Serious misgivings about Penn Surgery

pennresident · Feb 16, 2009

As the match list deadline approaches I feel compelled to warn people about my own program (Penn surgery). This warning won't come with much consequence because the Penn surgery department tells everyone on the list if they have been chosen. And this year there are rumored to be a large number of Penn people already chosen.

I came to Penn with strong thoughts about what it would be to join a top 5 academic surgery program - strong mentorship/guidance, advanced technology, cutting-edge research, long hours, collegiality. That conception was quickly erased.

I heard rumors about Penn's malignancy before I came - I chose to ignore those rumors, and now I experience that malignancy everyday at work.

Penn's surgery practice is very much like a private practice - most decisions are deferred, attendings are under enormous pressure to operate and earn more RVUs (low starting salary, and strict bonus structure), very little teaching in and out of the OR, little or no operative autonomy (often times the attending does all critical portions of the case).

There are few things required of a Penn surgery residents: high ABSITE scores, high conference attendance (many sign in and leave), and promptly logged worked hours that are <80. Besides that, your clinical judgement, operative ability/talent, and personality are overlooked. We promote and graduate residents who are unacceptably poor technical surgeons, who have illogical clinical decision making, and who are just plain wierdos. It's a system that makes you feel that your only value is the 100+ hours per week of labor that they squeeze out of you - and guess what... they get you for seven years including frequent overnight clinical responsibilty during your lab years.

The average morale of residents (from intern to chief) is very low. Besides some friendship amongst people in the same resident class, there is very little camaraderie. Residents don't spend time together as a group. Many residents don't know who the categorical interns are (7 months into the year).

The carrot that excused all of Penn's behaviour used to be the incredible operative experience. My observation is that it has been significantly erroded. You find chief residents taking simple cases from juniors (lap chole, inguinal hernia). You will find chiefs putting in chest tubes and central lines. If it's a thyroid, the resident opens and closes the neck. If it's a PTA/stent, the residents holds groin pressure after the case. If it's a lap gastric bypass, the chief resident holds the camera. If it's a VATS or lobe, the residents closes the chest. Not to mention that our Chairman (Kaiser) recently left along w/ another thoracic surgeon and a high volume vascular surgeon, amongst others.

If you can tolerate this kind of environment for 7 years, you may not be much of a surgeon but you will undoubtedly get a "Top 10" fellowship spot. For me, Penn has raised many questions about what kind of surgeon "Top" programs are actually producing - including myself.

On a whole, I would not choose Penn again.

Lance · Feb 16, 2009

Thank you.

sponch · Feb 17, 2009

Thanks for confirming what we all suspected.

BlondeDocteur · Feb 17, 2009

Seriously, that takes major cojones. Thanks much.

logistic · Feb 17, 2009

This post is too one-sided. There is no measured, objective taste to the post that makes me believe it represents what the majority of Penn residents experience at their program. While there is enough detail to make me believe that this individual is indeed a resident at Penn, it lacks information about what experiences led to a motivation to post such a negative message. It certainly wasn't the observation that the chief was holding camera...something tells me it was more personal than that. We also have no context...this is a first-time poster. And has this person gone through all years of training? 1st yr, 2nd yr, categorical, prelim?

SLUser11 · Feb 17, 2009

logistic said:
This post is too one-sided. There is no measured, objective taste to the post that makes me believe it represents what the majority of Penn residents experience at their program. While there is enough detail to make me believe that this individual is indeed a resident at Penn, it lacks information about what experiences led to a motivation to post such a negative message. It certainly wasn't the observation that the chief was holding camera...something tells me it was more personal than that. We also have no context...this is a first-time poster. And has this person gone through all years of training? 1st yr, 2nd yr, categorical, prelim?

Are you kidding? This guy is YOU in about 1-2 years.

The following quote from the OP particularly reflects your approach to the match process: "I heard rumors about Penn's malignancy before I came - I chose to ignore those rumors, and now I experience that malignancy everyday at work."

I first alluded to your tunnel vision in this thread, to which you responded "don't let me make that mistake!" However, it is very obvious that there's nothing we here at SDN could say or do to prevent you from making this mistake.

That's fine if you've decided to go to a miserable place to train in exchange for a big name, but don't come here and ask us for input on programs if you have absolutely no intention on taking us seriously.

After reading your posts, I see you as one of the many martyrs in the making. I've always felt that you are mostly a self-selecting group of students and surgical residents, but I honestly think it starts a lot earlier than med school, and your parents are at least somewhat to blame. For instance, looking at Penn's housestaff, for every Alex Johnson, there are several W. Reginald Farnsworth-Livingston III's who have likely been fed this bulls@#t from a very young age, "much like my father's father, and his father before him."

OH MY GOD WAKE UP!!!

ESU_MD · Feb 17, 2009

SLUser11 said:
That's fine if you've decided to go to a miserable place to train in exchange for a big name,

this summarizes what places like this represent. It is indeed a self selecting group, and I bet the residents put all excellent marks down on the acgme survey too as well as spew lies on interview day. as if to wish their misery away from existence.

the big name on your diploma isnt gonna help you when you are alone in some lonely OR late one night with a problem you cant handle.

BlondeDocteur · Feb 17, 2009

I think there is a risk of painting with too broad a brush, guys... both in condemning super-academic programs and the people who want to go there.

Logistic, I'm at the same level as you (well, I'm in limbo-- research yr), but I think you might have your head in the sand too.

Re: Penn's mugshots, how is easy was it to pick out the plastics guys in the lineup? Cracked me the hell up.

SocialistMD · Feb 17, 2009

SLUser11 said:
...there are several W. Reginald Farnsworth-Livingston III's...

