Why Do I Have To Do So Much Scut Work?

Geoffrey A. Talmon, MD

Disclosures

August 09, 2010

Question:

Why is the medical student always the one who is told to fetch the x-ray, find the consult, or draw the blood? What am I supposed to be learning from all these menial tasks?

Response from Geoffrey A. Talmon, MD
Assistant Professor, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska

As a bright-eyed, bushy-tailed, brand-new third-year medical student, you could not have found someone more excited about beginning their transplant surgery clerkship than me. The service was notorious for rounding with large multidisciplinary teams, trips for organ procurement, and ample time in the operating room. I had visions of being involved in grand, heroic procedures on patients with complicated medical problems that would give me the opportunity to finally use all of the information that I had learned during my first 2 years of training. Needless to say, after 2 weeks of walking films all over the hospital, holding a retractor, and chasing down laboratory results, my enthusiasm had somewhat faded. I remember one of my supervising surgery residents making some comment about fecal material flowing downhill -- I did not find the remark quite as entertaining as she did.

It may seem that scut work is the core of a medical student's responsibilities on some clinical services, often to the point of frustration. After fighting to get into medical school, sitting through difficult classes, and passing what seemed to be endless examinations, your reward is what one of my friends once called "the equivalent of bedpan duty" -- a series of menial or monotonous tasks for the lowly peon. (A side note: the word scut is thought to be derived from a term implying contempt for a person or suggesting their lack of worth). At some point, nearly every medical student has probably asked themselves if there was a way to think about scut work that would make it a little more palatable.

One thing that med students must understand from the outset is that some "menial" work is likely unavoidable, especially on busy inpatient services. When censuses are full at a teaching hospital, a lot has to happen during day-to-day patient care, and delegation of tasks among all members of the healthcare team (including students) is a necessity. This parsing of duties has become even more important with the constraints imposed by resident work-hour guidelines. In addition, you as a medical student just do not always have the training, experience, or certification to do some of the things that need to be done. Often, the assignment of scut-type work to the student gives those above you in the pecking order more time to do these other tasks. The best way to think about it is that you are still a part of the team helping to treat a patient, even if that "help" seems tedious.

It is important to keep the intent of your supervisors in mind. Although it may occasionally seem like it, the attending physician or resident is not typically trying to punish you with scut work. In many cases, the point is to keep you involved in the care process by giving you something to do -- in other words, "active learning." Believe it or not, people remember what it was like to be in your shoes, and some believe that nothing is more useless to a student than to be standing around doing nothing. Also, watching you efficiently and willingly do simple tasks is one way in which the team develops trust in your skills and work ethic. Which medical student do you think a surgery attending would be more likely to let scrub in on his or her liver transplant, the one who was happy to help out on rounds or the one who grumbled when something was asked of him or her?

Even the most boring job can teach you something. Remember that simple tasks such as searching through medical records gives you experience navigating hospital information systems and access to consultants' notes. Acting as a messenger (such as shuttling radiographic films around) affords an opportunity to interact with other specialties and allied health personnel, sometimes allowing you to ask them questions about your patient. Your 50th blood draw may be a chance to review regional anatomy, go over the complications of phlebotomy, or think about which preanalytic variables might affect your patient's lab values. An internal medicine attending once told me that if I did not find some educational tidbit in every experience that I had as a medical student, it was automatically worthless to me. "Scut work" was no exception. Sometimes it may take a little extra effort, but dull jobs are often much easier to stomach if a lesson can be gleaned from them.

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