The Life of a Prelim Surgery Resident...

I am writing this as a means to vent, but perhaps it may help some of you MS-4s out there not to make to same mistake that I did. Some background: applied for ortho with Board scores in the 220s; didnt get in. scrambled into a Gsurg prelim last year at a lower tier but University program. I decided at that time (June)to no longer focus on ortho because i enjoyed general surgery in med school as well. Hell begins...
1. My 1st month, I was placed by myself in the Surgical ICU to work nights. I was to respond to every trauma alert, but was not allowed to go to any of the trauma surgeries. Of course no sleeping and was told that interns dont have time to eat... so i didnt. My nights began at 7p to 7a in the bulletin, but I was told to come in 30 minutes early and couldnt leave until about 930am the following morning due to morning conferences every day and having to check out to each time. Of course I was made to write all of the unit notes at nite, even though the daytime STICU intern, which was a categorical at the time in July, made rounds with the team, did all the procedures, and never had to say a word during rounds. Of course, I was grilled mercilessly, my first month about details of events that supposedly happened during the day, but were never documented in the chart. When I pointed it out, i was told that it was still MY fault for not being SMART enough to ask the right questions during my checkout from the daytime categorical intern. # of operations at this point = zero
2. My 2nd month, I was placed on Surgical ICU days. This was supposed to be a great month because I thought that I would be able to do surgeries and really learn and enjoy the SICU like my categorical counterpart did. WRONG! All of a sudden, a rule was made that it didnt make sense for the night SICU intern to write notes because they didnt make any of the big daytime decisions with the attending. So, guess who had to write all of the notes, present all of the patients, and still take all of the grilling again. ME! the prelim! This is month 2 and no matter what i do, i get yelled at, am yet to receive a "did a good job", and am made to feel worthless QAM in front of the full team and medical students. It was so bad that the med students used to ask why they gave me such a hard time. The other nurses confirmed this treatment stating that no other interns get yelled at to the degree that I do and that it is always a name calling yell fest whenever im presenting. But, I made it thru that month. # of operations at this point = zero
3. My 3rd month, I am placed on the General Surgery floor. This is a relief because it is not as malignant as the ICU and is calmer. As you know, every residency has a rotten egg resident. Well this one has several, but one of the most rotten in Dr. X. Dr. X is very mean to nurses and underlings(interns). Dr. X is known to page an intern every 30 minutes just to see if their eating/using the bathroom too long/whatever. This resident will not only call every 30 minutes during teh daytime, it contines all night until about 430am when Dr. X goes to write notes. This Dr. is sooo loony and mean spirited until noone wants to work with them. Well, guess who are the only interns placed with Dr. X all year. Preliminary residents. I looked at the remained of the schedule and was placed with here for a total of 4 of my 12 months here. Incredibly bad luck or coincidence? I think neither. This month went so poorly, that even on my operating days, Dr. X had me doing floor work, dischargeing patients, finding out antibiotic start dates and placing them on a list for 30 plus odd patients which is purely a medical student job. When asked if i could have a student do this since it was my OR day I was told. "No, students should be learning surgery, they need to be in the OR." Am I not an intern? Also, these were jobs for the oncall resident who was not to be in the OR!!!! That's why we have OR day the day after being on call. But unfortunaely, this resident was a categorical intern who was sent to the OR on every day, even my OR day while I was made to do their work. # of operation: 3!!!
4. My 4th month, i was sent to the ER. This was truly a well deserved month. I needed a break and was on the verge of packing up and leaving. Here, I almost made the decision to quit, but sadly did not. Still # of operations total: 3
5. My 5th month, i was to have my vacation. Two weeks of bliss at once. How perfect! Wrong!!! Nope, for the last two weeks of this month I was placed back into the SICU at nights. Magically, the system was switched back to the nite intern. More abuse. You know it would have helped if I was ever commended on anything, even for being able to walk and talk at the same time. But it never came. I was berated every morning, if not for one reason, some other one. Again in front of students, and nurses. At this point, I began to speak loudly back though. I was no longer ashamed, i was already humiliated enough. So at every opportunity, i was forced into shouting matches with the upper level residents. Won some, lost some, but at least have respect for myself if they dont. Total operations: 3
6. My 6th month was spent on the general surgery floor again. By far my coolest team. But ohno, guess what. One of our team members (upper level) has scheduled vacation during this month so an enormous amount of patients are to be seen by 2 people. This included being on call for Thanksgiving, Christmas, and New Year's Eve. Total operations: 13
6. My 7th and current month, I am on the General Surgery floor again. Guess who is on my team again. DR X.... So you know how its going. Total operations as of today: 18

If you even think of becoming a prelim, slap yourself and think again. I wouldnt wish this on anyone. I am q3, tired all the time, and ill motivated because I am dumped on and put down daily. The attending are all nice, so its funny that i hate to see upper levels coming. I have yet to do one thing right since ive been at this program. If you dont match, scramble for categorical positions. If you dont get one, do research and strenghen your application with publications. My program seems to despise me, and i hate to go to work now. The other prelims have had similar experiences. Hope this helps someone to make better decisions than i did.
Please no inquiries about name of institution.

