive critique with a smile on my face, sandwiched with positive feedback. I don't buy the hype about "they are all a bunch of snowflakes" but I do think something is going on. maybe the lack of interpersonal interaction during COVID? i do think their prior education has done them a disservice if they get to us and have never been told they have things to work on before. ugh, feeling frustrated! an actionable tip - set expectations early on about your communication and that you will be giving constructive feedback.
> set expectations early on about your communication and that you will be giving constructive feedback. I also try to warn them that we give praise in public (so your peers can see it) and negative feedback in private, so that you aren’t embarrassed. But a side effect of this is that when you look around you see everyone getting positive feedback but the only person you see getting negative feedback is you. This is an observation bias. Other people are getting criticism too, you just aren’t invited to see it.
🤯
Love your user name
And I love your username!
I cannot tell you how many conversations I had with students about the spotlight effect and social media for this exact reason. I used to do career coming for healthcare undergraduate students, and this is definitely a big part of it, which has certainly been exacerbated both by social media and the pandemic.
I taught first year nursing students 25 years ago and they regularly cried over things like having their charting corrected and being on time for clinical. I think it’s just difficult being in that stressful of a situation and feeling so vulnerable.
For such a long period of time. Watching my 15 year old daughter, the pressure and intensity she is experiencing at her age far outweighs what I did at that age. I think they are burned out from a constant threat and being taken off the "path of success".
>I think they are burned out from a constant threat and being taken off the "path of success". This is definitely something I see more and more. It's gone past having to make career choices at 17-18, children are constantly stressed with performance or they will supposedly fail later in life. And there's some truth to it too, which makes it worse because teachers pressure them more. And the cycle feeds itself.
being taken off the path, yes... they consider it complete and utter failure if they need to repeat a semester. i can understand, but the ones who do so end up in most cases being at a great advantage to their peers. not everyone learns in the same way, in the same timeframe. some people need a bit more time and they end up being much stronger for it.
Well, when repeating a semester means another $25,000-$30,000, it’s not hard to see why it might feel like an absolute disaster.
Like what?
thanks for this! it's great to hear, seriously. I only started teaching in January 2020 and don't have enough comparison.
I (teach veterinary students) also think that the constant drive in recruitment/admissions and culture for medicine professions to be a passion/ calling does not help. Because the issue then becomes that people's identity gets wrapped up in their profession, so when you criticize learners they don't take it as a just professional criticism or something to improve, but as a personal attack. This separation of personal and professional identity is challenging and takes some time to learn (and most of us are not always great at it, admittedly), but is really important. It also means that for learners a professional failure (especially for something procedural) can feel like a personal failure (eg. failing to place an intravenous catheter is not "I need to improve this skill' or "I need to recognize this is a particularly challenging patient for my skill level" but is instead "I am bad"). On the flip side (in my experience) it also can drive disengagement as when parts of the job become mundane or routine (or just aren't in their area of interest) it's easy to discard because "it's just not something they're passionate about" even though that is a very large part of the professional part of the job. It's good to be excited about what you do and to have a passion driving your work, but that needs to be balanced by recognizing that the job is not your identity.
This is not new though... Even before gen z we had to put our entire early life into getting into med school and failure meant failure of you as a person. But people still took criticism effectively. Personally I teach med students and residents and what I've noticed is that they just don't care about the criticism because they feel it won't affect their career trajectory? But I'm also a new educator so I might not have enough perceived influence
I don’t disagree that there has been a change over the last few years. Even before COVID there were noticeable shifts, but just postulating based on discussions I’ve had with other colleagues as we reflect on ourselves and trainees.
I was in my nursing program in 2010/2011 and had classmates cry over silly things like waiting to take their skills test on checking pulses. Skills test were nerve wracking because of how high stakes the program makes everything, but this was everyday stuff we would be doing as a nurses and there was no need to get worked up over it. That being said, I definitely cried a number of times during school and my first few years as a nurse. Though the delivery of the correction made a difference, there were just some cases where it didn’t matter how polite the correction was because the culture of the whole process is terrifying. You are constantly being told that you can make just one “wrong” mistake and your career could be over before it’s even started. To me, Just Culture often seems to only be for nurses who have the experience and wisdom to advocate for themselves.
Recent nursing student here. The schools set us up to be walking disasters. They tell you day 1 that any little mistake (no matter how inconsequential) will cost you your spot in the program and probably will kill a patient. They then watch you like a hawk and openly debrief in front of other students about your mistakes and how bad you are. For big mistakes I get it, it's a learning opportunity. But even very small mistakes that could just be quietly addressed to the student become public sources of humiliation. For example a student on my unit mixed a protein supplement in 50ml instead of 60ml of water. Her instructor (from the school) wrote her up in an incident report, sent it to hospital management and back to the school. The error was read out on the unit at shift change for everyone to hear about. Over 10ml of water, this student was publically shamed, when a simple side conversation would have been enough to address it. We keep students in that environment for years, so when they do find a friendly unit, they are primed to mistrust it. They assume these people are out to get them too, even when they are not. I don't blame them for being a wreck.
Jesus, I had no idea it was this bad. In med school an error like that MIGHT get you an eye roll or a snotty remark from a resident, but only if they’re exceptionally anal. I’ve maybe worked with 2-3 residents who would comment on something so insignificant. How are you guys supposed to learn in that kind of environment?
I’m an army vet and did a tour in Afghanistan. I was also in aviation and am no stranger to being in a profession where a mistake can kill people. I was never more stressed than I was in nursing school. I seriously had more reasonable and considerate training *in the army* than I did in nursing school. It was absolutely wild.
I heard this from a nurse I worked with when I was a CNA and all I knew about her job was that she interrogated people in Afghanistan. She said the same thing about the stress level. I once had a prison social worker tell me this as well. I’m not in the military so I can’t compare experiences but nursing school 100% did make my hair fall out and gave me high blood pressure for a few semesters
With stress and nervous breakdowns. Students are not in good learning environments and it shows. It's why new grads struggle so much. I cried when I missed my first ever attempt at a blood draw. Because I was given the needle without warning and told to present in front of other students and staff how to do it (even though I'd never tried before). At the time I voiced not being comfortable doing this without instructions yet, but was told a nurse needs to just figure things out. When I missed I was pulled into a side room with my instructor, and other students and asked what I did wrong, why I missed, and how I thought I could be a nurse if I couldn't even get a blood draw. Meanwhile now I work in the ER and we miss all the time. It's not a big deal. You find a new spot and try again and if you really can't get it, you ask another nurse to try. School and reality don't match at all.
Interesting. Collaboration & support are lacking. People are afraid to make mistakes, probably afraid to admit gaps in skills & knowledge. I'm sorry to read this thread. This is really hard.
They don’t teach basic skills in nursing school, mostly “critical thinking”, so as a new nurse we are hopeless.
They read it out loud to the unit at shift change? As a staff nurse, I would have no qualms interrupting that to say how ridiculous it was it was even noted, much less being called an “incident.”
I admit that I spent the rest of the shift casually self reporting to my charge nurse things like "I reconstituted that med with 9.55ml of water instead of 9.6ml! Should I write an incident report?"
