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Composition of a Hospital Team

by Mohammad Hajighasemi-Ossareh, MD, MBA
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    00:01 Welcome to the third year of medical school lecture series.

    00:04 In today?s lecture, we?re gonna discuss the composition of the hospital team and where the third year medical student fits in.

    00:11 We?re gonna discuss the role of each member of the team.

    00:14 What are their responsibilities and expectations of a third year medical student? So let?s start with the academic hospital team.

    00:22 Now, you?re a third year medical student. Congratulations.

    00:25 You?re out of the classroom and you?re into the hospital.

    00:28 The first thing you need to know though is the environment in which you?re going to be working in and what your role is in this environment, the environment of course being the hospital.

    00:37 The traditional hospital team is an academic hospital.

    00:41 It?s composed of a hierarchy and let?s go through it and we?ll go from the top to bottom.

    00:46 The top of the hierarchy, the top person, is what?s called the attending physician.

    00:51 Below the attending we have the fellow.

    00:53 Below the fellow we have what?s called the senior resident or resident also as it?s called and below the resident we have what?s called an intern.

    01:01 Below the intern we have the fourth year medical student and below the fourth year we have the third year medical student.

    01:09 At first glance is you kinda go through this hierarchy, you?ll notice the third year medical student is actually at the bottom of this list.

    01:16 Don?t be upset though.

    01:18 Starting from the bottom and working your way up over time really is the best way to learn and it actually works to your advantage and we?ll discuss this shortly.

    01:26 Before we discuss all these benefits and the responsibilities of being each person of the team, let?s first discuss the role of each member of the team, so you?ll know what the attending does, what the fellow does.

    01:37 So let?s go through the role of each member of the hospital team and we?ll start with the academic attending or what?s also called the attending physician.

    01:46 Now, the attending is the big kahuna, the boss, the all in power authority, AKA a god in the hospital.

    01:53 The attending is a person who?s the most senior member of the team, usually an older physician.

    01:58 This is someone who enjoys teaching residents and medical students.

    02:02 This is why they chose the academic medicine over private.

    02:05 An attending physician will show up every day for what we call attending rounds.

    02:11 Attending rounds usually happen later in the morning and just walk into the hospital space that we have for work and the entire team will surround the attending and each person of this team will present their patients to the attending and attending will listen.

    02:25 He or she will listen to all the presentation.

    02:28 The attending will ask questions, well, to inquire regarding the patients but also to test the knowledge of each medical student and resident.

    02:37 And what the attending will also do after hearing presentations or, you know, kind of asking questions and getting their response will actually give reading assignments or ask you to give a presentation to be completed the following day on a specific topic.

    02:51 Now, what?s the purpose of an attending physician? Do they just come in to make themselves feel all powerful? No, they?re an extremely important member of the team, if not the most important, and that?s because the purpose of the attending physician is to supervise the medical care of the entire team.

    03:09 They have to make sure the team?s giving good care to the patients.

    03:12 Also, another critical point and more important for you is that the attending is there to help grow and teach the medical team.

    03:20 They will ask the medical student questions, they will ask the resident questions, they?ll give lectures, they?ll give talks, they?re there to grow and nurture the team so you really do have to treat your attendings with the utmost respect.

    03:32 They do have the most years of wisdom and experience under their belts.

    03:36 Now, the next person in this hierarchy is called the fellow.

    03:40 Now, the fellow is a person, we call them fellows, who have completed their residency training and they?re obtaining additional supervised training in what we call a fellowship program.

    03:51 So when a fellow graduates they?ll become an attending.

    03:54 The role of the fellow is to supervise the team and teach the team when the attending is not around.

    04:00 Essentially, during the short period of time every day when the attending is there the attending is in charge but for the rest of the day the fellow kind of access or fill in attending.

    04:10 And given when the attending is not around, the fellow does have the responsibility of caring for the entire team and making sure proper medical care is given to all the patients the rest of the day.

    04:21 The fellow is usually a younger person having just completed residency and they have more of a connection to resident and medical student life.

