Disappointed with clerkship selections

[3rdMetatarsal]

Is anyone else disappointed with some of the clerkships they chose? When picking programs, the only reviews to rely on were SDN and APMSA 2019. I'm not sure how other places are, but my school didn't have a good resource for seeing what previous graduates thought of various programs. I've noticed many programs do not have residents doing skin-to-skin, but instead about 25-50% of the 'easier' parts of the surgery. I can't help but feel I'm only going to have 2 or 3 places that I actually like in the end, making all the other months feel like a wasted opportunity.

How has everyone else's clerkship experience been? Am I the only one surprised to see how little residents are doing in the OR?

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[iridocyclitiss]

I'm sorry that's been your experience! So far I haven't noticed that. I would recommend reaching out to the graduating classes above you to figure out places that allow for more freedom and flexibility to good residents. Another reason they could not be going skin to skin is the residents themselves. Maybe they aren't very good and need help.

I will say though I have seen at one program where there were 4 attendings scrubbed in with two residents and a student to fix one hammertoe.

 

[ConsciousCalc]

I think this is really program dependent and surgeon dependent. I saw this even at some of the "top" name programs and even then sometimes it varied. I wouldn't get completely discouraged. You can always reach out to uppers and visit some extra programs.

 

[Feli]

... I've noticed many programs do not have residents doing skin-to-skin, but instead about 25-50% of the 'easier' parts of the surgery...

What's the 'easier parts' of surgery?

For an amp, if you handle the skin poorly, it'll fail to heal or necrose and create major problems or a more proximal amp. I will gladly let a resident make the bone cuts... but they are done if they use the forceps to clamp on skin edges.

For a DMO bunionectomy, if you don't make the cuts well, it won't translate well or might shorten. I can fix a bad screw, but I can't fix a deep peroneal nerve injury, you know?

For a fusion, it's much harder and much more critical to position the joint than to put the screws into the plate.

For an ankle scope, if you don't place the portals correct, you are screwed on visualization.

It all matters. Sure, the fixation or the reduction are usually the fun or macho parts, but if you bag the perforating branch of the DP on dissection down to bone, wrap up the sural on the closure, or leave an ugly scar with bad tension of the skin... well then, it's not a success to the patient's perception or the final outcome.

...For most surgery, the outcome is largely won or lost before you even step into OR (counseled expectations of elective stuff, deciding on joint salvage vs fusion, viable amp vs BKA, candidate for ORIF vs just casting, etc). Not sending the pt for toe filler or not doing a gastroc with TMA or not helping a Lapidus patient to understand the aftercare and return-to-shoes timeline can doom them to trouble even if the TMA or Lapidus procedure itself was technically a 9.88 on Olympic judging scale.

As was said, you can learn a lot by watching. For some of my more skilled attendings (and even some senior residents), I'd almost rather watch. You can always learn by doing with the more mediocre attendings (assuming your program has enough volume and some good attendings). The good ones, though? Those are limted chances, and I want to soak up their tricks and efficiency techniques. I'd honestly like to mainly watch and learn with them - esp for the first half of residency.

 

[air bud]

What's the 'easier parts' of surgery?

For an amp, if you handle the skin poorly, it'll fail to heal or necrose and create major problems or a more proximal amp. I will gladly let a resident make the bone cuts... but they are done if they use the forceps to clamp on skin edges.

For a DMO bunionectomy, if you don't make the cuts well, it won't translate well or might shorten. I can fix a bad screw, but I can't fix a deep peroneal nerve injury, you know?

For a fusion, it's much harder and much more critical to position the joint than to put the screws into the plate.

For an ankle scope, if you don't place the portals correct, you are screwed on visualization.

It all matters. Sure, the fixation or the reduction are usually the fun or macho parts, but if you bag the perforating branch of the DP on dissection down to bone, wrap up the sural on the closure, or leave an ugly scar with bad tension of the skin... well then, it's not a success to the patient's perception or the final outcome.

...For most surgery, the outcome is largely won or lost before you even step into OR (counseled expectations of elective stuff, deciding on joint salvage vs fusion, viable amp vs BKA, candidate for ORIF vs just casting, etc). Not sending the pt for toe filler or not doing a gastroc with TMA or not helping a Lapidus patient to understand the aftercare and return-to-shoes timeline can doom them to trouble even if the TMA or Lapidus procedure itself was technically a 9.88 on Olympic judging scale.

