Dear Surgery Residents: go %&$# yourselves. Sincerely, MS3

[Perrotfish]

Um.... Residents still have to study. In fact, I read more now, study more now than I did as a student. You just do it faster, smarter. Remember, we have boards to take at the end of residency, yearly in service exams, and still have to take step 3 during the first few years. And we have to read on our patients.

When medical students say they need to study, they mean they need to do hundreds upon hundreds of practice questions to get ready for the shelves. Resident don't do that unless they within 3 months of taking boards. And when they're at that point in residency they always weasel out of work because they have to study.

All I do as a resident is read on patients. Which medical students also need to do.

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[Buckeye(OH)]

when students go home, they still have to study

and also, no one cares "how it works for you". im guessing most of the people who work with you hate your guts and talk shi* behind your back

Right. Good luck to you as well!

 

[ShyRem]

*sigh*

 

[JourneyAgent]

*sigh*

I think it's possible that IM has an abnormally high academic knowledge burden that would necessitate your level of reading/studying in residency. Generalists in general, might face this obstacle. I wonder if its universal though?

 

[ArcGurren]

Ill tell you how it works for me as someone half way through PGY 4 year. It is very, very, very easy to get on my bad side.

The only thing you have to do to stay on my good side is to do your job, and do it well. To many medical students roll through my service (ortho) rolling their eyes, and whining about the hours.

Suck it up. Its for a month, or 6 weeks, or whatever. Do yourself a favor, don't ever to complain to a resident about how hard you have to work or how much you have to do. I promise you, that resident has way more on his/her plate than you do.

So your personality sucks, and you've forgotten what it was like to be a medical student on a service that you might not enjoy. Good to know.

I don't know where some residents get off excusing their crappy anger/personality dysfunction upon med students. I had an ortho senior resident who had the same attitude towards students as you do, and he was universally hated by both the students AND the other residents.

 

[45408]

its not the same. you dont have the same strict deadlines to read. its all more flexible. we have 4-6 weeks to learn a large volume of info, and then take a test that is essentially a competition between classmates.

Yes, I do. Don't act like you know what other people have to do. We have regular didactic conferences with assigned reading, and we also have pretty extensive conferences on M&M, case-based discussions (during which you had better know everything about your patient and what you did to them), etc.

When medical students say they need to study, they mean they need to do hundreds upon hundreds of practice questions to get ready for the shelves. Resident don't do that unless they within 3 months of taking boards. And when they're at that point in residency they always weasel out of work because they have to study.

I didn't do hundreds of questions for anything but my medicine shelf, and I did better than just squeaking by. I also have to take the ABSITE every year, and I've done hundreds of questions for that already this month. Weaseling out of work isn't really an option.

 

[JasonE]

Yes, I do. Don't act like you know what other people have to do. We have regular didactic conferences with assigned reading, and we also have pretty extensive conferences on M&M, case-based discussions (during which you had better know everything about your patient and what you did to them), etc.


I didn't do hundreds of questions for anything but my medicine shelf, and I did better than just squeaking by. I also have to take the ABSITE every year, and I've done hundreds of questions for that already this month. Weaseling out of work isn't really an option.

chill out. no one said you didnt have to read. every physician will for the rest of their life.

its just different when you have to take a test every month or two that counts for a grade. its a lot more pressure and it drives you to study way more than you normally would because letting little facts slip through the cracks might mean getting questions wrong.

 

[duckie99]

chill out. no one said you didnt have to read. every physician will for the rest of their life.

its just different when you have to take a test every month or two that counts for a grade. its a lot more pressure and it drives you to study way more than you normally would because letting little facts slip through the cracks might mean getting questions wrong.

surgery residents have to take standardized tests every year... that they have to study for similar to board exams. In residency you have to study all the time and know your stuff in order to be allowed to move on. You just can't go in and learn on the job alone while doing nothing else. They may not have structured exams like students every month but it's not like they just go home at the end of the day and can do whatever they want...

 

[45408]

its just different when you have to take a test every month or two that counts for a grade. its a lot more pressure and it drives you to study way more than you normally would because letting little facts slip through the cracks might mean getting questions wrong.

It's also different when you're actually making decisions that affect patient care, and your attendings trust you at night to do the right thing (and not have to call them every 10 minutes). Doing mediocre on the psychiatry shelf probably means little/nothing to most people going into any other specialty, but once you're in your chosen specialty, it is all relevant to you. It will all potentially be on your boards.

I study/read a very similar amount now as when I was a student, and now I have kids too. I had as much/more free time as a student on my surgery rotation than I do as a resident on a surgery rotation.

 

[SouthernSurgeon]

chill out. no one said you didnt have to read. every physician will for the rest of their life.

its just different when you have to take a test every month or two that counts for a grade. its a lot more pressure and it drives you to study way more than you normally would because letting little facts slip through the cracks might mean getting questions wrong.

Out of two groups of people (M3s and residents)...only one of these groups has done both jobs.

When EVERY resident is telling you that intern year and residency has more time pressure, workload, and responsibilities...you should consider listening.

 

[JasonE]

Out of two groups of people (M3s and residents)...only one of these groups has done both jobs.