    04:30 The benefit here is that the fellow is much more approachable than the attending and they really do have the potential to teach you in extremely large amount of knowledge.

    04:39 Make friends with the fellow and I?ll give you a personal side note.

    04:43 When I was on my critical care rotation in medicine, I had an amazing fellow on my team.

    04:48 He was young, he was one of us, he was just a couple of years out of residency, he was fun, he was approachable, and he really took the time to teach the residents and the medical students much more than the attending did and that?s simply because the fellow has to be in the hospital all day and they have more of a managerial position so they have more time to teach and grow the team.

    05:08 So really make friends with the fellow.

    05:10 They?re an extremely valuable asset to you.

    05:12 Now, below the fellow we have what?s called the senior resident also called a resident at some hospitals.

    05:19 Now, the senior resident or resident is the oldest resident on service.

    05:24 The resident, not more senior one, and the fellow work close together to run the entire team.

    05:29 Now, the resident is in charge of all the work and then the fellow really just supervises the senior resident and teaches him or her.

    05:38 What the fellow really does to the senior resident is kinda try to pull the senior resident up to attending a fellow status and kinda supervise while the resident practices managing the entire team.

    05:49 Now, the workload is very large for the senior resident.

    05:52 He or she really is the backbone of the team, so be very nice to your senior resident.

    05:58 They are tired, they are the most busy out of everyone and they have the most responsibility of managing the team.

    06:04 Now, below the residents we have what?s called an intern.

    06:08 Now, this is a very common phrase you?ll hear probably in TV show if you?re not familiar with it now.

    06:12 The first year of residency training is called an intern.

    06:16 So we will say someone is completing an internship.

    06:19 Now, the intern, to put in politely or maybe not so polite, is essentially the mule or the horse of the team and I can say that ?cause I was an intern and you know sometimes you do feel like that in those days.

    06:30 The intern is the workhorse.

    06:33 It?s the person who writes all the notes for each patient on the team and co-admits every single patient coming on to the service with the senior resident.

    06:42 The intern has really quite a challenging task. A learning, number one, had a transition from being a medical student to a resident or an intern first year of residency.

    06:52 And they?re also responsible for writing all the notes, putting in all the orders for the new admissions and running the logistics of the entire team.

    07:01 What the intern does is work closely with medical students, to help prepare the medical students to prepare their patients and also to help and train the medical students when admitting patients.

    07:11 The intern also works one level up with the senior for continuous guidance and growth.

    07:17 Now, below the intern we have the fourth year medical student.

    07:21 Now the fourth year student will be on a team for two reasons.

    07:25 They?re either completing what we call a sub-internship or they are completing required rotations in order to graduate.

    07:33 Now in future lectures we?ll go through the details of what is a sub-internship.

    07:37 Now, fourth year medical students usually work directly with the senior resident.

    07:42 Alright, and this is kind of interesting ?cause that then allows the intern to more work directly with the third year medical student and this is a unique oddity of the fourth year.

    07:50 The interns work with the seniors but the interns also work with the third year medical students, but a fourth year medical student bypasses the intern essentially and works directly with the senior in that way the senior can get the fourth year medical student ready for intern year faster and just focus on them, that?s kind of why we have this weird quirk.

    08:10 Now, the fourth year medical student is essentially your friend when you are a third year medical student.

    08:17 They will teach you the tricks of the trade and how to survive and thrive during your third year.

    08:23 Watch what the fourth year medical student does very closely.

    08:26 If you have a good one, and hopefully you?ll do, your goal is to be just like them as a third year medical student.

    08:33 They essentially are your most immediate role model.

    08:36 Now, last in our hierarchy below the fourth year medical student is the third year medical student.

    08:41 We are at the bottom of the totem pole and that?s okay.

    08:43 Now, the third year medical student is the most novice member of the team and usually the most confused member of the team as well.

    08:51 They?re responsible for co-carrying patients with the intern what that means is when the interns has their sub-set of patients, the third year medical students will seed some of those patients with the intern together.

    09:03 They share the patient.