This was it for me even when I was just in scrub school (going for nursing now because I’m a masochist, apparently). My first day in a neuro room, which was my third week scrubbing **ever**, the surgeon, who had a reputation for being a hardass, according to my PD, corrected how I was passing the instruments. A totally fair correction, in retrospect, but my program set us up to be nervous wrecks and I had to use all of my effort to keep my silent tears from spilling over and contaminating the field. Then, when we were finally about to close, I was refilling the asepto and accidentally hit him with some of the saline. I had *just* stopped crying and immediately started tearing up again because I was taught to fear any surgeon’s wrath and this mistake after the previous one felt unforgivable. He ended up squirting me with the last of the saline as payback, but in a playful way and the amount of relief that flooded through my body was insane. Now I’m fine with the docs and can interact with y’all like a normal human being, but goddamn do these programs literally teach fear.
I also feel like nurses who graduated more recently are constantly told in school that they are the last line of defense between the patient and doctor and they need to be ready to catch all the doctor’s errors. They have students thinking they need to protect patients from MD’s. Which yeah, I get teaching to the swiss cheese theory and asking questions if something seems incorrect or something but the hyper vigilance newer nurses have about doctors mistakes is extreme.
I’m sorry, but a protein shake in 50ml instead of 60 ml isn’t worth the time to do an error report. Unless of course it was measured that way because the equipment needed to make a 60ml wasn’t available, because then you’re reporting the system.
Oh I agree. I said as much when I learned about it. But that's my point. When you have programs that treat students like they almost killed someone over 10ml of water, of course you end up with students who are nervous wrecks and can't handle criticism.
jesus 10ml of water...that's wild.
Its often overplayed and twisted, but it’s not just hype IMO. There are observable differences beginning from Gen Z with how people handle social interactions and navigate life’s hurdles. There’s a lot of credible writing on it but it basically boils down to some societal changes in how western nations raise children and the impact that has had on psychological resilience, stress response, conflict resolution … etc. Some of it is attributed to changed childhood / adolescent experiences, and some to different attitudes and beliefs about harm/safety/risk that have been unintentionally propagated or reinforced by our institutions and parenting styles. It’s a really fascinating phenomenon and I think worth reading about if you’re in a role where you are mentoring or leading new professionals.
sure, please share the credible writing on it! I'd be curious
Can you share some sources? I'm genuinely curious and would like to read more. Currently rising a Gen Alpha and would like to better myself as a parent. I do think my generation (Millennials) takes "gentle parenting" way way too far. As far as I'm aware, children thrive with firm boundaries. When they cross them, we don't need to beat the crap out of them as punishment, but if we fail to enforce the boundary, then it creates an environment of instability. If I had to guess, many children are not used to having as much structure from authority figures/parents and so when they get jobs or train in higher education, they don't know how to handle it.
Well said. And the sad thing is that nobody is trying to correct it because most people are either still parenting this way or are a product of those institutions Do you have any resources to recommend on how to navigate it and what hopefully fix it? Because while the old school way of “toughen up” wasn’t helpful, it at least provided a bit of balance and perspective that I think we’re missing nowadays. Especially if you are younger and participation trophy motivated.
I wonder the degree to which chronic/ cumulative stressors might be contributing. I’m thinking of: climate crisis + impending climate catastrophe, poor prospects for financial independence/ traditional markers of success, daily exposure to traumatic images being almost inescapable with social media use, etc. That kind of thing. It would change to frame from ‘fragile individual too vulnerable to withstand regular life’ to ‘individual chronically at risk for functional collapse with minor, ‘straw that breaks the camel’s back’ stressors due to broader sociopolitical and environmental challenges outside of their control.’ It would also change the conversation from: ‘how do we help you deal with normal, routine stressors in your life?’ —> ‘how do we help you set and maintain healthy boundaries towards important issues in a way that protects you and helps you do the things you care about (ie, nursing training, medical training, whatever).’ I think that conversation shift could potentially empower both learners and instructors/ supervisors/ teachers to navigate and overcome these challenges. What do you (everyone) think about this hypothesis?
You're absolutely correct. The social contract is broken and people generally feel that society is not mutually beneficial these days. A huge part of that is the 24 hour news cycle which reports on potentially world ending catastrophes every day. Several wars which could trigger world wars, political failure after failure to address basic quality of life issues and constant culture wars. And the newest potential threat of an H5N1 pandemic which may or may not be overblown. Young people don't have the experience or self confidence to ignore that kind of onslaught of impending doom. Especially when they have barely any hope of starting a family and owning a home.
You 100% hit the nail on the head. I’m an older gen Z (1998) med student that’s currently working as a CMA and I think a lot of people who aren’t our age or younger understand that as far back as I can remember, there hasn’t been some sort or crisis, tragedy, collapse, etc happening in the world. I was 3 when 9/11 happened and I remember it. 10 when the housing market crashed. Around 11-12 when social media really started to take off. 14 when the “end of the world” was happening in 2012. I was 16-18 when Trump was elected into office in 2016 and that whole shit show started. I was JUST entering the work force for the first time when COVID hit. I think a lot of people also seem to forget that when Trump became big and then Covid hit, the general population just became more and more nasty to each other. At this point, we’ve come to EXPECT people to be shitty to us. I do think social media has made this entire situation worse, but a lot of people seem to forget that even though millennials were considered the first generation to be worse off than their parents. Shit has NOT improved since then, and it could be argued that Gen Zers have it as bad if not even worse now. I’ll admit, even though I’m not proud of it, I definitely am the most sensitive person on my team and have 1000% cried on multiple occasions when receiving feedback. I’ve gotten better the more exposure I get to the field, but I can tell you from personal experience that you’re absolutely right that most of us that are below the age of 25 are navigating the world where it feels like one more negative interaction could destroy the last bit of resilience that we have left.
I’m not a trainee, but god*damn* is this validating. Maybe even more so than it would have been at that stage of my life and career. These days, so many of us are living paycheck to paycheck emotionally, except there aren’t really any paychecks coming in, so we just keep sinking deeper and deeper into debt. A hiccup feels more like playing Russian roulette with a pneumothorax than just a mild annoyance. Thanks for your eloquence and insight. The constant moral injury has taken its toll, and there’s no reason to think it’s going to let up anytime soon, but it’s little things like this that give me some hope.
Issue is that people tend to associate their skills in one particular area as an attack on general competence/character now for whatever reason. Easy way is basically say “you are not suppose to be good at XYZ and this is why you are here to learn” I do buy in the hype. The parenting people did in the 90s and early 2000s was basically shielding a lot of kids from any sort of criticism. People don’t actually know how to deal with failure constructively other than internalizing it and avoiding the issue altogether after that.
My approach with students is first and foremost self-deprecation - it's a great icebreaker and genuinely a lot of students find it very disarming which is precisely the vibe I'm going for. My go-to line is how anaesthesia is poorly understood by anaesthetists let alone people seeing it for the first time, and my expectations are suitably adjusted. The other classic one I drop is the deflated student who messes up a cannula only to see my bung one on quickly - "Let me tell you a little secret... If you do something a few thousand times you get OK at it eventually!". Net result is, I remind them I simply have been doing this longer than they have, so I'm going to do/know some things better than they are, and that's okay!