When EVERY resident is telling you that intern year and residency has more time pressure, workload, and responsibilities...you should consider listening.

no one said residency has LESS pressire, workload, responsibilities. you're making incorrect assumptions instead of reading what i actually wrote. I specifically mentioned study time as it relates to exams.

and EVERY resident isnt telling me this. most residents and even attendings say residency is way better than med school, even though its more work. of course its more work. the higher you go up, the more you have to do.

anways this is now off topic. im out

 

[Bones DO]

I don't think I even have a bad side. You can be the rudest person ever, and I'll still have a big cheesy grin on me, and suffocating them with kindness
If it's that easy to get on a bad side, maybe it's best to find stress relieving techniques...cause it shouldn't be considered easy to get on a bad side whatsoever. Being moody is not good for anyone!

This is my philosophy on surgery and every other rotation. On the occasion that I encounter someone in a sour mood, I just let it roll off my shoulders...surgery residents and even attendings have pleanty of reason to be stressed out. That said, all the residents and attending’s I've encountered thus far have been eager to teach. Seeing what my poor attending's life is like is the only thing that has turned me off to the specialty. I can see how the culture of surgery can be prone to attracting certain unsavory personalities...luckily that hasn't been my experience.

 

[Perrotfish]

Out of two groups of people (M3s and residents)...only one of these groups has done both jobs.

When EVERY resident is telling you that intern year and residency has more time pressure, workload, and responsibilities...you should consider listening.

This resident is disagreeing.

 

[KnuxNole]

just curious why?

MS3s have little responsibility, pressure, and work much less hours compared to an intern/resident. Shelf exams aren't too "difficult" to do decent on if you spend an hour/two a day prepping for them(reading on patients/reading a review book). I much preferred shelves to the first two years of med school. MS3s have the bonus of hiding in the library to study depending on the rotation

Or, maybe I'm making intern year to be more hell-ish than expected? Kinda like the pre-med to med school transition phase...

 

[Perrotfish]

just curious why?

MS3s have little responsibility, pressure, and work much less hours compared to an intern/resident. Shelf exams aren't too "difficult" to do decent on if you spend an hour/two a day prepping for them(reading on patients/reading a review book). I much preferred shelves to the first two years of med school. MS3s have the bonus of hiding in the library to study depending on the rotation

Or, maybe I'm making intern year to be more hell-ish than expected? Kinda like the pre-med to med school transition phase...

For me there were several things that made MS3 worse than Intern year

1) Conflicting responsibilities. In Intern year you have a job. Its hard, its a lot of hours, but its one job and you don't have anything else pending until you're in your last year and your boards come due. As a medical student you had two jobs: study for a standardized test, and do a fake job that barely has any overlap with that test. Several people have posted that they did amazingly well on shelves either by just reading on their patients or by doing a handful of questions at the end of the block. Well that wasn't me, I needed to carve out 20+ hours/week of studying and practice questions to even hit the average on shelves. It sucks feeling like you can't get everything you need done. It also sucks being told you're 'weaseling out of work', or some such, to do the other mandatory, work like thing that you have to do. If I'm going to have someone make me feel like I'm cutting class I would like to be doing something cooler than UWorld.

2) MS3 is graded, Intern year is pass fail. While there are lots of good, patient care related reasons not to just say 'good enough' when you're an Intern,the fact is that at the end of the day your only real options are getting fired and not getting fired. There is no Honors, there is no high pass, and that extra little bit of brown nosing won't open up any career options for you. It makes you feel a lot less guilty about watching a movie when you actually have a day off, and at the very least it lets you focus on the real things you need to learn (your job) and not the asinine brown nosing things (the details of your attending's alimony settlement).

3) A lot of MS3 is box checking. Our medical school system was formalized by a handful of ancient Hopkins physicians in the 1950s and was very carefully designed to produce a WWI era GP. Assuming that's not what you want to be, most of what you do in medical school is agonizingly pointless. Pediatricians don't need a surgery rotation. Surgeons don't need a psych rotation. No one other than an Ob/Gyn or an FP needs an Ob/Gyn rotation. I think I've made it clear that I think we are decades past the point where we need to have Surgery/Pediatrics/Medicine schools rather than just all inculsive medical schools. Until we get there every student is going to spend an enormous amount of time learning skills that will be about as useful as sword swolllowing, and much less fun.

4) Every evaluation on MS3 was random, and most were a kick in the nuts. Since I hit intern year my evals, good and bad, have usually had some reasonable correlation to how I know I performed my job. In MS3, after all the hard work and ass kissing was over, there was a better than 50% chance that your eval would be commentless, or random, of focused entirely on one single comment you made on your last day. Which was kind of frustrating considering that, as mentioned above, that was the year where the evals affected a grade that determined my career options. It turns out that people have a much better memory of the job you did when you have a real job to do.

Anyway that's my opinion. I certainly respect the right of others to disagree.

 

[45408]

I don't disagree with most of what Perrotfish said, and I'd rather repeat a year of residency over repeating M3, in a heartbeat. M3 sucked at a fundamental level because you feel pretty ignorant and useless on most or all of your rotations, with some exceptions. That's not fun. You can do things to make yourself become useful, but the place is mostly designed to run without you. Intern year is also wildly variable from one program to the next, and from one specialty to the next. Call can be absolutely brutal, or you can sleep most nights. You might not start til 8am on many rotations, or you might be there at 5:30am most days. You might work one or both days of most/all weekends, or you might have a lot of weekends off. You might be doing a transitional year, where everyone knows that you're not doing their specialty, and unless you literally fail the rotation, it's not that important how/what you do.