SLUser-
Seriously, while I know its primary intent is not humor, this is one of the funnier posts I've read in a while. And there really are a lot of Roman numerals in their program...

PennSurgRes · Feb 17, 2009

Hi,

I wanted to give another view of Penn's surgical residency. While every program has problems, and ours is no exception, the post above was very one-sided and inaccurate in places. We have an excellent operative experience (although it tends to be the focus primarily in the CY3-5 years), with what is probably the greatest degree of autonomy in the country. For example, we are one of the few programs left where attendings run two rooms. I also haven't seen what the above poster comments on regarding attendings do all of the key portions of the procedure. In fact, one of the impressive things about our program is how comforatable the chief residents are doing the most difficult cases on graduation. When attendings try to take away the more difficult parts of a case, the chiefs complain to the program director, who is very receptive and acts on their feedback. When we have fellows and residents visiting from other programs, most comment on the technical focus of the residency, as well as the autonomy Penn residents enjoy.

The clinical responsibilities during the lab years are minimal (working as the surgeon of the day, who backs up the junior residents on call on nights and weekends and covers unstaffed cases), and do not interfere with research productivity (or moonlighting, for that matter). While we aren't marrying each other as at one highly ranked program, we get along fine and work together to get the work done.

Our new chairman, Dr. Drebin, is a well-regarded hepatobiliary surgeon who is very committed to resident education. He is truly a gentleman surgeon, and a pleasure to work with.

To the applicants, I wish all of you the best in the match process. I know it's hard to get objective information on programs, and a post like the OPs has some allure. Still, if you are really interested in Penn, I'd encourage you to talk to people you know who are familiar with Penn's residency rather than trusting an anonymous forum for the final word.

beaverfetus · Feb 17, 2009

double post please delete

beaverfetus · Feb 17, 2009

SLUser11 said:
for every Alex Johnson, there are several W. Reginald Farnsworth-Livingston III's who have likely been fed this bulls@#t from a very young age, "much like my father's father, and his father before him."

Yay stereo types about roman numeral named residents! I'll bet we all can guess how a "IVth" looks...

http://www.uphs.upenn.edu/surgery/housestaff/mkl.html

and yes i realize you were being facetious

/narrowly dodged a numeral

SLUser11 · Feb 17, 2009

PennSurgRes said:
Hi,

I wanted to give another view of Penn's surgical residency. .......Still, if you are really interested in Penn, I'd encourage you to talk to people you know who are familiar with Penn's residency rather than trusting an anonymous forum for the final word.

We absolutely welcome your opinion and experience. I like to see both sides of the issue when making a decision. Of course, I can't say from the two contrasting accounts which one is more accurate. They both likely carry an element of truth.....of course I usually believe that where there's smoke, there's fire....

What I don't like are people who see surgical residency in black and white. This place is bad, that place is good, this is my experience therefore this is exactly how residency is everywhere, etc. That is what I see in Logistic's posts that make me upset. I obviously have nothing against Penn in particular.

beaverfetus said:
and yes i realize you were being facetious

/narrowly dodged a numeral

I was. Honestly, I don't care if you have the same name as your Granpappy....but when you want to make a Penn Omelette, you have to break a few eggs.....

PennSurgRes · Feb 17, 2009

SLUser11 said:
<chop in various places> I like to see both sides of the issue when making a decision. What I don't like are people who see surgical residency in black and white. This place is bad, that place is good, this is my experience therefore this is exactly how residency is everywhere, etc. That is what I see in Logistic's posts that make me upset. I obviously have nothing against Penn in particular.

<chop>

....but when you want to make a Penn Omelette, you have to break a few eggs.....

I'm a new poster, SLUser, but I've been reading for long enough to know you have something against "not Penn in particular" but rather something in particular against the entire East Coast. And as far as seeing surgical residency in black and white, from your posts it would appear Black is New York, the rest of the East Coast is a sort of dark, dark gray, and the shining light of the whole country is the Midwest. I guess maybe that qualifies as seeing subtle shades of gray.

SouthernSurgeon · Feb 17, 2009

PennSurgRes said:
I'm a new poster, SLUser, but I've been reading for long enough to know you have something against "not Penn in particular" but rather something in particular against the entire East Coast. And as far as seeing surgical residency in black and white, from your posts it would appear Black is New York, the rest of the East Coast is a sort of dark, dark gray, and the shining light of the whole country is the Midwest. I guess maybe that qualifies as seeing subtle shades of gray.

Yikes. This thread is getting ugly

PennSurgRes · Feb 17, 2009

The stereotypes kill me. I understand the OP posting based on his experience, and you have to respect him for that even if you disagree, but when people start going on about roman numerals and automatically assuming we're lying on interview day (most of us are pretty up front about the strengths and weaknesses of our program) it's hard to be completely calm about it. This is a real program you're talking about -- our program, where we are spending some of the best years of our life -- and the people you're talking about a real people -- close friends and comrades.

smq123 · Feb 17, 2009

PennSurgRes said:
The stereotypes kill me. I understand the OP posting based on his experience, and you have to respect him for that even if you disagree, but when people start going on about roman numerals and automatically assuming we're lying on interview day (most of us are pretty up front about the strengths and weaknesses of our program) it's hard to be completely calm about it. This is a real program you're talking about -- our program, where we are spending some of the best years of our life -- and the people you're talking about a real people -- close friends and comrades.

Hi -

I can certainly understand why you'd defend your program. That's totally understandable.