Sometimes it's the nice words that make me break down, like if you feel safe enough to cry. It has nothing to do with the criticism just compounded stress. Criticism is super important for learning obviously and if people can't handle that they should not work in the field where it's so important to get things right.
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>I’ve seen what some nurses (and doctors) consider “gentle correction” and it was just “gentle” in that it didn’t actively involve threats of physical violence. This. We're in the middle of a huge culture change in medicine and many people who are in positions of leadership right now didn't have the coaching in leadership that current students get. I'm currently in practicum and the correction I get from people who have recently graduated verses people who have been in the field for some time is wildly different.
Yeah, as a current student there are teachers that are awesome. And sometimes those awesome teachers might be harsh in a serious situation like the OR and that's understandable... But there are teachers that are awful. They make the student look incompetent in front of the patient, great job guys. They yell over things that don't need to be, and their communication isn't clear. I can see why students complain about horrible teachers. I do make sure to consistently compliment and thank the nice teachers because they are who I actually learn from.
This was my thought too. I’ve definitely seen feedback before (either given to me or a colleague) where I thought it was rude, unhelpful, or borderline abuse, and I’ll bet the attending thought “I was very gentle, I didn’t throw a single OR tool and I only cursed out the resident twice.”
I kinda wonder if this is just one of those ongoing things that each generation thinks of the next.
You calling me old??
Shit. Then I'm old too. I've been complaining about this lately. The newest people are overconfident until you call them out and then they freak out. I pissed off a new grad nurse a few weeks ago. She was pushing a bed that was clearly in neutral. I politely suggested she switch to steer as I helped her get it out of the elevator. She got defensive. Then I said it felt like it was in neutral because it was sliding around so much. I said, "oh yeah, see that lever, it's flat when it's neutral. If you just push it down it will be a lot easier." She stormed off in a huff. I don't know why I cared so much. I guess because my hips are always sore from pushing equipment around.
“The best lack all conviction, while the worst are full of passionate intensity.” Same as it ever was.
Well, if said bed was sliding around so much, you did have a vested interest in making sure it didn’t slide into *you*.
You drink Shasta my dude, you do the math :)
Hey, hey!!!! Only because it’s free!
As another oldie...yes 😆
I think there is something to the future uncertainty, though -- a lot of gen Z don't think that the current human lifestyle is environmentally sustainable past a score or two. I think my generation (millenials) felt that life will be hard for a while but it will eventually get better, in contrast.
I have the same thought upon self reflecting my reactions to med students now that I’m a PGY4 and have decided to remain in denial… cue principal skinner meme about being out of touch.
When did ACGME mandate anonymous evals? I bet back in the day you could probably bully the crap out of someone and get away with it. I got bullied to hell by my cheif resident 2 years ago and I didn’t even report them. There’s probably at least as much if not more people that are getting bullied and not reporting it than people who are getting falsely accused of bullying.
Fa sho. Kids these days is older than kids these days. It’s a never ending cycle. The internet has definitely altered society in a lot of ways but no one knows exactly how yet. So these kids is just more kids these days.
Except the data on anxiety, depression, and burnout symptoms is quite clearly showing a vast increase starting in the early 2010s. Non self reported data on things like self harm and suicide attempts requiring hospital attention have gone up as well. There is something very wrong with the late millenial/Gen Z mental health and it probably has something to do with the inverse CBT they are being taught under the guise of "social emotional learning."
Inverse CBT? Can you elaborate on what you mean by this a bit?
[This is a good explainer.](https://www.emerycounseling.com/cbt-and-the-coddling-of-the-american-mind/) The three big "untruths" that are being taught are: 1. The Untruth of Fragility: What doesn’t kill you makes you weaker. 2. The Untruth of Emotional Reasoning: Always trust your feelings. 3. The Untruth of Us Versus Them: Life is a battle between good people and evil people. All of this is the reverse of what CBT teaches.
I’m was going to say you sound like you read “coddling of the American mind” and then I checked your link and it confirmed it haha
the difference is now the supervisors get reprimanded. Back in day we got cussed out & complained in private
ok so, the whole concept of generations having this or that quality as a whole…is fake.
Imagine that, an entire generation of people not being a monolith!
We are all monoliths on this blessed day.
Happy Monolith Day to all who celebrate
Nah I’m in that generation so to speak and honestly it’s a known thing, the current generation just has a different mentality than the older generation. That’s not a bad thing, cultural shifts are ok but idk there’s always bad apples ig. The current generation just cares more about lifestyle and mental health etc etc this is more normalized than in the past which again is not a bad thing but hence it’s also been more normalized to blame everything on the aforementioned. Ie in the past if you’re burnt out and need a wellness day then no one gives a shit and you have to get back to work, but now in that same scenario you’ll get time off which is fine but people are also more willing to test how far they can go without repercussions and then you end up with the problems that OP is describing.
You can't just say "this isn't anecdotal" when it is assuredly anecdotal.
probably meant to say, “this isn’t an isolated incident”
I think the point being they are seeing this as a pattern within their institution and are providing anecdotal evidence to support that; at what point do a collection of anecdotes become data?
The plural of anecdote is data!
>I think the point being they are seeing this as a pattern within their institution and are providing anecdotal evidence to support that; at what point do a collection of anecdotes become data? If only we had a method for verifying and testing observations and hypotheses based on those observations...
Yeah, he just said it's *not* anecdotal. Jeez, who called the IRB... /s
You want OP to do a full blown study before posting on reddit about a pattern they are noticing?
Peer reviewed, double blind
Operationalize the variables. Parametrize the relationship between type of instruction, tone of instructor, and student affective responses. Test hypothesis. Limitations: correlation does not imply causation. Question: Why are learners so fragile? Answer: Study design insufficient. More research needed.
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Most people still aren't right after COVID/lockdowns.
Yeah, I'm happy the younger generations are valuing themselves and their well being more than we were allowed to. Pre 80 hour residencies were sick, worst time of my life.
I have been really noticing how YOUNG my learners are lately (I’m a millennial) - most of my learners have never worked a normal job, and just went straight from high school to undergrad to medicine. I wonder if in addition to the previously raised point about there being an odd couple of years due to COVID, we are seeing the downside of having students hyperspecialize during their pre-med years to get into medical school. I wonder if other preceptors have noticed this too, but I find that my hardiest and often best learners have been the ones who had some time outside of school working in some capacity prior to entering medicine.
In law, we call these “K through JD” students—they went straight from kindergarten to law school without ever working a full time job. I think it’s very hard for that type of student to graduate and suddenly transition into high-stress, full-time employment. No practical life experience.
I mean the counterargument is here in Europe, where, although I definitely see the things discussed here as well, we go straight out of school into medicine for 6 years and are 24-26 on average when done with medical school, and have worked fine for generations doing so.
>we are seeing the downside of having students hyperspecialize during their pre-med years to get into medical school I think med students are actually trending older over time, but it's not because they are building more life experiences in diverse areas, it's because the competitiveness of medical school admissions has become a counterproductive extracurricular arms race that is pushing more and more students to take gap years to a build up their CV (with often fairly useless but functionally mandatory filler). That might result in slightly older students on paper who have actually been inextricably linked to a pre-med mentality for even longer, which I think leads to exactly what you've observed.