There are a lot of factors that go into someone saying one is worse than the other, but really, this all started because JasonE said "but when students go home, they still have to study." That's not going to change when you become a resident.

 

[Mass Effect]

Pediatricians don't need a surgery rotation. Surgeons don't need a psych rotation. No one other than an Ob/Gyn or an FP needs an Ob/Gyn rotation. I think I've made it clear that I think we are decades past the point where we need to have Surgery/Pediatrics/Medicine schools rather than just all inculsive medical schools. Until we get there every student is going to spend an enormous amount of time learning skills that will be about as useful as sword swolllowing, and much less fun

As an MS3, I don't really understand this. Why doesn't everyone need an OB/GYN rotation, assuming everyone will be caring for pregnant patients at one time or another? Wouldn't it help an aspiring cardiologist to be exposed to medical problems in pregnancy since they all have some affect on the heart? Wouldn't it be beneficial for a budding surgeon to be able to recognize psych disorders before agreeing to perform elective procedures? Surely some internal medicine patients will have surgery at some point and be returning to their IM doctor afterwards. Shouldn't they be somewhat aware of how surgical procedures/complications affect and/or trigger the most common IM problems?

I guess I see a big overlap in the specialties. I realize no one will be an expert at anything in third year, but a little exposure is still nice, in my opinion, so that when you're actually handling your own patients intern year, you won't be totally clueless when you run into a woman with an undiagnosed borderline personality or when a pregnant woman presents to an ophthalmologist with a headache and visual problems or when your family med patient asks why he has neuropathy months after hernia surgery.

 

[ijn]

As an MS3, I don't really understand this. Why doesn't everyone need an OB/GYN rotation, assuming everyone will be caring for pregnant patients at one time or another? Wouldn't it help an aspiring cardiologist to be exposed to medical problems in pregnancy since they all have some affect on the heart? Wouldn't it be beneficial for a budding surgeon to be able to recognize psych disorders before agreeing to perform elective procedures? Surely some internal medicine patients will have surgery at some point and be returning to their IM doctor afterwards. Shouldn't they be somewhat aware of how surgical procedures/complications affect and/or trigger the most common IM problems?

I guess I see a big overlap in the specialties. I realize no one will be an expert at anything in third year, but a little exposure is still nice, in my opinion, so that when you're actually handling your own patients intern year, you won't be totally clueless when you run into a woman with an undiagnosed borderline personality or when a pregnant woman presents to an ophthalmologist with a headache and visual problems or when your family med patient asks why he has neuropathy months after hernia surgery.

Meh. I think another problem is institution specific. Every rotation here has to be 8 weeks, so psychiatry is given as much face time as surgery or internal medicine. I don't think that's right. 8 weeks of psychiatry is unnecessary, but for the sake of "fairness" everyone has to go through it. I think we'd graduate better interns if we had 12 weeks of IM and 4 weeks of psychiatry...

 

[Mass Effect]

Meh. I think another problem is institution specific. Every rotation here has to be 8 weeks, so psychiatry is given as much face time as surgery or internal medicine. I don't think that's right. 8 weeks of psychiatry is unnecessary, but for the sake of "fairness" everyone has to go through it. I think we'd graduate better interns if we had 12 weeks of IM and 4 weeks of psychiatry...

I agree that it depends on your school. At my school, we have 8 weeks of IM, 8 weeks of surgery, and 8 weeks of FM with only 4 weeks of psych. Of course, as someone who enjoys psych, I wish we had more

 

[VA Hopeful Dr]

Meh. I think another problem is institution specific. Every rotation here has to be 8 weeks, so psychiatry is given as much face time as surgery or internal medicine. I don't think that's right. 8 weeks of psychiatry is unnecessary, but for the sake of "fairness" everyone has to go through it. I think we'd graduate better interns if we had 12 weeks of IM and 4 weeks of psychiatry...

Psych is, to my mind, extremely important. Every single doctor, without exception, is going to be dealing with psych patients.

That said, I wish at my school they had spent less time on Axis I and more time on Axis II as those are the ones that us non-psych people see and have the most trouble with.

 

[ArcGurren]

As an MS3, I don't really understand this. Why doesn't everyone need an OB/GYN rotation, assuming everyone will be caring for pregnant patients at one time or another? Wouldn't it help an aspiring cardiologist to be exposed to medical problems in pregnancy since they all have some affect on the heart? Wouldn't it be beneficial for a budding surgeon to be able to recognize psych disorders before agreeing to perform elective procedures? Surely some internal medicine patients will have surgery at some point and be returning to their IM doctor afterwards. Shouldn't they be somewhat aware of how surgical procedures/complications affect and/or trigger the most common IM problems?

I guess I see a big overlap in the specialties. I realize no one will be an expert at anything in third year, but a little exposure is still nice, in my opinion, so that when you're actually handling your own patients intern year, you won't be totally clueless when you run into a woman with an undiagnosed borderline personality or when a pregnant woman presents to an ophthalmologist with a headache and visual problems or when your family med patient asks why he has neuropathy months after hernia surgery.