That being said, when you come in and post things like this:

PennSurgRes said:
I'm a new poster, SLUser, but I've been reading for long enough to know you have something against "not Penn in particular" but rather something in particular against the entire East Coast. And as far as seeing surgical residency in black and white, from your posts it would appear Black is New York, the rest of the East Coast is a sort of dark, dark gray, and the shining light of the whole country is the Midwest. I guess maybe that qualifies as seeing subtle shades of gray.

it kind of detracts from your posts.

Particularly when that post that you're referring to wasn't directed at you.

Penn has had a reputation for being incredibly malignant for YEARS - not just in surgery, but in IM and OB/gyn as well. So I don't think that SLUser's post necessarily has anything to do with an "East coast bias" (which I hadn't really actually noticed, myself), and more to do with the fact that a) you can never really characterize ANY program as all good or all bad, and b) med students (like myself) have such bad tunnel vision that we're willing to flat-out ignore other people's advice, even when we're looking right at it.

PennSurgRes · Feb 17, 2009

I think I probably came off harsher than I intended with the shades of gray thing... I find SLUsers ability to go off about New York more amusing than anything else, and usually appreciate his insistence that surgical residency doesn't need to be a malignant experience to be a good one.

You'll find that most of the colorful stories of a malignant Penn you hear bandied about are relatively old. The story, told on this board a few years ago, about a resident being made to stand in a corner is actually a story from about 20 years ago. Dr. Morris, the program director, committed himself a long time ago to a cultural change which, I believe, has occurred. Dr. Kaiser was also committed to that change, and I believe Dr. Drebin will continue in that spirit. Abuse of junior residents by senior residents and such is just not tolerated. Attendings who don't let residents operate get their residents pulled.

Like most programs, we have some really nice residents and attendings who take exceptional pride and joy in teaching, and a few who lack social graces, and a wide range in between. Residents who come here have good days and bad days. If you come here for residency, I guarantee you're going to have some great days where you do things you can't even imagine doing right now. I can also guarantee you're going to have some really low days, where you just want to go home and curl up with a nice cup of tea or vent to your friends. That's surgical residency just about anywhere. It goes better if it's a good fit. At Penn, you will have friends among the residents to vent too when you need to, the senior residents are supportive, there's always someone to call when you think you're in over your head. If you feel like you didn't meet residents who were willing to talk straight with you during your interview, I'd encourage you to come back for a second look (although I realize it might be too late to arrange at this point) and talk to more of us in a less structured setting. We want you to have an accurate view of the program, too.

SocialistMD · Feb 17, 2009

PennSurgRes said:
...when people start going on about roman numerals...

Do you deny there are a lot of III's and IV's at Penn? I wasn't making a judgment, just observing that there really are a lot of people at your program who are named after their grandfather. One of my best friends just did the same for his son, and I wouldn't consider him malignant, nor his upbringing, and he certainly isn't a legacy. I just found it interesting, that's all. We, too, have the stories of the attendings making residents stand in the corner, many of which occurred in more recent memory, so I understand your defensive posture. However (and not to pick a fight, just making another observation), we have shed the malignant label we once had, so why do you think it still persists at Penn if your program is not still somewhat "malignant?"

smq123 · Feb 17, 2009

PennSurgRes said:
You'll find that most of the colorful stories of a malignant Penn you hear bandied about are relatively old. The story, told on this board a few years ago, about a resident being made to stand in a corner is actually a story from about 20 years ago. Dr. Morris, the program director, committed himself a long time ago to a cultural change which, I believe, has occurred. Dr. Kaiser was also committed to that change, and I believe Dr. Drebin will continue in that spirit. Abuse of junior residents by senior residents and such is just not tolerated. Attendings who don't let residents operate get their residents pulled.

That sounds fair enough.

And I do know that Penn had a reputation for being a crappy place for med students to do their surgery rotation, but that has vastly improved.

Out of curiosity (and out of interest to improve the amount of info on SDN), what about the operative experience? The OP mentioned that after Dr. Kaiser left, the volume went down. What are your thoughts?

I actually hadn't realized that Dr. Drebin was the new chair at Penn. TWO Hopkins-trained HPB surgeons are chairs in Philadelphia?? Oooohhh...that should be interesting.

PennSurgRes · Feb 17, 2009

Our Thoracic volume is probably down a little bit at HUP (I'm not high enough on the totem pole to actually see the numbers and am judging based on the schedule), but that isn't really where the residents get most of their thoracic experience. The fourth year rotation is done at Presbyterian hospital, and is a great rotation because it's relatively high complexity, excellent volume, and there aren't any fellows competing for cases. Some thoracic cases actually go unstaffed. We have a couple of new thoracic surgeons who are, by all accounts, really good to operate with. General and the other specialties haven't been affected at all by Dr. Kaiser leaving, from what I can tell. Our operative volume is not limited so much by referals or not having enough patients, but rather by... well, you can only operate on and take care of so many people per day.

As far as our surgery rotation for medical students, it's now actually the highest ranked rotation among the core clerkships. Again, there is a real cultural change which is ongoing and impressive. It's very education focused, with very high quality didactics. This is a leadership thing -- Dr. Kelz has really changed the structure of the clerkship to emphasize cognitive development.

BlondeDocteur · Feb 18, 2009

SocialistMD said:
Do you deny there are a lot of III's and IV's at Penn? I wasn't making a judgment, just observing that there really are a lot of people at your program who are named after their grandfather. One of my best friends just did the same for his son, and I wouldn't consider him malignant, nor his upbringing, and he certainly isn't a legacy.