As was said, you can learn a lot by watching. For some of my more skilled attendings (and even some senior residents), I'd almost rather watch. You can always learn by doing with the more mediocre attendings (assuming your program has enough volume and some good attendings). The good ones, though? Those are limted chances, and I want to soak up their tricks and efficiency techniques. I'd honestly like to mainly watch and learn with them - esp for the first half of residency.

man, i would love to go back and watch a few of my attendings operate again. I bet I could learn so much.

 

[Weirdy]

Is anyone else disappointed with some of the clerkships they chose? When picking programs, the only reviews to rely on were SDN and APMSA 2019. I'm not sure how other places are, but my school didn't have a good resource for seeing what previous graduates thought of various programs. I've noticed many programs do not have residents doing skin-to-skin, but instead about 25-50% of the 'easier' parts of the surgery. I can't help but feel I'm only going to have 2 or 3 places that I actually like in the end, making all the other months feel like a wasted opportunity.

How has everyone else's clerkship experience been? Am I the only one surprised to see how little residents are doing in the OR?

Every 4th year talks big until they are handed the blade as an intern.

Unfair scolding aside- You need to realize how much you actually don't know. Surgeons are trained- not born. Some may have better hand skills, better wrote memorization skills, better "feel" than others. But all need to practice, manage, and see poor outcomes and learn from them to be competent.

You are there as a resident to first and foremost- learn.
Just because residents are not doing the case skin to skin- does not mean they are not learning. It also does not mean they are poor in quality of resident or of training.

 

[dorsiflexor]

While I agree there are times to watch and learn. Watching and holding a retractor for 3 years is a waste of time in a surgical residency. Residents should be progressively doing more and more in the OR or advancing to higher level cases and actually participating in cases.

 

[Feli]

man, i would love to go back and watch a few of my attendings operate again. I bet I could learn so much.

True, but we need $, not professional and surgical growth. Ppl can watch us too...

Let's start the StrifePointe fellowship... people who already did 3yrs and have good skill can do 2 months with you, fly down for 2 with me, fly back up to rinse and repeat for a year?

We'll split the application fees and the xtra collections we'll get from not having to see post-ops and nail pts or do notes anymore. We can make them publish stuff for us and get powe-die-a-tree famous.

 

[air bud]

True, but we need $, not professional and surgical growth. Ppl can watch us too...

Let's start the StrifePointe fellowship... people who already did 3yrs and have good skill can do 2 months with you, fly down for 2 with me, fly back up to rinse and repeat for a year?

We'll split the application fees and the xtra collections we'll get from not having to see post-ops and nail pts or do notes anymore. We can make them publish stuff for us and get powe-die-a-tree famous.

pretty sure they don't have the money for this...shareholders gotta eat.

 

[3rdMetatarsal]

I think this is really program dependent and surgeon dependent. I saw this even at some of the "top" name programs and even then sometimes it varied. I wouldn't get completely discouraged. You can always reach out to uppers and visit some extra programs.

Will visiting a program for a day be enough to land an interview?

 

[AttackNME]

Will visiting a program for a day be enough to land an interview?

Depends on program and if you can make a good and lasting impression but short answer is yes definitely

 

[ConsciousCalc]

As AttackNME mentioned, really program dependent. For the most part if you truly show interest, visit, text the residents etc. then yes.

 

[dtrack22]

As was said, you can learn a lot by watching.

But you don’t learn much from watching when you don’t understand what you’re looking at. Watching as a med student or intern is significantly less valuable (IMO) than watching as a 3rd year who’s actually done the procedure, handled the instruments, understands the difficulties, etc.

I can watch an Instagram story and mimic someone’s technique or setup pretty easily now, as an attending. Would have been pointless early on in residency. Sure you might need to see incision placement once before you do it yourself. And you may benefit from watching the dissection and seeing some common instruments being used. But there can be a lot of nuance to all of that you will totally miss until you aren’t worried about the most basic aspect of the procedure and you can actually watch someone else work.