100% agreed with this. This whole "oh I don't need to know how to take care of pregnant patients if I'm not doing OB/Gyn!" or "I'm going into psych, I don't need to know how to do rectal exams!" kind of attitude is not only stupid, it's reactionary. Medical school isn't a trade school where you learn how to plumb or do phlebotomy; it's a school where you lear the science and practice of medicine to make you at the very least a well-rounded doctor. For every surgical resident we hear whining about how much they hate knowing how to manage diabetes or every medical resident who complains about taking care of psych patients... ugh.

 

[ArcGurren]

Psych is, to my mind, extremely important. Every single doctor, without exception, is going to be dealing with psych patients.

That said, I wish at my school they had spent less time on Axis I and more time on Axis II as those are the ones that us non-psych people see and have the most trouble with.

I agree, going through psych helped me immensely appreciate how to take care of some basic psychiatric issues and learn when it would be appropriate to call psychiatric consults (i.e. after I've already at least done SOME legwork to manage the problem). I think 8 weeks is excessive though - one month would suffice IMO.

 

[45408]

100% agreed with this. This whole "oh I don't need to know how to take care of pregnant patients if I'm not doing OB/Gyn!" or "I'm going into psych, I don't need to know how to do rectal exams!" kind of attitude is not only stupid, it's reactionary. Medical school isn't a trade school where you learn how to plumb or do phlebotomy; it's a school where you lear the science and practice of medicine to make you at the very least a well-rounded doctor. For every surgical resident we hear whining about how much they hate knowing how to manage diabetes or every medical resident who complains about taking care of psych patients... ugh.

Um, I wish I knew how to manage diabetes better.

 

[duckie99]

Um, I wish I knew how to manage diabetes better.

I think the point is that the attitude some people have of discounting the knowledge they gain during their rotations once they have decided what field they like is a poor one. The knowledge, though perhaps not useful on a daily basis for the majority of residents, is still important to learn an understand even if you are not the primary person managing a certain condition on a long term basis. Just learning the specifics of one field would drastically reduce a physician's knowledge basis and capacity to learn and acquire more knowledge in the future.

Take diabetes... surgeons don't manage a person's diabetes in the outpatient setting such as by seeing follow-up for it, screening, etc... that is the job of the primary care doc. However surgeons deal with diabetes and must manage it for surgical issues on a regular basis. Skipping the learning of diabetes from the primary care doc's perspective would decrease the knowledge the surgeon possesses to manage diabetes as he currently does and would potentially decrease his ability to learn more about the disease process.

While the length of any one rotation can be debated I think they are all valuable. I think the better foundation a physician has the better the physician will be in the long term. Also, all these rotations are important for students to find out what field they like the best. Lots of people change their mind about their favorite fields as they go through their training.

 

[ArcGurren]

Um, I wish I knew how to manage diabetes better.

Glad you do. Tell that to some of your co-residents bro.

 

[Perrotfish]

100% agreed with this. This whole "oh I don't need to know how to take care of pregnant patients if I'm not doing OB/Gyn!" or "I'm going into psych, I don't need to know how to do rectal exams!" kind of attitude is not only stupid, it's reactionary. Medical school isn't a trade school where you learn how to plumb or do phlebotomy; it's a school where you lear the science and practice of medicine to make you at the very least a well-rounded doctor. For every surgical resident we hear whining about how much they hate knowing how to manage diabetes or every medical resident who complains about taking care of psych patients... ugh. .

1) Medical school is certainly a trade school, or if it isn't I don't know what is. You are learning to do a job and the quality of your education can be judged on how well you perform that job. That's a trade school. Its certainly not the dispassionate pursuit of knowledge for its own sake, its a very practical professional education.

2) Its not that you don't need to manage pregnant patients as a non-ob, or psych patients as a surgeon, its that you need to know how to manage them within the limits of your profession, and not as a member of a different profession. When you're on a rotation for a profession you learn a lot of tips that are outside of your scope of practice, at the expense of a knowledge base you need FOR you practice. That kind of knowledge is best learned from members of YOUR profession practicing YOUR profession. Doing a rotation in surgery to understand how to manage Pediatrics patients who have had surgery is like a chef working as a farmer to better understand how to cook food. Its not that I can't imagine a situation where the education would help a little, but it certainly seems like it would be a lot simpler and more direct for the chef to just take some more cooking courses.

Do surgeons manage diabetics? Absolutely, they write sliding scale insulin and insulin drips all the time. Do they optimize a patients A1C as an outpatient, and therefore need to know family practice algorithims and diabetic teaching? Never, and I challenge you to find a surgeon who still remembers how three years into residency. Do psychiatrists manage pregnant patients? Absolutely, that's why they need to know exactly how all their antipsychotics affect the baby. Do they ever manage a patient in active labor, and therefore need to know all the details of stations, the expected delivery time with and without an epidural, and how to catch a baby? Absolutey not, it would be a slam dunk for the malpractice lawyers if they did. Do Pediatricians need to be able to recognize a surgical abdomen? Absolutely, happens all the time. Does it in any way change their management if they know what happens in the OR after they call the surgical team to take care of the surgical abdomen? No, not ever. What you learn on the rotations in medical school is how to mange other people's patients in a way that would be malpractice if you ever actually attempted it without getting that other team involved.