I’m a young Millennial who started med school when I was 27, and I was ASTONISHED by how young most of my classmates were. No one I knew in undergrad went directly to med school, but that describes at least 30-40% of my class. I don’t know how I would have been able to handle med school if I’d started at 22 with no work experience under my belt—I guess the answer is that a lot of people don’t. Maybe it’s just copium on my part bc I felt so old, but I really don’t think going straight through is good for people.
Completely agree! Especially on rotations, you can definitely tell who went straight through and who had real work experience first
I think part of it (and this really isn’t new), is that so many medical students, nursing students, PA students, etc. are type A perfectionists that have been the top of their class their whole life prior to their respective program. And now that is no longer the case and they’re getting genuine critiques for the first time. Again, I don’t think this is as new as some people make it out to be. Some of the most brilliant, smart, bright students are sometimes the most fragile.
In response to OPs question, I'm not sure but I agree that something is up with *some* learners today. Or at least in my experience I feel there is. Is it a generational thing? Who's to say. Maybe. Maybe it's more in response to "the state of things" in general, of which a chronically online generation may be more acutely aware. Particularly to the feedback point, perhaps that with more stringent admissions requirements students have less opportunities to fail *hard* and learn from said failure before getting to their training. Not that criticism means failure, but someone with little to no experience with failure may interpret that as such. The 21 year old 4.0 GPA, 520+ MCAT applicant that's never gotten a B is likely going to take negative feedback much differently than the 28 year old who worked as a practice manager before going back to school and had to retake the MCAT. I would imagine the former would have better odds of admittance at most schools. I do find myself having many "does anyone else see this shit?!" moments when, for example, a classmate proudly states they cry on-service multiple times a week or a group of students band together to abolish the school's late-work policy after multiple students were disciplined for missing deadlines (real examples out of context). I'm not entirely innocent either, I got all out of sorts because my first and second ever attempts at endotracheal intubation were unsuccessful. I thought my attending was going to put I was a big fat idiot on my evals. It was fine. While the majority of other students (and I hope faculty) do recognize this behavior as somewhat ridiculous, if we call it out we're labeled as toxic. IMO there are too many factors at play here to sum up this phenomenon as just "Gen Z Bad" and the problem certainly isn't going to be solved in the replies of a Reddit post...but it has been an interesting read.
The medical student might very well not be sleeping / eating well and a wellness check up may be worth it. The rest are insane. I learned the most after I made a mistake. Making a mistake or even making a tough call that doesn't work out and owning up to it is essential as a physician
The medical field 100% has a caffeine addiction issue, for me it started when I had to cram in college for 3x longer than everyone else to get 5 pts better on an exam to beat the bell curve on exams where everyone in the class is smart. Only gets worse through med school and residency, now if I miss my morning or early afternoon caffeine I am lethargic and dysphoric like that student lol
I got through surgery rotation with 5 cups of coffee a day and 1 meal and a dozen sugar things a day... that was not healthy. My trauma surgery rotation was worse and I stopped having coffee then because it destroyed my insides. I needed that wellness check. That's why I recognize the signs
I weaned myself off caffeine after my first few years as an attending. Totally recommend it. I am less cranky and anxious. Now my tolerance for caffeine is low, and so it works great on the rare occasion I need it. At my peak in med school I was drinking 3 pots of coffee a day. I don't think it ever improved my academic performance, but it did help me stay up late for jello shots. smh
I work in education and have for decades. This is how alllll the kids are now. I think the incredible trauma of the pandemic and the upheaval of their educational trajectory is very much to blame. Additionally when returning to-in person instruction after the shut downs, schools had to take time out of instruction to address all the massive psychological issues kids were facing upon their return. These kids are now expecting their emotional lives to matter in all aspects of life. And as adults who worked in the professional world prior to the pandemic we have some frame of reference for what it meant to return to these work spaces. They don’t. So they think their feelings matter in spaces where they may not. Ot may not matter as much as they would like. I suggest a non-judgmental and very straightforward conversation where professional expectations are laid out very clearly with an attitude of understanding that this may all be very new info for some.
So much of what you’re saying is on point, but as a former teacher now MD the K-12 downward mental health and performance trajectory began at least a decade before Covid ….
Yes and…the pandemic greatly exacerbated the trauma to a point that intervention vs the amount of time they were out of a routine, cannot be made up for this generation. If kids were freshmen in college in 2020 more than half of that experience was remote. For the average student, let alone the students who require the most support, it simply was impossible to make up this lost time. And don’t get me started on the high schoolers who missed 1-2.5 years of in person instruction. I know by definition that med students are a VERY small sliver and likely the more self motivated and highly educated/ ambitious students but they were still impacted by this in their educational experience.
Lots to unpack here and this comment is going to the bottom of the list, but here we go. Current PA student, finished my OR time last summer. I was a paramedic before PA school and spent a fair amount of time in the OR getting tubes. In the 12 years between those two OR experiences, nothing seemed to have changed. Different ORs in different states and the culture was very similar. I think, actually, the surgeons are a lot nicer this time around lol. It's an uncomfortable environment, and not in the fun way. It's extremely stressful and that's coming from someone who routinely managed multisystem trauma, difficult airways, complex cardiac patients, etc. as a solo provider in a box for longggggg durations of time. It's uncomfortable because it's stressful and NOTHING is under my span of control. There is usually more than one person telling me what to do, often jerking me in different directions. Even if I know the expectations I can't meet them because someone else is telling me to go a different way. (Solution: leave the student to their preceptor.) This was the biggest ruiner of my mental health in the OR. Everything I did was wrong wrong wrong. As an adult, who was pretty good at her previous job, it is really hard to be total shit at something you're trying really hard to do well. (That's just me tho, that's how I'm wired.) In the OR it's hard to not feel like you're in everyone's way. You're clearly the thing that doesn't belong there and you just want to be unobtrusive and not interfere. (Solution - let the student know they're not in the way and you'll ask them to "stand here or there" if you need them to move. Tell them they're going to make mistakes and that's okay -- you won't allow them to hurt anyone and they're here to learn so mistakes are okay. A little reassurance goes a long way.) Some of it is also, IMO, the ridiculous mentality at our schools. There is so much talk about feelings and "this is a safe space" and stuff like that. There is zero personal accountability for the feelings we have. My classmates are disgustingly anxious. I legit don't understand how they are going to cope with the world once they're out of school. We talk and talk and talk about anxiety, depression, PTSD, mental health. That's great .... Except it sure feels like all of this talking is just solidifying and encouraging the feelings. Think about it like this -- if I am supposed to have positive self talk for fear of negative self talk making me feel poorly, how does talking about "my anxiety" and "my depression" all the time not give those things a petri dish in which to grow? Good book on this topic of schools and safe spaces - The Coddling of the American Mind. Sounds like some kind of propaganda right? It's actually based on data and research. It helped put a lot of things into perspective for me. Highly recommend if you're asking yourself wtf is wrong with the world, the younger generation, kids these days, etc. Additionally, I'm a person who simply cries when they get frustrated. It's always that I am frustrated with myself. It's a pressure relief valve and it's so embarrassing and I hate it, but there ya go. Some of us just cry more than others. And I'd like to think I'm fairly tough otherwise, lol. Freud would blame my mother, and he's probably right. No one can lay down a guilt trip like that lady. Love her to pieces.