It's not just Eastern Establishmentarians passing along directorships of banks to their sons. It's a Southern thing too, and it's *certainly* not linked to social class. I knew a good number of "Trips" and "Treys," and even one Six. The only thing they inherited was a predilection for certain brands of chewing tobacco, and knowledge of how to keep a hemi running.

discontinuebed · Feb 18, 2009

Considering I interviewed with multiple students who claimed to cry during their 3rd year surgery rotation at Penn, I'm inclined to believe the stories of malignancy.........

logistic · Feb 18, 2009

SLuser says:
Are you kidding? This guy is YOU in about 1-2 years.

OK, that 's pretty funny.

SLuser: I first alluded to your tunnel vision in this thread, to which you responded "don't let me make that mistake!" However, it is very obvious that there's nothing we here at SDN could say or do to prevent you from making this mistake.

I was just making a point about the post not having much context. Maybe the OP is a first year just coming off of a bad rotation(s). Perhaps his/her outlook will change as he./she progresses through the years of residency.
I remember myself being very frustrated with rotations where attendings and residents did not teach, did not value my knowledge or personality, and were primarily interested in the service I could provide (scutwork, bird-dogging, pre-rounding, etc.). It's frustrating when the hard work you put in is not rewarded with education and mentoring. I was not only frustrated...I was angry. And if asked to comment on my medical school, I will make some negative judgements to prospective applicants (although in temperate fashion...being objective as per strengths and weaknesses). And if asked to make some comments on an anonymous forum, these comments would likely be more one-sided, and less temperate.

SLuser then blames my parents for inculcating an infatuation with big academic names. But you forgot to blame them for my work ethic and being a team player above all else that my attendings appreciated and more often than not motivated them to teach me a thing or two.

toomuch · Feb 18, 2009

hmm, I am a surg resident in Philadelphia and I would tend to believe the OP over any of the other posts. I know one of my friends told me of an applicant of Penn was told he was ranked to match and he ended up matching in Buffalo so maybe they call their top 10 instead of how many spots they actually have.

SLUser11 · Feb 18, 2009

logistic said:
I was just making a point about the post not having much context. Maybe the OP is a first year just coming off of a bad rotation(s). Perhaps his/her outlook will change as he./she progresses through the years of residency.

Maybe, but we're almost 8 months into the year. This resident has plenty of different experiences, even if only an intern, with which to form a negative opinion. You say he's not objective, but of course he's not objective....he's knee deep in it....but his bias has obviously been formed by a negative experience. You say he's too vague, but it seems to me like he is very specific about the things he doesn't like, and gives examples:

Lack of autonomy and teaching: Penn's surgery practice is very much like a private practice - most decisions are deferred, attendings are under enormous pressure to operate and earn more RVUs (low starting salary, and strict bonus structure), very little teaching in and out of the OR, little or no operative autonomy (often times the attending does all critical portions of the case).

Resident relationships:The average morale of residents (from intern to chief) is very low. Besides some friendship amongst people in the same resident class, there is very little camaraderie. Residents don't spend time together as a group. Many residents don't know who the categorical interns are (7 months into the year).

Operative experience: You will find chiefs putting in chest tubes and central lines. If it's a thyroid, the resident opens and closes the neck. If it's a PTA/stent, the residents holds groin pressure after the case. If it's a lap gastric bypass, the chief resident holds the camera. If it's a VATS or lobe, the residents closes the chest.

logistic said:
SLuser then blames my parents for inculcating an infatuation with big academic names. But you forgot to blame them for my work ethic and being a team player above all else that my attendings appreciated and more often than not motivated them to teach me a thing or two.

If you're saying I forgot to blame your parents for you being awesome, I apologize.

And, honestly, I have no idea why you are approaching the match the way you are, and your parents may have nothing to do with it. I also believe that in some sick masochistic way, you'll probably be happy at a nightmare program, and you'll carry that cross with great pride.

I definitely am being hard on you in this thread. I will back off a little, especially since in about a week, you will finalize a decision that will completely change your life.

One last super-wordy comment: Remember that most of the residents in this forum were just like you at match time, similar scores, similar desire to be excellent, similar feelings of invincibility, etc. We've all made different decisions on where to train, and bring different perspectives to the table, all of which are more enlightened than your current perspective. Not because we're smarter or better, but because we've lived it.....not for a month-long sub I or a 2-day tour, but for several years of our lives.

Several people have quit surgery, just on SDN, since I started posting here in 2005. Many others have chronicled their daily struggle to get by. Don't assume that they are just the weak ones, and that your fate will be different. These are intelligent, motivated, hard-working residents who struggled to stay afloat in antagonistic environments with little support. Some were able to swim to shore, and others drowned. When they tell you to wear a life jacket, take their warnings to heart. You can still jump in, but use all the tools you have to make an educated decision that can set you up for a healthy surgical education.

smq123 · Feb 18, 2009

logistic said:
I was just making a point about the post not having much context. Maybe the OP is a first year just coming off of a bad rotation(s). Perhaps his/her outlook will change as he./she progresses through the years of residency.

Don't people tend to get MORE bitter and angry as they go through residency?

SLUser11 said:
And, honestly, I have no idea why you are approaching the match the way you are, and your parents may have nothing to do with it. I also believe that in some sick masochistic way, you'll probably be happy at a nightmare program, and you'll carry that cross with great pride.

One last super-wordy comment: Remember that most of the residents in this forum were just like you at match time, similar scores, similar desire to be excellent, similar feelings of invincibility, etc. We've all made different decisions on where to train, and bring different perspectives to the table, all of which are more enlightened than your current perspective. Not because we're smarter or better, but because we've lived it.....not for a month-long sub I or a 2-day tour, but for several years of our lives.

