Except for daily rounds with the residents, conferences, clinic (which most attendings have 3+ days per week), attending rounds, in-patient/ED consults, trauma activations....
Our surgery rounds were lighning fast, no real discussion of anything and in any event nothing really to discuss since they were all pots op checks. The only questions were if they had a fever and if they passed gas. MS3 surgery students didn't do much clinic at my school (wish they did), and I don't know any program where they participate in trauma (even interns are generally regulated to checking distal pulses and sphincter tone). At conferences no one talks at those but the presenter. In-patient/ED consults are the best example of where a medical student CAN shine, by basically doing the full H&P and presenting it to the resident. However on surgery the opportunity was rarely provided. Med students can take over an hour to do an H&P, and well over 20 minutes to present it, and then you need to do it over anyway because you can't trust it. Even on a Pediatrics or IM service its agonizing for the residents, and we sometimes bypass them on the worst/busiest nights. On a faster paced service like surgery there generally wasn't time to do it at all. When the ED called the residents went and the students either stayed with the team, or if they went they basically shadowed.
In my program, if students are in the OR constantly, it's either their choice or their fault
This is wierd. Not that your students have an OR light Surgery rotation, I'm sure those exist somewhere, but that you're giving medical students a choice about what they're doing. Medical students generally don't get a choice about where they go, on any rotation. You're told to go to the OR, told to go see consults, assigned patients, and sent home. That's not a problem either, actually a big part of the reason for giving medical students so many orders is courtesy: with everyone struggling to look enthusiastic giving someone an option is just a crueler way of giving them an order. For anyone aspiring to honor 'would you like do this 8 hour case' is just a way to make them blame themselves for the thing you're doing to them.
No. That's a great way to graduate with no experience ever starting an IV, placing a Foley, intubating a patient, suturing up a laceration or surgical incision, do a bronchoscopy, let alone something more complex like placing a central line or a chest tube.
This in my opinion isn't appropriate MS3 learning, and for that matter I don't think these are skills that every civilian MS3/resident should learn at all. Every procedure has a serious error rate when you start doing it, and even when those errors aren't fatal they all at least suck/hurt: IVs infiltrate, Foleys hurt, intubations can chip teeth, shody sutures cause cosmesis, and I won't even get into bronchs and chest tubes. No one should subject patient's to the risk invovled with learning a procedure unless they know they will, later in their career, actually DO that procedure. No civilian needs to do foleys. Only a few need to understand suturing and intubations. Only anesthesiologists need to understand IVs. Everything else is even more specialty specific.
Learning on surgery, to me, means learning the differential for a patient, to know when you can let the patient be, when you need run a test, and when you need to consult surgery immediately. That kind of learning can be done effectively while you hang back and stay quiet outside of rounds and pimping.
What is "ridiculous" scut work compared to regular scut work compared to "just learning clinical medicine"?
Skills that require no learning = ridiculous scut work. Putting papers into three ring binders, calling patients to tell them appoitment times, faxing things, etc.
Learning clinical medicine means practicing the skills that you need medical school to learn. Writing coherent notes, taking H&Ps, reading images, and calling consults. The things you couldn't do as an MS3, but can do now. If somethings so basic that an MS3 can do it right, and it helps the team, then honestly its a pretty good sign they shouldn't be doing it at all
An MD is not an "academic degree." It is a professional degree, in which you are learning a profession. If you are unprepared to be an intern on July 1st, then you are behind the 8-ball and will remain that way until you put in the extra work to catch up. In the meantime, your attendings (in your chosen specialty, no less) will be forming opinions about how you are less efficient, less skilled, and don't seem to know what's going on as much as your peers do.
That's kind of the point, though. The scut work nonsense that you do to get the grade to get the residency doesn't prepare you in any way for the residency. Since I started Intern year I have never been called upon to put something in a three ring binder. Meanwhile the book learning, some of which I didn't do because I was trapped in an OR, is something that I desperately need to know. Being a good medical student isn't genearlly the best preparation for being a good resident.