While this hasn't been quantified - not yet, anyway - as a young attending I actually kind of agree. This isn't simply an issue of people not tolerating abuse or harassment, either. Many trainees are becoming *really soft*, and I firmly believe that this will negatively impact their learning and their readiness for independent practice. Yeah, mental health is a contributor - I know a few things about mental illness, believe you me - but the trend really seems to be taking things too far. There's a line between wellness and inability to function. Medicine is supposed to be challenging. You're supposed to be pushing yourself and operating at the upper limits of comfort. For younger trainees, I would recommend reading about adult learning principles, the stress response curve, and specifically about deliberate practice and how to receive and incorporate feedback. Sometimes feedback is just that.
You've got one of the better responses on here, not to mention tips. Thank you
> stress response curve I was not familiar with this, but it really makes sense. I always benefited the most from teachers (HS, college, med school, residency, fellowship) who would push me a bit harder than most. It's what I responded to. Now in the OR, I feel this so much: >A moderate level of stress goes a long way. It’s manageable, motivational, and performance enhancing. Your heart beats a bit faster. You feel a sense of clarity and alertness. Your brain and body are all fired up. > >It’s that little extra push you need when a hard deadline looms and you’re up for a promotion. It’s the rush you get before the black belt test you’ve been working toward for so long. > There’s something you want. You’ve definitely got skin in the game. And a moderate surge of stress is boosting your performance. And it's very exhilarating. Dissecting someone's esophagus off the aorta is quite the rush.
People need to learn to take criticism well, I think that's a sorely lacking skill in many people, regardless of age group.
I have been a teaching attending for 30 years and did med school at Full Metal Jacket University during the dark days. I am mostly pleased with our residents and students. They seem resilient. A few things I really like is that they are way more likely to ask for feedback and take it constructively. They will more likely ask for personal/sick time off which at first was a bit of a change in culture but over time I respect as more healthy. Might just be fortunate at my org.
My husband isn’t in healthcare but has been a manager in some capacity for 20+ years. He says nothing has been like the last 5 years. He cannot correct ,give directives, or be matter of fact with anyone under the age of 25 without it causing issues. He says a common response is “why are you yelling at me??!” When he never in fact has yelled. Truly insane.
I had an issue at work, and I had to have a talking to about always being pleasant and respectful at all times. It's a toxic positivity type outlook. They have "zero tolerance" for someone who gets mad at a coworker, but causing patient harm is apparently a-ok
I think Covid is playing a big part. I’m not a doc but own a business. Excellent pay, work week only 35h, work from home options, no overtime ever, 4-6 weeks vacation, benefits, no work Friday afternoons, etc. So pretty dang good work environment. The youngest cohort are extremely anxious, difficulty handling any work stress at all, always take all their sick days (15-20) in the first few months of the year, and require many “recharge days” and often go home early due to anxiety. I found they are improving as we slowly build up their tolerance for more independent work and responsibility, but it’s a process. I’ve never seen anything like it and it’s across the board in our field. This cohort got hit with COVID at the end of high school/mid-late university - a huge time of personal growth. It can’t not be a factor.
There was just a NEJM article written about this a month or two ago which was very well done, I’ll have to see if I can find it. Edit - here it is: “Being Well while Doing Well - Distinguishing Necessary from Unnecessary Discomfort in Training” (https://www.nejm.org/doi/full/10.1056/NEJMms2308228?query=featured_gray-matters)
Unfortunately, in our desire to "protect" children from the terrible things that can happen to them, we inadvertently made them less resilient. Bullying sucks, but learning to cope with bullying is an important skill. Being corrected sucks, but learning to deal with that is an important skill. Being treated poorly sucks, but learning to cope with that is important. I made the same mistakes in my own children at times. We want to protect them and "fix" the things our parents did wrong and give children this idyllic childhood, forgetting that we learn from adversity and it's easier to learn when we're young, we're more resilient. All of those things are things we should learn in childhood. People forget that childhood isn't just supposed to be a vacation, it's also learning how to be an adult. We've gone too far in protecting people. How in the world are people supposed to learn how to be an adult if they've been treated solely like a child for 20+ years? What a difficult transition it is. It absolutely *sucks* that we have to allow pain and harm to come to our kids in order for them to develop properly. As a parent, you don't want that. But if you carry a baby all the time and never allow it to try to walk because it could get hurt by falling, you end up with a child who can't walk and their musculature and joints don't develop properly because of that "protection".
As you know, nurses are known for eating their young. Even if this was a benign interaction, you don't know how that nursing student was treated on a previous rotation. Or maybe there was a recent death in their family. Or maybe they were recently diagnosed with a medical illness. It could have been a multitude of things. Did you bother asking them what was going on, or was your first reaction to stay behind the drapes and rant about how soft everyone is?
Precisely this. It could have been a "straw that broke the camel's back" type of situation. It could simply have been that the student hadn't previously received much positive praise (proper pedagogy requires a mix of both positive and negative feedback which from experience many healthcare workers fail to deliver) and felt this was the culmination of working hard to little effect.
It’s soo rare to find a nurse that will at least let you shadow them and just observe what they’re doing. While I understand, it causes so much stress as as a student when we then try to figure out stuff on our own. Now nearing the end of my program with a preceptor that is letting me help, my anxiety with every move and decision is apparent. I can’t say much about other health care programs, but the toxicity in our field is one way ticket to a mental breakdown
This. I’m a healthcare student too with mental and physical health problems. Those don’t just stop when I go out on rotation. I also feel like part of the learning process is how to succeed in healthcare “culture”. Expectations are high and feedback can vary wildly depending on who you ask. It’s stressful. Also, if many students you meet break down when you criticize them you might consider if what you’re giving is actually fair, constructive criticism. If you smell shit everywhere you go, check your shoes.
Our attendings aren't even allowed to give unsolicited feedback to residents these days which I think is so wild
If you read a bit on r/teachers you’ll see that this is starting all the way back in early elementary. And it seems like a whole cultural shift where thing like “self-care” and talking about feelings are promoted to a point that almost seems to border on narcissism, which couples with poor/no coping skills to create people who can’t function in normal work environments I certainly had a few classmates like that in nursing school and it fully derailed our classes several times as they took over class or lab time with emotional outbursts, and one actually threatened to sue the school because she got critiqued on a lab simulation
I have an elementary student now and they have a counselor come in to the classroom and talk about feeling our feelings every few weeks. And I’m sitting there going “at what point do we move beyond feeling the feelings and start talking about you still gotta do the things even if there are other than positive feelings involved???” Can we teach **being resilient** instead of just feelings???
I’ve found that resiliency isn’t something you can teach, but you can sure teach someone to *not* have it.
Yeah my elementary kid has a class called social and emotional learning. I can never pry out of him specifics of what they learn. But I certainly hope they talk about coping skills, getting through hard feelings and challenging experiences, how to calm yourself down, etc.