Several people have quit surgery, just on SDN, since I started posting here in 2005. Many others have chronicled their daily struggle to get by. Don't assume that they are just the weak ones, and that your fate will be different. These are intelligent, motivated, hard-working residents who struggled to stay afloat in antagonistic environments with little support. Some were able to swim to shore, and others drowned. When they tell you to wear a life jacket, take their warnings to heart. You can still jump in, but use all the tools you have to make an educated decision that can set you up for a healthy surgical education.

SLUser - This is a great post. And I hope that it doesn't fall on deaf ears.

But, as long as the belief that "Prestige trumps all" is still out there, people aren't going to listen to experience. This is also what happens in pre-allo, when people are trying to pick a med school. There is the definite feeling that the med school education you get at Yale will automatically, by default, be MUCH better than the med school education you would get at a state school, because so many people are so busy chasing name and prestige. I hope more people read your post and take it to heart.

Winged Scapula · Feb 18, 2009

smq123 said:
Don't people tend to get MORE bitter and angry as they go through residency?

I think it changes course many times during residency.

I was fairly bitter and angry as an intern.

It got better as a 2nd year, MUCH better as a 3rd year and then went downhill the last two years.

Bitterness and anger abated during fellowship and has picked back up now in practice. :laugh:

I agree with you...the post above from SLUser is great. We were ALL gung-ho bright eyed eager little rabbits when we started. While it is true that the weak do not survive, it is also just as true that very strong residents have left surgery - either because they were somewhat emotionally and intellectually normal and realized what a F'd up field this can be, or because they just had the desire beaten out of them. I certainly came close to leaving many times myself (for the latter reason).

Danbo1957 · Feb 19, 2009

Winged Scapula said:
Bitterness and anger abated during fellowship and has picked back up now in practice.

Feel like elaborating a little? Commenting in general terms will be fine - unless you want to name names...

Winged Scapula · Feb 19, 2009

Danbo1957 said:
Feel like elaborating a little? Commenting in general terms will be fine - unless you want to name names...

No names need to be named.

Its almost all stuff we weren't exposed to in residency.

- insurance payment issues
- patients that don't speak English well enough to have a real conversation but yet come to their consultation without an interpreter
- patients who bring an interpreter who:
a) doesn't speak any better English than the patient
b) seemingly speaks good English but is apparently unable to explain things to the patient because they patient clearly is VERY confused about the plan
- self-pay patients that can't pay (which isn't really an issue because I won't see them without payment up front, but I feel bad to have to send them to county)
- personnel issues ("my BF broke up with me so I'm not myself today" or my MA who tells patients when she's never done something before [way to instill confidence] or that something grosses her out

)
- patients who lie, make up stuff or simply don't hear what I tell them
(Patient: "You said you were taking out 17 lymph nodes", Me:"No I said I was taking about whatever you had, I have no idea how many that is ahead of time",
P: "Dr. Cox said my surgery would be on Friday." My staff: "No, she said she operates on Fridays. She didn't say your case would be THIS Friday."
P: "You never told me about the possibility of a false negative frozen section or positive margins." Me: Yes I did, remember when I showed you this video and then we discussed it afterwards?" "P: Yes but I didn't really understand it." Me: When I ask you if you have questions after our consultation it is your responsibility to tell me if you are confused."

)
- patients complaining about "peripheral stuff" (ie, why did the hospital make me check in so early [cue violins], those nurses were mean to me, that hospital is too far away, I'm hungry, they wouldn't let all 17 of my family members stay overnight in my room, etc.); I spend so much more time fielding this &^%* than I do complaints about post-op pain, appearance of the incision, etc.
- nurses who make up ^&%$ they know nothing about to patients ("Oh, the [JP] drain is only in about 1 inch", "You need to use your pain pump more even if you don't have pain because it will help you heal faster" (to patients claiming they have no pain), "You should stay in bed tonight and rest" (despite strict ambulation orders from me), "You should have had both breasts operated on to prevent cancer from spreading to the other side", "There must be someone in your family who had cancer because its passed down, you don't just get it without a family history"

- assistants who don't assist (I'm sorry but just sticking a retractor in the wound ISN'T assisting me, I can use a Martin arm for that) but still get paid
- plastic surgeons who take drains out too early and then tell the patient to call me when the patient has, suprise suprise, a post-op seroma
-radiologists who apparently have never heard of microscopic disease and tell patients that since there is no evidence of the lesion anymore on imaging (after a needle biopsy) that "its all gone" leaving the patient to look at me like a fish-eyed fool when I explain they still need excision for high risk lesions
- patients who decide to ignore my recommendations because they don't "feel its necessary" yet then place me in a legal bind where I am required to find them another surgeon or terminate them
- what I feel is an unfair call schedule - despite the agreement to take it 1 month at a time and rotate, I have been on call since September save for 1 weekend when I went to Boston for a conference (part of it is my fault because I haven't said anything but I feel like its sort of obvious since there are only two of us - if YOU aren't on call, WHO IS?).

and so on...sometimes all the hand holding I have to do is tiring. I knew these would be high maintenance patients, so it wasn't unexpected but yes, it does make me bitter from time to time.

...to_the_OR! · Feb 20, 2009

ESU_MD said:
the big name on your diploma isnt gonna help you when you are alone in some lonely OR late one night with a problem you cant handle.

Wise words indeed. This is what MS4's need to be thinking about when making their rank lists.

Neuronix · Feb 21, 2009

PennSurgRes said:
As far as our surgery rotation for medical students, it's now actually the highest ranked rotation among the core clerkships.

How do we rank core clerkships anyways? I didn't realize there was a ranking. I mean, it's nowhere near as bad as when the Spoof video was made with the student putting a gun to his head at the thought of continuing his surgery rotation. But, I'd still be surprised if surg gets the highest evals of any rotation.