Preach on brother man, preach on...

Just a couple of questions:

Are you going to try to switch into a categorical track at your current or another institution? Or has your prelim experience drawn you away from surgery completely?


Glad to hear you're no longer allowing the upper-level residents to verbally abuse you without giving it right back to them.

I hope it all turns out OK for you in the end.

Damn, this sucks... but is in no way representative of how prelims are treated.

At my old residency, the prelims were treated as equals, and often given more slack because we knew they weren't categoricals. Prelims who didn't want to be in the OR were assigned other tasks. Those that wanted to operate were rotated into the OR at the same rate us categoricals were. They were required to rotate in the SICU or the burn unit, not both. They were given the option of doing an orthopedic month like the rest of us or arranging for an elective month. They were happy, and great doctors. Several are still good friends.

Glad to hear you aren't taking that crap anymore. Did you have any hint of this when you interviewed?

Although you've had it much worst than myself, I certainly sympathize with your situation and understand how it feels to be berated and unappreciated in a clinical setting. I'm a student in physical therapy and although my job isn't as tough and demanding as yours, the amount of demeaning and derogatory treatment I recieved from my supervisor during my clinicals as a first year PT was certainly hurtful and unexpected, especially since it wasn't warranted. I'm happy to see that you did the one thing that I didn't, which is to stand up for yourself. I silently accepted the harsh treatment, counting the days until I would be done with my supervisor. I hope things work out for you.

🙄
Hi,
I am doing prelim surgery. i sympathise with your situation.I am disappointed in this program . the discrimination started from Day 1.I am being used as a warm body in the busiest of services ,given operating opportunities rarely in the fashion of a dog been thrown a bone, never given credit for all the stuff that I do right,get my smallest mistake highlighted,get the worst of the call schedules(happens too many times to be a coincidence)and doubt the work hours I report are ever reported to the RRC(for they far exceed the so called 80 hr week)I think all prelim surgery residents who are facing such discrimination should get together and report to the RRC .
The only redeeming factor is the fact that the attendings appreciate my sincere work and diagnostic and therapeutic skill. and have given me great letters for the match this year.I do not intend to match at this place,obviously.

This topic has been repeatedly discussed on SDN (but, I am NOT saying it has been beaten to death - it has not). Prelim surgery is, in my opinion, a medical fate worse than hell. I've said many times that, offered surgery or no job, I'd take unemployed. As prelim, you ARE the "red-headed stepchild". The other PGY-1's are either categorical (and there for 4 more years), or surgical subspecialists next year (giving them "street cred"). An undesignated prelim (someone who only has that one year job - nothing next) is just what Pineal said - a warm body.

No matter what anyone says, it's ipso facto - the truth speaks for itself (whoops - res ipsa loquitur): every year, time and again, after the match, prelim surgery spots are wide open. Why would you think this may be?

This is unacceptable. I am categorical, and personally would raise hell to see anybody treated like this. Spur of the moment rule changes to your detriment? forget it. this program does not deserve to have you around.

One option, if you can afford it financially and temporally, is to quit, obviously. Do research, moonlight and then apply categorical next year. you will be plenty competitive for an excellent gsurg program even without research. Your still competitive for ortho. I hate it for you man.

peace

Wow. That is truly a living hell. There are some good prelim programs. I have heard good things about the Methodist program here in Dallas. At the same time, I've heard similar about similar problems in some of the Houston area and San Antonio area prelim programs. It's a risky business these days for programs to do that to prelims. I say that because one intern became so distressed that he attempted suicide and came close to achieving his goal. That brought a lot of attention to the program and actually forced the program to no longer offer preliminary positions on top of a sizable payout in the subsequent lawsuit.

Also, the RRC became involved after the prelim's lawyers contacted them to report their findings.

Bottom line is that it doesn't help you in any way and hopefully you have at least learned what NOT TO DO when you are in a future position of influence as a senior resident and attending.

Hang in there, focus on your future, and get your year done. Although quitting may be a tempting option, it is always a task to explain why you stopped your education midstream, not to mention having to defend yourself against any letters they may place into your file for doing so.

If you still want to continue with surgery thereafter, contact the general surgery department here. The chief residents here are also exceptionally cool and would answer any questions you might have (ask for Franklin Yau).