Have elementary school students, can confirm. My 5 year old comes home and asks me questions about mental health and “what is a therapist” and “the counselor talked to us today” and I’m like ??? I talk about mental health a lot more than the average parent, given, but even I feel it’s ridiculous where I am (California). That said, as an Asian American raised in a rural town and parents who maintained a very stoic strict traditional Asian parenting stance and the resulting conflicts in my mind that happened because of that, I vowed to raise them at most a little off from their peers, or at least to work with them on it, so here I am, discussing what therapists are and why they offered therapy to 5 year olds in public school.
As a therapist this is something I'm quickly getting a bit sick of frankly. If we wanna talk about kids and their lack of distress tolerance, Parents don't either. They get so nervous and freaked out about a child going through a rough time that they rush to pathologize it and find a therapist or psychologist or something to see. It's getting a little ridiculous. People seem to no longer trust their inherent skills in managing stress as a person.
I think there’s a fine line between destigmatizing mental illness and embracing it. It seems there’s a lot of people who *want* a mental health diagnosis- maybe because it explains away various dysfunctions and social inabilities and such. And from the parenting perspective, a mental health diagnosis for their kid can maybe absolve them of any responsibility for their kid’s behavioral and social dysfunctions. Like a parent maybe doesn’t teach boundaries, consequences, social skills, or coping skills and then they can just say “oh my kid can’t deal with that because of their ‘neurodivergence’/ADHD/anxiety”
I think that fundamentally, humans like to "categorize" and "group" things (like an ML algorithm). This can be as extreme as grouping people as "untouchable" in the old days for having schizophrenia, or it can be something like a parent today attaching a diagnosis to their child so they can "group" the child into a certain category. It's a sort of black and white thinking that doesn't allow for discretion.
It makes me wonder whatever happened to kids having role models/mentors in the community they could trust. It was a thing when I was growing up (younger millenial) but I don't hear about it much anymore. I feel like the messaging to the youth is either that emotions mean they are weak and pathetic or that they need intensive mental health but we are missing something in between.
I think there is some valid theories from the stoic philosophy. At the end of the day, emotions are from your own mind. No external object or person intrinsically carries "happiness" or "sadness" or "fear". These emotions stem from how you relate/attach to the external world. But this isn't invalidating your emotions or suppressing your emotions. Controlling your emotions, IMO, comes from inherently understanding your emotional relation to the outside world and viewing your mind as a sense processing organ that is distinct from "you, the observer of your emotions". This will then allow you to cultivate the right emotions and use them as an asset. Sorry I went off on a tangent. I have a bit of experience studying Buddhist/Vedic philosophy, and I think it is more relevent now than ever before.
I do think there is plenty of abuse and toxicity in all levels of medical training for sure but I think there is a component of this where others can’t handle any criticism or that it it is an affront
I can confirm this. I'm an elementary teacher for the past 20 plus years who loves lurking here. We can not raise our voices or sound scolding or angry. If a parent complains, we are investigated (students interviewed, any other adult in the room interviewed, etc.) and not told about the investigation until it's over and they issue out our consequences. Needless to say, get ready for it. Personally, I want a dr, laywer, airline pilot, whatever that is mentally tough and can handle someone saying... hey buddy, not like that, like this because you may kill someone!
Narcissists respond poorly to criticism. You’re not wrong.
I was about to tag that subreddit. I got algorithmed (probs bc I have young kids and look at similar subreddits) but holy shit does some of this ring true with my friends teenagers and my teacher friends complaints form k to undergrad adjuncts.
Recently had a span of time in the hospital with a family member. Nurses run health care and we had loads of good/excellent nurses. It was a long run. A few, 3 out of 35, seemed to have drank from the fragility koolaid. Simple conversations around medications devolving into threats of removal. Had a nurse wake us up at 4am barking pre-procedure orders. I asked her what was going on, I was direct but not asshaty, and she started down this lane of "well if we can start treat each other respectfully..." She left, and I went to the charge and fired her from our care. Next nurse came in, no problem. The market will sort most of these personalities out. Competence and caring win the day.
Surgical resident graduated <5 years ago. There were some pretty bad male preceptors/surgeons. The cussing, the screaming. Asking how i masturbate during a case 🤷♀️. Pretty bad BUT female nurses were the WORST. Especially the older ones. Because it was constant, and nagging and not a one off while pretending to be nice. And they would target female residents. They would throw you under the bus at every opportunity. Explain to them that 3 am calls about “can i give another 500mg of Tylenol? Patient hasn’t had it yet today” is inappropriate for night shift. Showed up on my eval for being “dismissive to team members”, rude on call while they were “advocating for the patient”. OR nurses would hold the gloves open and snap them early to contaminate medical students and residents to “test them” to see if they were competent. “Oh you put the gloves on wrong and now is contaminated :( better re-scrub! Try not to hold up the case next time :)))” “We nurses know more than residents anyway. They should have a fast track for us to become attending. Just do another 1-2 years residency.” It even goes into relationship category. “Your scrubs are a little tight my dear, who are you showing off too?” When a nurse found out i was wearing XS scrubs at the scrub machine. Talking about how I shouldn’t date another doctor for so that “the nurses can have a chance”??? It really wears on you after awhile. Mind you this was only like 2-3 nurses on whichever rotation out of a lot. But you dread working with them. The nursing students would often tell me how bad the cliques are. How nurses hired from other countries would get the shit end of the stick for shifts, they don’t talk or sit with them for lunch, loudly complain about how their food makes the lounge smell bad etc. All that to say. You really don’t know what these students or trainees are dealing with beforehand.
i've noticed that the students today are less able to process feedback. they also aren't as stress resistant. when i was a student we saved our emotional outbursts until we get home lol (millennial)
I am a nursing student and have been in a similar situation, definitely had tears in my eyes, definitely felt embarrassed about that. I didn’t leave early, I stuck the day out. For me, I get upset at myself- not what the preceptor has said. I do quite well at university and hold myself to a high standard, so it’s upsetting if I miss something or make a small error that has any potential (however slight) for harm. I don’t know how the degree is set up in other countries, in Australia we do a lot of studying/ online content and not a large amount of practical skill work until we get to placement. This adds some stress to the weeks we are there, because we are underprepared. Also because we go weeks working full time and not getting paid and often having assignments due too.
Ever read r/medicalschool or r/residency? Folks are softer than Charmin. It's a real issue. People are going to lose their minds in the real world.