Low resident morale in surgery is something all the medical students see. We all joke around about it, because surgery residents do make a lot of nasty, rude, and off the cuff comments. We all know many of you haven't seen your kids/spouse awake in a long time (if you have them), many think constantly about quitting and don't recommend surgery to the students, and all the other things said about patients that medical students pass around on Friday from their week in the surg rotation. I mean you get some of this from the other rotations (Medicine most notably), but nowhere near as dramatically or frequently.

At least there isn't so much vitriol directed at the students anymore, as the administration seems to have become a lot more receptive to student feedback. It's probably not like ~4 years ago when one of my classmates claims to have been failed from a subspecialty surgery rotation for reporting that he was being told to work well over 100 hours a week as a 3rd year medical student shortly after the 80 hour work rules went into effect. Or when it was ABSOLUTELY DO NOT IF YOU CAN HELP IT do X subspecialty because you will stand there immobile all day, the attending will ignore you, the resident will hate you, you will learn pretty much nothing (except how to copy labs from a computer screen or carry around a scut bucket), and you will be miserable. But, that was only 4 years ago.

So has it really changed THAT much? I dunno. Need someone who's rotated through surg more recently to comment. I remember some other posts by Penn medical students over the years on SDN complaining about how much they hated their surg rotations. But then again some of my classmates went on to do surg at Penn and like it. It's just a personality match or a balls to the wall attitude in my opinion.

But that's all I know looking up instead of down or around. Grain of salt must be taken.

MediCane2006 · Feb 21, 2009

Some people need that aggressive, rigorous, uber-competitive hierarchical training style in order to push them to do their best. Others get stifled by it and need a more laid-back approach to surgical training. The residents I know at Penn thrive on the stress and misery and really seem happy there, but obviously it's an environment that's not going to be ideal for everyone.

The best advice I can give medical students is to talk to as many residents as possible when you're considering a program. No program is perfect, and similarly you can't always base your judgment on a single negative review. Identify what it is you want to get out of training, and then seek out the programs that will allow you to accomplish that.

Me, I don't care how hard I'm working as long as I'm having a good time, and it was really important for me to find a program with a strongly-bonded group of residents. Which is why I chose to go a few blocks east of Penn for training. Working your ***** off all week isn't bad when you know everybody's meeting up at the local bar Thursday night for the mandatory weekly liver rounds...

ESU_MD · Feb 21, 2009

Neuronix said:
one of my classmates claims to have been failed from a subspecialty surgery rotation for reporting that he was being told to work well over 100 hours a week as a 3rd year medical student shortly after the 80 hour work rules went into effect.

Personally, I dont think medical students should work more hours than residents. But, I dont think the ACGME 80hr work week rules protect medical students, rather most medical schools pre-arrange work hour limits for their students.

Neuronix · Feb 21, 2009

ESU_MD said:
rather most medical schools pre-arrange work hour limits for their students.

This ended up happening at Penn, so it is now a non-issue.

Before that though there was a lot of talk about medical students spending more hours than the residents because they would have to get in to pre-round earlier and then stay as long as their residents did. At some sites it was common as well if you were going for that H to volunteer to come in for extra surgeries... I mean, what determines an honors grade more than enthusiasm! Most students know this and fake it as much as possible. Some downright lie and say they're going into the specialty they're rotating through on every rotation. Others just say they don't know but boy isn't this fun!!!!!!!!!!!!!!!!1111111!!!!!!!ones!!!!

Not sure if this still goes on within the new fixed hours system.

smq123 · Feb 21, 2009

ESU_MD said:
Personally, I dont think medical students should work more hours than residents. But, I dont think the ACGME 80hr work week rules protect medical students, rather most medical schools pre-arrange work hour limits for their students.

The 80 hr work rules don't apply to med students.

Theoretically, it shouldn't be an issue since you should leave (at the latest) when your resident leaves...and they shouldn't be working more than 80 hours per week, either.

maxheadroom · Feb 22, 2009

smq123 said:
The 80 hr work rules don't apply to med students.

Theoretically, it shouldn't be an issue since you should leave (at the latest) when your resident leaves...and they shouldn't be working more than 80 hours per week, either.

While the ACGME rules don't apply to students, I thought that the LCME had come up with some similar guidelines.

Mariah246 · Feb 22, 2009

smq123 said:
The 80 hr work rules don't apply to med students.

Theoretically, it shouldn't be an issue since you should leave (at the latest) when your resident leaves...and they shouldn't be working more than 80 hours per week, either.

True, but I worked with a student who felt the need to take overnight call, every night.

:scared:

smq123 · Feb 22, 2009

maxheadroom said:
While the ACGME rules don't apply to students, I thought that the LCME had come up with some similar guidelines.

If they have, it's news to me.

Since there is no way of tracking the number of hours that a student actually works, I doubt that the LCME has made any guidelines regarding this.

On my sub-I, I worked with one of the most inefficient interns ever (who also, for some bizarre reason, wouldn't let the students leave when we were done our work

), and as a result was putting in 120-125 hour weeks. No one asked, no one cared.

Mariah246 · Feb 22, 2009

smq123 said:
On my sub-I, I worked with one of the most inefficient interns ever (who also, for some bizarre reason, wouldn't let the students leave when we were done our work ), and as a result was putting in 120-125 hour weeks. No one asked, no one cared.

We have protocol for this at our school:

1. Swift kick to the groin
2. Depart with smile
3. Tattle to program director in return for extra vacation

BlondeDocteur · Feb 23, 2009

Med students are not protected by the 80 hours rule. No way, no how. My school sets a few brightline rules ("you're not allowed in the hospital before 5," "on call nights you're home by midnight since you don't get the postcall day off," etc) but they're ignored when necessary/desired, with absolutely no repercussions. I know I was in the hospital by 4:30 many days, and on call nights stayed till 1-2 AM before coming back the next AM. All under the direction of my residents.