3) Once again, the guys who made this system up weren't interested in a broad base of knowledge or in intellectual naval gazing, they designed a very practical, nonsense free trade school education. They just happened to design it to produce old fashioned, WWI era GPs. That's why we have the rotations we have. After medical school and one year of residency a GP could set up his own office and do open abdominal surgery, closed reductions, amputations, manage deliveries, compound drugs, do the town's autopsies, and run all his own labs in the back of the office. Thats why we have such an emphasis on Surgery, Ob/Gyn, pharm, path, and even biochem. It also explains the courses that you don't need: you can have a medical school without a shelf or a rotation in radiology (then sciece fiction) or ER (then triage in the biggest cities) even though these days those are probably the most universal specialties. When medical school staff opine that 'this is not just a trade school' they're ignoring our history, and they're doing it because they are too lazy and cheap to adapt our trade school to the modern realities of our trade.

 

[neusu]

1) Medical school is certainly a trade school, or if it isn't I don't know what is. You are learning to do a job and the quality of your education can be judged on how well you perform that job. That's a trade school. Its certainly not the dispassionate pursuit of knowledge for its own sake, its a very practical professional education.

It is, by definition, a professional school. Medical students rarely learn any specific aspects of how to perform a job but do learn the tools to understand how/why things are done. Residency is more like a trade school or apprenticeship.

2) Its not that you don't need to manage pregnant patients as a non-ob, or psych patients as a surgeon, its that you need to know how to manage them within the limits of your profession, and not as a member of a different profession. When you're on a rotation for a profession you learn a lot of tips that are outside of your scope of practice, at the expense of a knowledge base you need FOR you practice. That kind of knowledge is best learned from members of YOUR profession practicing YOUR profession. Doing a rotation in surgery to understand how to manage Pediatrics patients who have had surgery is like a chef working as a farmer to better understand how to cook food. Its not that I can't imagine a situation where the education would help a little, but it certainly seems like it would be a lot simpler and more direct for the chef to just take some more cooking courses.

Chefs and farmers typically do not directly interact. Surgeons and pediatricians often do. Having an understanding of one another's thought processes as well as a common ground from which their training was derived is implicit to their relationship and in the best interest of the patient being treated.

 

[duckie99]

1) Medical school is certainly a trade school, or if it isn't I don't know what is. You are learning to do a job and the quality of your education can be judged on how well you perform that job. That's a trade school. Its certainly not the dispassionate pursuit of knowledge for its own sake, its a very practical professional education.

2) Its not that you don't need to manage pregnant patients as a non-ob, or psych patients as a surgeon, its that you need to know how to manage them within the limits of your profession, and not as a member of a different profession. When you're on a rotation for a profession you learn a lot of tips that are outside of your scope of practice, at the expense of a knowledge base you need FOR you practice. That kind of knowledge is best learned from members of YOUR profession practicing YOUR profession. Doing a rotation in surgery to understand how to manage Pediatrics patients who have had surgery is like a chef working as a farmer to better understand how to cook food. Its not that I can't imagine a situation where the education would help a little, but it certainly seems like it would be a lot simpler and more direct for the chef to just take some more cooking courses.

Do surgeons manage diabetics? Absolutely, they write sliding scale insulin and insulin drips all the time. Do they optimize a patients A1C as an outpatient, and therefore need to know family practice algorithims and diabetic teaching? Never, and I challenge you to find a surgeon who still remembers how three years into residency. Do psychiatrists manage pregnant patients? Absolutely, that's why they need to know exactly how all their antipsychotics affect the baby. Do they ever manage a patient in active labor, and therefore need to know all the details of stations, the expected delivery time with and without an epidural, and how to catch a baby? Absolutey not, it would be a slam dunk for the malpractice lawyers if they did. Do Pediatricians need to be able to recognize a surgical abdomen? Absolutely, happens all the time. Does it in any way change their management if they know what happens in the OR after they call the surgical team to take care of the surgical abdomen? No, not ever. What you learn on the rotations in medical school is how to mange other people's patients in a way that would be malpractice if you ever actually attempted it without getting that other team involved.

3) Once again, the guys who made this system up weren't interested in a broad base of knowledge or in intellectual naval gazing, they designed a very practical, nonsense free trade school education. They just happened to design it to produce old fashioned, WWI era GPs. That's why we have the rotations we have. After medical school and one year of residency a GP could set up his own office and do open abdominal surgery, closed reductions, amputations, manage deliveries, compound drugs, do the town's autopsies, and run all his own labs in the back of the office. Thats why we have such an emphasis on Surgery, Ob/Gyn, pharm, path, and even biochem. It also explains the courses that you don't need: you can have a medical school without a shelf or a rotation in radiology (then sciece fiction) or ER (then triage in the biggest cities) even though these days those are probably the most universal specialties. When medical school staff opine that 'this is not just a trade school' they're ignoring our history, and they're doing it because they are too lazy and cheap to adapt our trade school to the modern realities of our trade.

I actually didn't write the quote you attributed to my name in your post... In any case, your points have merit and I do think there is room for improvement in how to best train medical students. But medical school isn't about learning how to be a physician... it's about learning who you are, what you think you would like do, and how to be a good resident. Residency is where you learn how to be a physician.