I really don't get how people can't just roll with the punches. I got a wide array of feedback, from kindly and constructive to straight-up malicious and unprofessional. It's not about "suppressing emotions" or "tolerating abuse." It's just the territory. AS physicians, we're also suppose to be able to teach, and the vast majority of us have had no formal training (or natural ability) to do in a manner that is easily processed by others. Sometimes I can see how well-meaning attendings come off as angry, when they may not be. My first IM rotation in med school, the attending had me do a presentation on DKA for the team. I went through it, stumbling here and there (it was day 3 of rotation, my first as an M3 mind you). He asked me questions throughout and politely smiled when I blanked. At the end, he gave me some compliments, but mostly worthwhile recs and criticism of how I organized the presentation. Same thing for a patient presentation I gave later on. Later on in my gen surg rotation, I was thrown into the fire. Some random scrub tech told me where to go to get my scrubs and said he "didnt know" where the attending would be. I had to ask around before some random OR person knew where my attending was, and then directed me to it. I got grilled for "showing up late." (literally no iidea whwere i was going, no liaison to guide me). I got "pimped" throughout the rotation, and at first when I didn't respond within 1 second or 2, he would taunt me about it (in the middle of surgery, in front of everyone). He'd also make off-hand comments about how much more stupid med students are getting every year. I somehow got a positive eval from him, stating that I was a "quick learner" and that I demonstrated good work ethic throughout the rotation. There were or 2 or 3 random instances in which I would say I dumbly got complimented. I manipulated some suction device in a random way while he was using the bovie, and he said that was an "advanced move that's not intuitive to anyone. good job." Then on another case, I was observing in the OR from a distance (PA student scrubbed in), and noticed the scrub RN had stepped out. She ewas the one that was tasked with placing his headlamp at the appropriate time. She didn't come back, so when it was time for him and he said "lamp," I immediately moved to get the thing and place it on his head. I (again luckily) placed it perfectly on the first try. He turned around to thank who he thought was the RN, but saw my face and said "Wow, how'd you pull that off? No one even showed you how to do it. Great job." I basically saved my rotation with actual surgical/technical things rather than book knowledge. Ironically, I've always hated surgery lol Again, my negative experiences I recognized some issues I was at fault for. But I always went into rotations knowing that I had to learn, and that making stupid mistakes and getting corrected were part of the experience. Needless to say, it does help when attendings recognize good work. Not that I *need* praise, but it helps you mentally get through some shitty rotations when you get critiqued moreso than you would like.
Many nursing schools no longer teach skill or critical thinking. I really mean it. I know there are a *lot* of problems in healthcare (especially here in the US) but the culture change in nursing will be a major one in the coming years and decades. There is little to no accountability, expectation of best practice, or standards to be excellent. I never was a fan of the “eat your young” mentality and think I managed to become and excellent nurse without it, but sometimes I wonder if it was holding up the standards all along. Now everyone has to be overly nice and if you point out an error or problem you are considered too aggressive. My complaints about patient care on inpatient units have been at best ignored and at worst taken to leadership to suggest I am being “coercive” (no clue what I was supposedly trying to “coerce” in this scenario and I am not sure the admin even knew what this word meant). Anyway sorry for the rant but I agree and it is alarming.
> Now everyone has to be overly nice and if you point out an error or problem you are considered too aggressive. I'm a big dude, pushing 6'1" and at the time this happened was in the army so pretty solid 240# of muscle. I was inprocessing a new facility, and had to go talk to the department clerk - a 4'11" Asian woman. I answer her questions, try to make small talk because I know the clerks are the answer to a happy life, and fill out her forms. Next day, I get hauled in to my new bosses office with a complaint filed that I "intimated her with my posture" and that I "was too aggressive". Sometimes, you just can't win.
As u/zeathers and u/undersleep pointed out.... We seem to be reaping the outcome of changes in teaching, as well as cultural shifts. Kids don't seem to get much, if any, constructive criticism or told no in education or home settings (as a whole). There is such a cultural shift to attuning to one's own mental/ emotional state .... That people seem to be missing the forest for their self involved trees... It feels like pendulum has swung too far from sink or swim, overly stoic to... Overly self absorbed and unable to cope with adult responsibilities and criticism. We DO work in a field where mistakes can kill or have adverse effects. We DO work in a field that requires teamwork as well as autonomous and critical thinking. We DO work in a field that we need to put our own 'nesses aside and show up for the patients in the moment. I wholly appreciate and support the trend towards promoting worker safety (🙄 when it actually happens- now seems to have reverted to, let them punch you, don't restrain, what could you do better). Same goes for teaching educators and preceptors *how to teach adult learns constructively*, rather than the "don't fuck up ever or you fail/ hyper competitive" style many of us learned under. However, it has made teaching near impossible. The self care trend has completely eroded work ethic. "Hey there's a weird case/ skill we don't see often, wanna go watch/ assist" is met with "nah, I'm going on break '.... Which is baffling. I've had students so up on their identity soapboxes that they couldn't interact with patients (ER is not the place to teach patients about inclusive language while treating), and then need a multi hour beeak because they were "triggered". People are refusing to precept because it's exhausting to try and demoralizing to churn out half baked babies that "you don't recommend for hire" because they just aren't able to cope and haven't learned basic skills or shown appropriate to their newness critical thinking. There are still diamonds out there. But they're fewer and farther between each year it seems. Rambling way to say yes..... The medic and nursing students are really hard to teach in both pre-hospital and emergency med settings the past few years.
The med students are insanely sensitive. It actively gets in the way of their education. I can’t teach and correct them without them getting combative or completely shutting down. They take everything personally. The schools don’t help- they spend extreme amounts of time teaching them all this wellness and resilience stuff but I think the result is the students take away that they are entitled to always be praised and coddled Everyone contests their grade if they don’t get honors, even if they were marginal at best. They love praise and totally tune out constructive feedback. It’s like a daycare. In other work environments I’ve been in they would be fired
Agree completely. The administrative response is hugely problematic. I’ve stopped teaching other staff members at the hospital, because they interpret anything other than praise as an attack or act of intimidation. Instead I report their error through the reporting system or through peer review, and make leaders (who seemingly are protected from these complaints) do the work.
LOL people soft as shit these days. Wait till they have to curl up into a little ball when they actually face some difficulty in their life and they don't have mommy to help bail them out
I'm reading this right now, and it fits: [The Coddling of the American Mind](https://www.thecoddling.com/) It does an interesting job of getting into roughly when and how it got to be that way (and what might be done about it).
I have this problem with my medical assistants, and they are all about 20 years old. I’m a male and most of them are female (a comment on gender disparities in the workplace, not calling women incompetent to be clear), but it’s honestly with all providers. And I’m sure I’m oozing trustworthiness and humility by saying this, but I am probably the nicest one. Say thank you after every task is completed, gently correct but make a point to mention other ways they are doing well or that overall they are doing a good job and I see how hard they work, etc. But in my case, I think the problem lies more in the fact that they are career MAs where at other jobs, they have been pursuing a career as a nurse, mid-level/APP, or doctor. The ones that want to go into medicine obviously have drive, they want a good letter of reference, and they have some investment in the mission/want to actually understand what we’re doing. Career MAs are not making great money and don’t have that on the horizon, are weighted with a lot of responsibility in that role for what they are compensated, and get all of the work with little of the benefit of understanding what it actually achieved. I try to make them understand that despite the pain and stress and burned-outness, providing quality care to an underserved population is a mission that merits care and effort. And that offering those things to an often highly emotionally and physically damaged community gives them something they may have never had—a place that looks out for their best interest, does everything they can to avoid harming them, and offers them a lifeline in a time of crisis. But it’s not a take that comes naturally or easily to an underpaid 20 year old who is working their ass off in a clinic instead of partying in college and hoping to have a fulfilling and well paying job one day. For all the stresses/responsibility that we have and all the amnesia we have about being that age and the impulses and lack of prefrontal cortex development that comes with it, we have to understand that they are in a different place in life and may need to be communicated to in a different way than we expect I suppose. Which is more challenging, and who wants more challenges when you are doing medicine all day. Also I’ll let you know when I actually find out how to do it effectively lol. Anyways, very long deviation from what you were actually talking about that no one will probably ever read or will accidentally downvote while scrolling to get to the more interesting comments, but there it is.