    09:05 What the third year medical student would do for the patients they carry is present them to the attending and what they?re required to do is do most of the reading and the presentations for the team. That means that during rounds when the attending is listening and asking questions back during the rounds and they say hey you know what, you third year medical student, why don?t you give us a presentation on something tomorrow and here?s a topic for you.

    09:27 That?s what the grant of what the third year student does in addition to clinical care.

    09:31 Now given that the third year medical student is the most novice member of the team, the goal of the medical team is to make the third year medical student have the most clinical exposure and also learn the basics of clinical practice.

    09:45 That?s the responsibility more senior people in the team feel that we need to get this third year medical student exposed.

    09:52 They came from the classroom into the hospital.

    09:54 Let?s get them growing up fast.

    09:56 So now let?s discuss the expectations and the responsibilities for being a third year medical student.

    10:02 Now, as a third year medical student you really do have a lot to learn and at times it can feel daunting since you will notice the other members of your medical team have more experience in a much larger knowledge based than you.

    10:15 You know, here?s what you should focus on as a third year medical student and not get distracted.

    10:20 Have a focus of what?s important for you to accomplish and you?ll do great.

    10:25 The most important thing if you weren?t listening, turn off your headphones now, get a piece of paper, write this down, tattoo it on your arm. I don?t care.

    10:35 You need to get this point.

    10:36 As a third year medical student, the most important thing you can do is be active and be engaged.

    10:43 You can be kind of dumb and you get away with it if you?re interested in trying to learn because at least you have the energy to soak up with people wanna teach you.

    10:53 That?s the most important trait we want as a third year medical student.

    10:57 When I see my third year if they?re energetic, active, and engaged and want to learn, I could ask for nothing more ?cause I know I can train them into something good.

    11:07 They were smart enough to get into med school.

    11:09 They made it through the first two years.

    11:10 They took step one. They?re gonna be fine.

    11:12 But if they?re passive and disengaged, that kid?s gonna be impossible to train.

    11:17 But if you?re active and engaged you?re already loved by your team.

    11:20 So, don?t sit around on the hospital and wait for someone to tell you to do something.

    11:26 When you see an opportunity to see a patient or help out the team, politely ask your team to help.

    11:32 Be like, hey guys can I go see that patient with you? Is there anything I can do? Be active, be engaged.

    11:37 The other members of your team will then become impressed by your enthusiasm and over time they?ll say, you know what this kid?s pretty interested.

    11:45 Let?s give him more responsibility and let?s go out of our way to teach the third year medical student more.

    11:51 The last thing you ever wanna do is sit in the corner and be reading.

    11:55 You want to be an active member of the team and you wanna help get the work done.

    12:00 You don?t want, you know, you don?t wanna be sitting and reading in the corner.

    12:03 You can always read at home.

    12:05 And that?s an important point to understand.

    12:07 When you?re in the hospital, work is being done.

    12:10 In the first two years of medical school you?re always reading and studying.

    12:14 That?s not necessarily work.

    12:16 But when you?re in the hospital you?re seeing patients, you?re admitting them, you?re giving them care.

    12:20 This is, you know, a work lifestyle.

    12:22 So the hospital team has work they have to get done every day.

    12:26 Now if you come on as a new member of the team, it can get that work done even better.

    12:31 So try to think of the team as, oh this is where people work now and I?m a working member of the team. I need to contribute.

    12:38 I?m not here to just sit and learn like in a classroom setting.

    12:41 Right, so in addition to being active as the most important trait, here?s other one you?re supposed to focus on as a third year student.

    12:49 You should know your patient or patients depending on how many you have better than anyone else.

    12:56 Now, you will hear this adage many times throughout your third year or career and everyone says this concept, know your patient better than everyone else, and they?re right. The third year student is caring the least amount of patients on the team and thus, you should know more about your patient than anyone else.

    13:14 You should know their most recent lab values, when they?re scheduled for a procedure.

    13:18 You should know all the details of your patient so that when you?re attending asks you a question the detail that you know shows your dedication to the patient.