As such is the goal of medical school, I do think having all the rotations necessary. The point isn't to remember everything that isn't applicable to your daily routine/job, but as I feel was said well below there is a lot of interaction between fields and diseases overlap. So it is important to, at the very least, have a knowledge base of the management of any one disease. For example, if all a surgeon knew how to do was write for a sliding scale insulin how could one then be expected to provide the best possible counsel to a patient on the proper management of diabetes for preventing further vascular disease? Removing rotations from medical school will lower the standard of care.

It is, by definition, a professional school. Medical students rarely learn any specific aspects of how to perform a job but do learn the tools to understand how/why things are done. Residency is more like a trade school or apprenticeship.

Chefs and farmers typically do not directly interact. Surgeons and pediatricians often do. Having an understanding of one another's thought processes as well as a common ground from which their training was derived is implicit to their relationship and in the best interest of the patient being treated.

 

[Perrotfish]

Chefs and farmers typically do not directly interact. Surgeons and pediatricians often do. Having an understanding of one another's thought processes as well as a common ground from which their training was derived is implicit to their relationship and in the best interest of the patient being treated.

This is an interesting idea, but honestly I can't think of a time where knowing how a surgeon thinks would have changed my management. Actually my interaction with surgery in PEDs is pretty minimal: place the consult, get sign out, read the note, etc. Also we make no effort to find common ground with other professionals we interact with way more often and have many more workflow issues with. We don't do a rotation with nursing, for example, or in the micro lab. And again I would point out that when this system was designed not only did they not care how Pediatricians interacted with surgeons, pediatrics and surgery weren't really distinct professions yet outside of major cities, but were both skill sets used by a GP. So I don't think that was the point of having us do these rotations.

 

[Perrotfish]

As such is the goal of medical school, I do think having all the rotations necessary. The point isn't to remember everything that isn't applicable to your daily routine/job, but as I feel was said well below there is a lot of interaction between fields and diseases overlap. So it is important to, at the very least, have a knowledge base of the management of any one disease. For example, if all a surgeon knew how to do was write for a sliding scale insulin how could one then be expected to provide the best possible counsel to a patient on the proper management of diabetes for preventing further vascular disease? :

You would say 'if your diabetes progresses its going yo make your vascular disease worse. You need to see your PCP to get it under control. Which, coincidentally, is precisely what surgeons DO day.

Actually I thinks that's what's best for the standard of care anyway. You wouldn't want a vascular surgeon advising a diabetic on how to adjust his diabetic drug regimen any more than you would want an FP trying to revascularize his foot. In medicine, I think a little knowledge is often more dangerous than none.

 

[duckie99]

Actually I thinks that's what's best for the standard of care anyway. You wouldn't want a vascular surgeon advising a diabetic on how to adjust his diabetic drug regimen any more than you would want an FP trying to revascularize his foot. In medicine, I think a little knowledge is often more dangerous than none.

I agree with you with you completely. We just differ in what the purpose of medical school is. IMO it is not to train a person to be a specialist. It is to train a person to understand and gain knowledge in as many fields of medicine as possible. It is also to facilitate you in finding a field you enjoy the most. Residency/fellowship is where you learn your specialty (i.e. trade). And personally I think there is value to be had in understanding at least the basics of the most common diseases out there even if it isn't something where you are not the primary provider for on a regular basis. Most everything in medicine is interconnected and patients are patients, not disease processes.

 

[45408]

This is an interesting idea, but honestly I can't think of a time where knowing how a surgeon thinks would have changed my management. Actually my interaction with surgery in PEDs is pretty minimal: place the consult, get sign out, read the note, etc.

It helps to know when you should place the consult. Likewise, I try not to consult psych/neuro/cards when it's something that doesn't warrant a consult. We have some hospitalists who just pan-consult everyone, resulting in numerous notes that end with "f/u in clinic in 2-3 weeks," and then we have hospitalists who would just know to have them follow up as an outpatient.

 

[Winged Scapula]

This is an interesting idea, but honestly I can't think of a time where knowing how a surgeon thinks would have changed my management. Actually my interaction with surgery in PEDs is pretty minimal: place the consult, get sign out, read the note, etc.

It might not change your management but it might change your interaction with patients.

As a primary care specialist, your patients (or their parents), will look to you, their long care provider, to tell them more about the surgery, the recovery, the followup care. Sure you could say "I don't know nuthin' about that, ask the surgeon", but they'll be disappointed. They want to know what YOU think.

This happens with all specialties. I frequently get asked what I think about the Medical Oncologist or Radiation Oncologist's plans. I've had patients tell me that they went back to their PCP after seeing me to make sure the PCP agreed with my plan. That irritates me but its the reality of a practice where you see patients long term. Being somewhat familiar with other specialties and how your patients will be cared for is important for all of us.

 

[Top Gun]

Agree with this. There is a reason we rotate through multiple specialties during clinical rotations. As an internist, I frequently get patients who are about to undergo surgery, and ask my opinion about whether they should go through with it, and what the risks might be. I also manage patients with more minor psych issues like anxiety and depression, to a certain extent. As a physician, it is imperative for you to be somewhat familiar with other specialties outside your own so that you can care for your patients more effectively. And if you happen to be a surgeon, I think its important for you to know a certain amount of medical management, such as when a patient develops a DVT or pnemonia postop.