Regarding the OP, you really need to identify likeable and intelligent students 1 and 2 years above you in school. Ask them where they clerked and what they thought about the programs. I had the benefit of having a pretty large network of “friends” at basically every school thanks to APMSA, but if smart kids with good social skills are rotating at or matching at certain programs, they are probably good programs. They are probably at least viable options from a clerkship standpoint. They might not be right for you, but there has to be some redeeming qualities for someone who had options to choose that program. Follow the smart kids (the socially normal smart ones, not the autistic smart ones).

 

[air bud]

But you don’t learn much from watching when you don’t understand what you’re looking at. Watching as a med student or intern is significantly less valuable (IMO) than watching as a 3rd year who’s actually done the procedure, handled the instruments, understands the difficulties, etc.

I can watch an Instagram story and mimic someone’s technique or setup pretty easily now, as an attending. Would have been pointless early on in residency. Sure you might need to see incision placement once before you do it yourself. And you may benefit from watching the dissection and seeing some common instruments being used. But there can be a lot of nuance to all of that you will totally miss until you aren’t worried about the most basic aspect of the procedure and you can actually watch someone else work.

Regarding the OP, you really need to identify likeable and intelligent students 1 and 2 years above you in school. Ask them where they clerked and what they thought about the programs. I had the benefit of having a pretty large network of “friends” at basically every school thanks to APMSA, but if smart kids with good social skills are rotating at or matching at certain programs, they are probably good programs. They are probably at least viable options from a clerkship standpoint. They might not be right for you, but there has to be some redeeming qualities for someone who had options to choose that program. Follow the smart kids (the socially normal smart ones, not the autistic smart ones).

Huh, I wonder who you are talking about.

 

[mingle_pringle]

This whole clerkship process isn't the greatest and seems to be unfair. It is what it is! Kind of makes me feel frustrated, cause i've worked my a** off to be where I am and I still see others with NO extras and low gpa's get selected (props to you).

-I have extracurriculars, ongoing research and a high class rank, but still going into round 3. Any advise on how to choose for the next round?
- I know it's program dependent, but is it known for students who don't clerk at a site still get interviews (possibly residency)?
- Do programs really avoid students who are at the top of their class? (cause there's a handful of us with great clinical skills too)
- Do we wait until the end of the round to see if we get other offers? On my end, it just says "requested."

 

[FutureDPM123]

This whole clerkship process isn't the greatest and seems to be unfair. It is what it is! Kind of makes me feel frustrated, cause i've worked my a** off to be where I am and I still see others with NO extras and low gpa's get selected (props to you).

-I have extracurriculars, ongoing research and a high class rank, but still going into round 3. Any advise on how to choose for the next round?
- I know it's program dependent, but is it known for students who don't clerk at a site still get interviews (possibly residency)?
- Do programs really avoid students who are at the top of their class? (cause there's a handful of us with great clinical skills too)
- Do we wait until the end of the round to see if we get other offers? On my end, it just says "requested."

I wouldn't worry about having to go into the 3rd round, it doesn't say much except for the place probably had a ton of applicants. Only thing you can do now is request a spot from multiple programs in each month you still have open. I've never heard of programs avoiding top students unless they heard something specifically about them (podiatry is a small field). If it says requested, it means you have not been accepted or declined, they just sent invites to other people who may not have accepted, so you might be next to get an invite in the next round. The requested programs will carry onto the next round so just add more programs as backup to those months. If you want to talk about programs specifically, you can DM me.

 

[mingle_pringle]

I wouldn't worry about having to go into the 3rd round, it doesn't say much except for the place probably had a ton of applicants. Only thing you can do now is request a spot from multiple programs in each month you still have open. I've never heard of programs avoiding top students unless they heard something specifically about them (podiatry is a small field). If it says requested, it means you have not been accepted or declined, they just sent invites to other people who may not have accepted, so you might be next to get an invite in the next round. The requested programs will carry onto the next round so just add more programs as backup to those months. If you want to talk about programs specifically, you can DM me.

Thank you!! You're message was so helpful. You're right...there should not be a worry going into the 3rd round. I think everyone around me was making it such a negative experience that caused me to spiral. In retrospect, it turned out better than expected!

 

[diabeticfootdr]

I wouldn't worry about having to go into the 3rd round, it doesn't say much except for the place probably had a ton of applicants.

This is true. Some of our top considerations ended up in 3rd round because of differences in schedules and too many students requesting the same months. You can try to email a program directly to work something out.