    13:27 Believe it or not the residents know the majority of the details of all of their patients.

    13:33 So on average, a third year student is caring probably between 1 to 5 patients and the resident is caring the entire service which can be up to 15 to 20 patients and they know all those details so you should absolutely know all the details of your patient if you?re only caring a handful or so.

    13:50 Thus, it?s absolutely expected that you as a third year student know the details of your few patients.

    13:58 Not knowing the details will show that maybe you?re not as interested or maybe you?re not paying attention because though those few patients maybe difficult for you to know all the details for is something that you need to practice and it?s an expectation at this point.

    14:13 The next skill you need to master or an expectation of you at least as a third year student is presenting well.

    14:20 Now, presenting your patient to an attending or even to a resident if they want a presentation for practice, this is your time to showcase your hardwork to showcase and your intelligence during presentations.

    14:32 Usually you present during morning rounds.

    14:34 What you should do before morning attending rounds is go over the presentation with the intern on your service in the morning.

    14:43 Be ready to have to answer potential questions that?ll be asked by the attending.

    14:47 Bounce them off the intern, present the patient, see what questions the intern asks you.

    14:52 If they don?t ask you many questions, ask them.

    14:54 What do you think the attending could ask me? Then, read as much as you can about your patient?s problems.

    15:00 There are illnesses.

    15:01 Whatever?s keeping them in the hospital or brought them to the hospital, try to read about that topic as much as you can because frankly it?s probably gonna be the topics we?re gonna ask questions about.

    15:11 And then work with your team, in particular your interns, it sets your first point of contact on how to take your presentation, how to organize it clearly and then how to present it in a confident and organized manner.

    15:26 Your intern is skilled at representing. They do it all the time.

    15:30 They?re the backbone of the team for this so that?s the best person to ask, hey how can I present stronger? How can I be more organize? And the better you present, the smarter you look and the more you can showcase your skills.

    15:42 The next trait or expectation you can have really is to work one level higher than yourself.

    15:49 Now, this is something we?re gonna talk about a lot in this lecture series.

    15:53 Always try to be one level higher than your current position.

    15:57 So your goal as a third year medical student and really through out your entire medical career is to work one level higher than yourself.

    16:05 So as a third year medical student, you should act like and work like a fourth year medical student and so on.

    16:12 A fourth year should be like an intern.

    16:14 An intern should be like a resident, et cetera.

    16:17 So watch the people above you.

    16:19 See how they talk to patients, how they present the patients to the attending, how they look things up, how they, you know, contact or utilize their resources.

    16:28 Talk to them very openly. Ask them questions.

    16:30 Get the inside details on how they do things and then do it yourself.

    16:35 Elevate yourself to the next level.

    16:38 That?s how you really stand out and that?s also how you push yourself to grow to the next level of your career.

    16:44 Now, we?ll talk about details about how to be an amazing third year student in our next lecture.

    16:50 So let?s summarize what we discussed today.

    16:53 We discussed the importance of understanding the hierarchy and the roles of each medical team member starting from the attending physician down to the third year medical student.

    17:04 We learned how to utilize each member of the team appropriately and then we discussed the responsibilities of a third year medical student.

    17:12 Now, always try to grow and work one level higher than yourself in your current training level and for the rest of your career.

    17:20 Thank you.


    About the Lecture

    The lecture Composition of a Hospital Team by Mohammad Hajighasemi-Ossareh, MD, MBA is from the course Med School Year 3. It contains the following chapters:

    • How does a Hospital Team Function
    • The Academic Hospital Team
    • Roles of Each Member of the Team
    • Expectations and Responsibilities for the MS3
    • Lecture Summary

    Author of lecture Composition of a Hospital Team

     Mohammad Hajighasemi-Ossareh, MD, MBA

    Mohammad Hajighasemi-Ossareh, MD, MBA


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    I would not mind this kind of lecture being mandatory for the end of 2nd year
    By Franklin N. on 28. April 2018 for Composition of a Hospital Team

    I can't believe I have completed 2 years of medical school without anyone explicitly discussing any of this information to my class