 

[Postictal Raiden]

I find it very ironic how medical school admission places so much emphasis on the type of personalities applicants must have, and yet doctors are generally known for their arrogant attitude.

Where did all values they learned from the homeless feeding, guitar playing to terminal patients, oversea missions, and other stuff applicants put on their p.s. go?

I volunteered at a teaching hospital for two years and rotated in departments. Most of the residents and even the attendants were extremely nice, helpful and down to earth. However, there were couple that everyone tried to avoid from volunteers to nurses to even interns. A colleague of mine, another volunteer, was once yelled at by one of these attendings for sneezing inside the OR while observing a surgery. He wasn't even standing directly next to the patient.

Being worked to the bone and having endless responsibilities do not justify such unprofessional and inhumane behaviors.

As future physicians we must end this type of metamorphosis.

 

[VA Hopeful Dr]

It might not change your management but it might change your interaction with patients.

As a primary care specialist, your patients (or their parents), will look to you, their long care provider, to tell them more about the surgery, the recovery, the followup care. Sure you could say "I don't know nuthin' about that, ask the surgeon", but they'll be disappointed. They want to know what YOU think.

This happens with all specialties. I frequently get asked what I think about the Medical Oncologist or Radiation Oncologist's plans. I've had patients tell me that they went back to their PCP after seeing me to make sure the PCP agreed with my plan. That irritates me but its the reality of a practice where you see patients long term. Being somewhat familiar with other specialties and how your patients will be cared for is important for all of us.

Heh. As a PCP, I can see why that would piss you off. I, of course, find it gratifying.

For what its worth, the only time I express even the slightest reservations about surgery is what spinal fusions. I have far too many failed back syndrome patients to be gung ho for that. I've never gone against my general surgeons.

 

[VA Hopeful Dr]

Double post

 

[JourneyAgent]

nm

 

[KnuxNole]

I find it very ironic how medical school admission places so much emphasis on the type of personalities applicants must have, and yet doctors are generally known for their arrogant attitude.

Where did all values they learned from the homeless feeding, guitar playing to terminal patients, oversea missions, and other stuff applicants put on their p.s. go?

I volunteered at a teaching hospital for two years and rotated in departments. Most of the residents and even the attendants were extremely nice, helpful and down to earth. However, there were couple that everyone tried to avoid from volunteers to nurses to even interns. A colleague of mine, another volunteer, was once yelled at by one of these attendings for sneezing inside the OR while observing a surgery. He wasn't even standing directly next to the patient.

Being worked to the bone and having endless responsibilities do not justify such unprofessional and inhumane behaviors.

As future physicians we must end this type of metamorphosis.

lol, that's what happens when you believe everything you read on an application for face value

 

[Winged Scapula]

Heh. As a PCP, I can see why that would piss you off. I, of course, find it gratifying.

Truth be told, I'm more annoyed when they mention asking the RADIOLOGIST who told them what surgery they should have (and I'm not talking about, "you need to have your gallbladder out" but rather making surgical recommendations for type of surgery without any real knowledge of the patient's risk factors, etc). At least with you, they've a long term relationship and you know them well, and what they would tolerate physically and psychologically.

 

[SouthernSurgeon]

Truth be told, I'm more annoyed when they mention asking the RADIOLOGIST who told them what surgery they should have (and I'm not talking about, "you need to have your gallbladder out" but rather making surgical recommendations for type of surgery without any real knowledge of the patient's risk factors, etc).

I had a GI doc write in their consult note that a cholecystectomy (for biliary dyskinesia) was "medically necessary" in a patient with an EF of 10-15% and portal hypertension. Sigh.

 

[Winged Scapula]

I had a GI doc write in their consult note that a cholecystectomy (for biliary dyskinesia) was "medically necessary" in a patient with an EF of 10-15% and portal hypertension. Sigh.

Let GI take the gallbladder out via NOTES then.

Yeah...I'm sure we're all guilty of this type of thing and that surgeons have been known to counsel patients on medical management (doesn't make it ok for any specialty to make recommendations outside of their area of expertise).

 

[JGimpel]

.

 

[ArcGurren]

I had a GI doc write in their consult note that a cholecystectomy (for biliary dyskinesia) was "medically necessary" in a patient with an EF of 10-15% and portal hypertension. Sigh.

Tunnel vision x 1000 right there.

In point, I think this shows that there's definitely a necessity to know other fields of medicine besides your own trade.

 

[ijn]

Is gimped a sociopath or is New York really that different from the rest of the country? I got 8 hours of sleep, ate in the physicians lounge every day with the surgeon, never had evening rounds, and got to wear scrubs all day. What he is describing sounds nothing like my experience. The rotation was pretty chill.

 

[ArcGurren]

I posted much of this in a neurosurgery post and I only got 2 complainers, but this worked for me in that as well as other surgical rotations when I was a medical student:

You must do an audition in general surgery at the location you want to train at. If it's a level 1 or level 2 trauma center, that's the most ideal.

Appear to be in the hospital 24/7, dedicated to this field. If this means going to the cafeteria the long way past a few of the nursing pods or ICU every few hours to pick up a bag of chips or carton of milk, do it. Your day off will be your most dressed up day and you'll do quick "fly-bys" on your patient list from the day before. This is gunner-central and the students that say they've got a day off will be the ones with ink on the chart on their day off and get called in to do emergency cases.