But for me, it was good. It was a "I've been to the mountain" experience-- as in, I did nothing for a month but work (100+ hours/wk) and sleep (4-5 hours), and I was happy. It put the last few nails in the coffin re: my worries about being cut out for surgery.

Sarcophageal · Feb 23, 2009

http://www.amsa.org/rwh/lcme.cfm

This may be old, but I guess it is vague.

Mariah246 · Feb 23, 2009

BlondeDocteur said:
Med students are not protected by the 80 hours rule. No way, no how. My school sets a few brightline rules ("you're not allowed in the hospital before 5," "on call nights you're home by midnight since you don't get the postcall day off," etc) but they're ignored when necessary/desired, with absolutely no repercussions. I know I was in the hospital by 4:30 many days, and on call nights stayed till 1-2 AM before coming back the next AM. All under the direction of my residents.

But for me, it was good. It was a "I've been to the mountain" experience-- as in, I did nothing for a month but work (100+ hours/wk) and sleep (4-5 hours), and I was happy. It put the last few nails in the coffin re: my worries about being cut out for surgery.

I had a similar experience on my surgery rotation and it too put in the final nails in the coffin.

Re: a career in general surgery or even any of the surgical subspecialties

SLUser11 · Feb 23, 2009

Sarcophageal said:
http://www.amsa.org/rwh/lcme.cfm

This may be old, but I guess it is vague.

Thanks. I've been looking for this for a couple years. I've always looked on the ACGME website, which was my first mistake.

.....Actually I just browsed the site, and I couldn't find any official statement. I've emailed the LCME, but does anyone know where to find an official statement?

PeepshowJohnny · Feb 23, 2009

From the LCME website:

"ED-38. The committee responsible for the curriculum, along with medical school administration and educational program leadership, must develop and implement policies regarding the amount of time students spend in required activities, including the total required hours spent in clinical and educational activities during clinical clerkships.

[SIZE=-1] Attention should be paid to the time commitment required of medical students, especially during the clinical years. Students' hours should be set taking into account the effects of fatigue and sleep deprivation on learning, clinical activities, and student health and safety."[/SIZE]

So, very wishy washy and no hard set hours on rules. They just want to see the schools have addressed this somehow, which they probably hand wave away based on how vague this is.

References here: http://www.lcme.org/functionslist.htm
Under "Curriculum Management"

pennresident · Feb 24, 2009

I stand by my original post. Of course, it's only my perspective.

I take great offense at choosing someone from our resident website and singling them out for their appearance or name. That particular resident is extremely smart, exceedingly hardworking, and nothing about his behaviour or background suggests privilege.

With regards to the student rotation. The surgery rotation, now, is the most popular rotation. The students attend Mon through Thurs - no more than 6am to 6pm (Fri is dedicated to didactics). The students have no clinical responsibility - they attend the OR or clinic. The residents and attendings are not mean to the students. The attending bonus structure is actually linked to their student evaluations. We are much more likely to ignore the students than anything.

With regards to my co-resident's post:

pennsurgres said:
probably the greatest degree of autonomy in the country.

This is a silly presumption. It's difficult to say which of the hundreds of programs in this country has the greatest degree of autonomy. But I do not think it is ours. See my original post for examples.

pennsurgres said:
chiefs complain to the program director, who is very receptive and acts on their feedback.

Dr. Morris, our program director, is fairly responsive to resident criticism. He recently pulled the residents from covering on of the gen surg attendings at Pennsylvania hospital (Pennsy).

pennsurgres said:
when we have fellows and residents visiting from other programs, most comment on the technical focus of the residency, as well as the autonomy penn residents enjoy.

Most outside residents/fellows that I have met comment on our lack of advanced laparoscopy. One person told me that Penn "felt very private practice."

pennsurgres said:
while we aren't marrying each other as at one highly ranked program, we get along fine and work together to get the work done.

Wow, sounds like a tight group doesn't it?

pennsurgres said:
our new chairman, dr. Drebin, is a well-regarded hepatobiliary surgeon who is very committed to resident education. He is truly a gentleman surgeon, and a pleasure to work with.

Dr. Drebin had a meeting with all of the resident's last week. The essence of the meeting was that on every major point about the residency and surgery program that nothing is going to change - a real visionary for you.

I have recently read some other posts by people matching this year. My best advice is that if there is a program that you felt was a good match (to abuse the oft used phrase) for you, go with it. Don't fall victim to lure of prestige - it's fairly hollow.

Good luck.

PennRes2 · Mar 6, 2009

I am also a Penn surgery resident. I've completed 3 clinical years and I'm currently in the lab.

I too take great offense that a specific resident in our program was singled out for his name or appearance. I agree that that particular resident is one of our very best - and by the way, he has an MD Ph.D from Penn. Who else on this thread can say that?

The surgery rotation for students is indeed ranked first based on the students' evaluations.

I can't comment on the autonomy at other programs around the country, but I can say ours is very high. As a first year, I logged over 60 cases in one month. As a second year, I performed a Modified Radical Mastectomy with the help of a third year med student. The attending was in the room for the last 5 minutes before the specimen was removed. How many did that during their second year?

I agree that advanced laparoscopy is a weakness in our program. The addition of rotations at Pennsy has significantly improved that feature.