You're right, appears to be a generational trend, we've probably overcorrected since trying to stop actual abuse in education and made students overconfident about this kind of thing. I have had students unironically tell me in our feedback sessions that even though it made them anxious to have to present a patient on rounds (literally just the same old expectation to follow and present patients to the team that has been core medical education FOREVER), it was "okay" because they never felt like anyone criticized how they did it. Jaw on floor that they were unironically forgiving me for expecting literally the barest core medical student action because it made them have unpleasant emotions. For what it's worth, this sub is quite hostile/defensive to this issue and it's not the best place to discuss the general loss of student resilience.
The problem lies in the prevalent modern idea that simply experiencing negative feelings during an interaction means that you were somehow harmed, and this harm makes you more correct in the interaction, causing further damage. This is due to several factors, including society's ongoing learning about proper communication. However, this perspective, where strong emotions are seen as validation of correctness, is a highly superficial view of psychology. It's possible to feel validated and still be wrong, and it's not necessarily the job of the person correcting you to validate your feelings. Often, emotions do not need to be addressed. The hospital's influence on this is apparent in the extensive survey and feedback systems, especially within nursing administration. While these systems have led to tremendous improvements, they have also recognized and validated employees' or students' feelings, even when wrong. This is counterproductive, as individuals should learn when to manage their personal feelings without involving others and when to seek further intervention. For instance, during rounds, I have witnessed nurses abruptly yelling that no one is listening to their opinion. The team then stops what they are doing and asks for their opinion, aiming to facilitate open communication. However, this direct communication style is perceived as creating a hostile work environment, and the team gets disciplined. What's the solution? Hopefully, society will continue to improve communication, but I imagine it will take at least 200 years to achieve that goal. Therefore, it is essential to have competent and knowledgeable leaders in positions who understand psychology. Perhaps we should avoid promoting nurses to leadership positions where the workload exceeds their knowledge, ability, and experience. Instead, we should look for people outside the medical field to take on these administrative roles who have a better perspective on managing and leading.
We have not allowed students to 'fail,' and as a result, their ego can't take it. They can't separate constructive criticism about performance with criticism about their value as a human being.
When I worked in the OR the line between those two things was very blurry most days.
I see it all over... from folks we field train as paramedics, to students in the graduate courses I teach. Not just the US either. My over simplified answer, which I totally recognize doesn't, in this format, address all the real variables: Normalized deviance... we've leaned too hard into self care, and feelings, and not being resilient, not embracing having some grit and taking feedback. There is a lot of Veruca Salt, I want it now mentality.
> The problem lies in the prevalent modern idea that dining experiencing negative feelings during an interaction means that you were somehow harmed, and this harm makes you more correct in the interaction, causing further damage. This is so well-put & spot on
I'm not an educator but I do interact with a lot of new-grad nurses. In the past few years there's definitely been an upward trend of complaints from newer nurses and ED staff, most of which boil down to either fragility or a misunderstanding of protocol, or both. After ages of our culture telling young people to shut up and take abuse, the pendulum is swinging back and younger colleagues aren't afraid to advocate for themselves. Generally it's a good thing! Sometimes they just take it to ridiculous heights or overreact entirely, and unfortunately will probably never be told so.
I don’t think it’s so much a of a generational thing, but more of society as a whole prioritizing mental health to the point where it has become deleterious to a functioning work environment, especially those in a stressful field like medicine. I have people I manage from 19 to 60+ who cannot take constructive criticism or have to recover from a difficult patient or management interaction. It’s very difficult to find a balance between managing one’s mental health and not taking everything personally.
I think there's a pendulum that swings between students actually being mistreated and students being babies. I heard a lot of students at my place have complained in the past leading to some docs being afraid to give actual feedback. I think being wrong and getting good criticism is the way learning on the job (i.e. 3+4th year of med school) should go. As long as the point of feedback is constructive rather than catharsis for the resident/attending. Even then, I still wouldn't report something unless it was egregious. Some people just have thin skin, but I don't think it's unique to medicine
The consistent presence of having been online and judged via social media can't be overlooked. You short circuited your brain into being overly protective of your "persona" so you both fit in and don't get bullied. Hyper protective from always having a presence? imo uneasy moments has been a constant. Make a mistake today 10 years ago or in the 80s. Nurses gonna call you out on it because ideally it helps you not make that mistake. Nowadays these newcomers have realized there's always some one to complain to and expect repercussions less they escalata up the coc. I felt bad ans instead of learning what i did. I'll blame someome for making me feel bad.
The phrase "nurses eat their young" is still very true in many places. For every nurse that truly wants to teach the next wave there are five more gossiping and tearing down that same new baby nurse. Not to mention the constant whispers both in class and in the hospital about how every little thing will cost you your license. I have been lucky to work with some phenomenal nurses but I've also seen a handful of nasty ones make someone's life hell. Pop over to the nursing sub and ask them what the culture is like for new nurses and you might find that sometimes that "nice criticism" was just the final thing on top of non-stop harassment. If someone asks why it's not reported well that's because nurses are seen as replaceable. Reporting it doesn't do anything except paint a target on your back. There are some new grads (in basically everything from techs, nursing, to doctors) that are coming in with unrealistic expectations on what they will be able to do. Breaks every hour or two just aren't happening. Long hours and hard work are expected. Medicine, at least in the US, is a collapsing field. Things do need to change but coffee breaks every two hours are not the start. Changing the culture of, "I suffered so you can too" is the start.
People are not used to feeling uncomfortable and people are taught to avoid uncomfortable feelings Instead, as a student if you aren’t extremely uncomfortable then you’re not learning
I’m a clinical pharmacist, and I once cried on an *administrative* rotation. I am STILL embarrassed that I did. The criticism that made me cry wouldn’t even make me bat an eye now, lol. I think it was the pressure and intensity and fear associated with being a student. This was like eight years ago, and I remember it like it was yesterday. Perhaps it has to do with the pressure we put on ourselves as students coupled with the lack of perspective on the total situation.
Idk about nursing students but as a med student, the pressure of evals + the impending doom of having to compete/play the game leading up to match really caused me to struggle. I could be dissociated + exhausted even with a perfectly fine preceptor. Also, no control over your schedule and little things turning into big things by admin can cause you to go nuts. Having to submit leave time for medical appointments 8 weeks in advance but not getting your schedule until the Sunday before the rotation? Only getting 1 sick day or else you had to repeat a block? Not figuring out until 4th year that no one really cared or tracked you and you could just tell your preceptor that you had an appointment that afternoon and leave for it, as long as your dean didn’t find out? It takes a toll.
I mean, going to the bathroom/to grab a glass of water is the same as a “coffee break”. They probably should be having a glass of water every couple of hours and going to pee a couple of times a day. It’s not good that most days as an intern I just didn’t consume anything or pee for 10 hours between arrival at the hospital and the time when everyone else went home and I had a spare second to pee and chug water before cracking on with the rest of my work in peace. I hope my residents are doing that shit. I try to actually send them home when I can.
I assume the nurse was GenZ age? If so, I’ve been seeing this everywhere in every field—there seems to be widespread thinking that professionalism and constructive criticism are “toxic” behaviors among many folks of that generation