Do not EVER yawn while on service. Your superiors have been there longer than you doing lightning rounds because their surgeries took some extra time or they got hit with a multiple MVA and everyone else is still on their way in. If you're their in that time, you will be "leaded" all the way up to your neck and first-assisting until everyone else gets there.

Arrive an hour before any other students are expected to be there and begin reviewing films and labs for the pre-ops for that day.

Families are absolutely destroyed when they see what shape the patients on your service are in. Be careful not to overstep what an attending needs to tell them but be firm that everyone must leave the room when you do your morning exam because some of the advanced stuff you do will make it worse if they have to watch you hurt their father or daughter with pins and needles to get an accurate status.

This schedule would work for any rotation, but will help you be successful in most surgical ones:

5AM: Arrive no later than this and pre-round on any patients you're assigned. This could mean just gathering their latest labs and ventilator values or actually doing a quick physical exam on them.

6-7AM: Residents come in and go over what you have with them and give their expectations of you when on attending rounds for the day.

7-9/10AM: Attending rounds and time to get pimped on everything and anything. You probably won't know half of what they ask you so make a note of it on your 3x5 card in your white coat and look it up when you have a moment but definitely before you go home that day.

or

4:30-5AM: You may start the day of with a surgery and round later. If so, be there before anesthesia gets to the patient and offer to help intubate the patient. If nothing else, you'll be there before the surgeon and be helping in prepping the patient one way or another. You should be with the patient from the time you wheel them into the surgical suite to the time you get them back onto the gurney and take them back to post-op holding.

10AM: You've either finished rounds or your first surgery. Slam down peanut butter and crackers that they have there for the surgeons and get going on either prepping the next case or doing office hours.

12PM: It could be lunch time or just enough time to wolf down more PB and crackers or a Powerbar you keep in your white coat.

1PM: Next surgery or afternoon office hours. It doesn't matter what you changed into for surgery, you're expected to be in professional dress at the office.

5PM: Office hours or a couple more surgeries are finished. Time for evening rounds, especially on the patients you just worked on today and those awaiting surgery the next day. Eat something quickly.

7PM: You may go home only if told to do so and if so, don't argue or be a gunner and stay all night; you won't make it through your first week if you don't get rest.

8PM: Research everything asked of you that day and any parts of the anatomy you weren't sure about that day. Practice one and 2 handed suture techiques for a few minutes a day to make sure you're accurate and fast in doing them.

9PM: You should be home, showered and in bed by now, ready to sleep for about 5 or 6 hours, then get up and start all over again.

Remember that the Interns and Residents have WORSE schedules than this, so they definitely will get annoyed if you complain about yours. If you're doing a sub-I/audition rotation, you should definitely keep with your resident/attending until they leave or have security kick you out by force.

Wow your surgical rotation blows. I'm glad I didn't have to deal with the crap I bolded up above. Most places are fine with you eating when you get the chance, and don't do this whole "be there before the other students!!" nonsense.

 

[JGimpel]

.

 

[Winged Scapula]

I posted much of this in a neurosurgery post and I only got 2 complainers, but this worked for me in that as well as other surgical rotations when I was a medical student:

You must do an audition in general surgery at the location you want to train at. If it's a level 1 or level 2 trauma center, that's the most ideal....
New York is generally a more malignant area to train, in my experience, by the way.

What does this have to do the with topic of the thread?

 

[KnuxNole]

Is gimped a sociopath or is New York really that different from the rest of the country? I got 8 hours of sleep, ate in the physicians lounge every day with the surgeon, never had evening rounds, and got to wear scrubs all day. What he is describing sounds nothing like my experience. The rotation was pretty chill.

I never had evening rounds, or came in an hour before pre-rounds. Sleep...well I couldn't sleep at 10pm(natural night owl) so I lived with 6 hours by choice. We also ate lunch for around an hour. That schedule didn't factor in free time after work or dinner D:

However, that post seemed like it was implied on how to succeed for someone doing a surgery audition. For a regular person, it seems a wee bit too much, but the general idea of "Work hard, don't come in late, read" still applies
Most people aren't going into surgery, so they aren't gonna do an audition rotation. If New York is that malignant, I guess it isn't the greatest city in the world to train/live afterall. That + the whole nurses situation talk. Gunner central is NEVER good for anyone,ever.

 

[Winged Scapula]

Is gimped a sociopath or is New York really that different from the rest of the country? I got 8 hours of sleep, ate in the physicians lounge every day with the surgeon, never had evening rounds, and got to wear scrubs all day. What he is describing sounds nothing like my experience. The rotation was pretty chill.

No you just had a different experience. That is exactly why when threads such as this one arise, it is important to recognize that while the OP needs to vent, the experience isn't the same for everyone. As I've said often before, my experience on Peds was much more unpleasant than on Surgery when I was a student.

In residency, our students always had morning and evening rounds, you could not wear scrubs except when on Trauma, and lunches were not guaranteed (and there was no physician lounge even if we did eat). Students did tend to get 8 hours of sleep even when "on call" because there was a stupid rule that they only had to stay until 1030 pm.