I am surprised to hear the assertion that Penn is very private practice. I can understand that teaching takes something of a hit - but that is primarily due to the extraordinarily high case volume (many of which are very complex). Does a Whipple, a distal pancreatectomy, and a lap adrenal in one day, by one surgeon, sound like a typical private practice schedule? On an average day, the OR schedule just at HUP will include 3-6 cardiac cases, 3-6 thoracotomies or VATS, a Whipple, a distal pancreatectomy, an esophagectomy, multiple aortic aneurysms, and a transplant or two. This is in addition to the more typical cases.

After three clinical years, I've logged 680 total major cases. Minimum requirements for five years are in parentheses. 90 (25) skin soft tissue and breast, 58 (24) head and neck, 78 (72) alimentary tract, 29 (65) abdomen, 3 (4) liver, 1 (3) pancreas, 74 (44) vascular, 51 (8) endovascular, 4 (10) operative trauma, 13 (20) non-operative trauma, 13 (15) thoracic, 25 (20) pediatric, 9 (5) plastic, 44 (60) basic laparoscopy, 15 (25) complex laparoscopy, 86 (85) endoscopy.

As far as cameraderie goes, my opinion is that ours is quite good. Are there people I'm not crazy about? Of course. But for example, I have been to our new chairman's (Dr. Drebin) house on multiple occasions. I've swam in his pool. I know his kids' names. He's been to my house too. My friends from our residency came to my wife's baby shower. I think that's pretty good for cameraderie.

Is Penn the best program out there? I don't know. Is it the most malignant? I have no idea. My personal opinion is that it's a great program and I don't think it's malignant. What kind of people come to Penn for residency? Well in my class, two people were ranked first in their med school class. The average Step 1 score in my class was above 250. Most of my classmates score above the 90th percentile on the ABSITE every year.

Oh and by the way, I'm one of the people who would classify as a W. Reginald Farnsworth-Livingston III. My dad is a sales manager. My grandfather was a stock broker. I went to an average med school. I paid for all of it with loans.

Neuronix · Mar 6, 2009

PennRes2 said:
and by the way, he has an MD Ph.D from Penn. Who else on this thread can say that?

Nobody I know... :laugh:

The surgery rotation for students is indeed ranked first based on the students' evaluations.

Nice work on the turn-around. Back in my early clinical days before the PhD the advice was "Take surgery before the PhD. Almost everyone hates it and you should get it out of the way before you come back as a 30 year old." Everyone who followed that advice now feels cheated

SLUser11 · Mar 6, 2009

beaverfetus said:
Yay stereo types about roman numeral named residents! I'll bet we all can guess how a "IVth" looks...

http://www.uphs.upenn.edu/surgery/housestaff/mkl.html

PennRes2 said:
I am also a Penn surgery resident. I've completed 3 clinical years and I'm currently in the lab.

I too take great offense that a specific resident in our program was singled out for his name or appearance. I agree that that particular resident is one of our very best - and by the way, he has an MD Ph.D from Penn. Who else on this thread can say that?

Congratulations to Penn Residents 1 and 2 for coming to the defense of somebody who didn't need it. As I've quoted above, BeaverFetus's referral to a specific resident was actually to point out that, being African American, he doesn't fit the stereotype of rich white privileged types that I poked fun at with my post.

PennRes2 said:
The surgery rotation for students is indeed ranked first based on the students' evaluations..

Of course. From your co-resident's description, they have no clinical responsibilities, and very limited hours. It's a known fact that many students don't want to work hard......I also have a personally developed theory about self-entitlement issues among students from "top 10 programs," but I won't get into it now, or PennStudent2 will bravely sign up for SDN and defend your wonderful school's honor.

PennRes2 said:
I can't comment on the autonomy at other programs around the country, but I can say ours is very high.

I agree that your operative experience is above average based on your personal stats. It is obvious, however, that you lack laparoscopic volume there. That's one downside to doing 5 whipples and 37 esophagectomies a day. Still, I don't think it takes 100 lap appies to become proficient, so I don't think there's a legitimate issue there.

PennRes2 said:
As far as cameraderie goes, my opinion is that ours is quite good. Are there people I'm not crazy about? Of course....

It sounds like there's some cliques, and pennresident didn't get invited to the last wine and cheese party.

PennRes2 said:
My personal opinion is that it's a great program and I don't think it's malignant. What kind of people come to Penn for residency? Well in my class, two people were ranked first in their med school class. The average Step 1 score in my class was above 250. Most of my classmates score above the 90th percentile on the ABSITE every year..

Am I supposed to be impressed? One of the residents from my program can recite the entire script of Star Wars from memory. Priorities, man......

PennRes2 said:
Oh and by the way, I'm one of the people who would classify as a W. Reginald Farnsworth-Livingston III. My dad is a sales manager. My grandfather was a stock broker. I went to an average med school. I paid for all of it with loans.

Dr. Farnsworth-Livingston, you have to be able to make fun of yourself. It's obvious that there are a few more III's and IV's in your residency than at State U.....instead of preaching about your humble beginnings, try proving to me that you don't have a huge stick up your @ss, and you'll do more for my overall impression of the Penn environment.

Seriously, we should end this debate soon. The ROLs are already certified, so nothing is going to change. Also, it's obvious that you guys have at least a partially malignant environment, and you should just embrace that, as it is obvious that you're still able to get top quality applicants every year.

Pennresident voiced his concerns anonymously that he was afraid to do in public. PenSurgGuys1 through 3 then retorted. We now know that it's not all bad, but not all good. Let's let it die before PennLuvr504 signs up and once again valiantly defends Dr. Lee's honor......

BlondeDocteur · Mar 7, 2009

One question-- how on earth do you know the average Step 1 score for your class? That raises a host of scarlet red flags for me...

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