I get extremely long-winded in this post, but my main points are that the surgical stereotype is most prevalent in the Northeast, and that there are a lot of programs in other areas of the country, both academic and community, where your experience can be different. It's up to you to decide (and it's also up to you if you want to read my whole post or not).
I've been on SDN for two years now, and I've noticed a very large population bias, with much less input from students and residents training in the Midwest, with most people who share their experiences being from the East or West coast. I understand that a part of this is the large ## of people training in these areas, but it still raises some issues for me.
I believe that a lot of our experience in surgery is limited to where we went to med school and where we trained for surgery. Still, since we're extroverts and know-it-alls (myself included), we still convey our limited experience as "the way it is." So, when SDNers come to this forum seeking information, they're told "this is what surgery is like, no exceptions," and it scares a lot of people away from our beloved field of medicine. Anyone who would make such an important decision based on an anonymous internet forum has their own problems, of course….
There is a small geographic area that is home to supposedly the "best schools in the country," and yet this is area from where I hear stories about:
1. the most outrageous physician mistakes
2. the worst student and resident behavior
3. the biggest violations of work hour regulations
4. the most deficient ancillary staff
5. the least autonomous and lowest volume of operative cases
6. etc, etc, etc.
However, these stories don't come off as cautionary. Instead, they sound like bragging or stating the surgical norm, with no desires or attempts to fix the problems. I believe everyone should express their opinions here, but I feel that those people who propagate negative stereotypes and facilitate bad behavior are not good for the field. We've cluttered this board with fallacies that impressionable students are accepting as fact. And, as soapbox-y as this sounds, we need to be instruments for change, not facilitators of outdated tradition.
To start, as a student, it is not necessary to do menial tasks unrelated to education to earn some teaching from the team. As a resident, it is not necessary to work 100+ hours/week, especially when a lot that time is spent doing low-yield work. It is not necessary to train at large big-name academic centers to get a good education and a strong fellowship, and so on.
Some other things that bother me:
1. The 80 hour rule- How many times have we heard students and residents alike state that this rule is some wild fantasy and is really non-existent. On SDN, we universally state that we lie on our timecards weekly, and we'd get in trouble with the program if we didn't.
This isn't true everywhere. There are plenty of programs, both big and small, that try their best to comply with the rules, and many who succeed. I average 80 hours, mostly thanks to night float. Granted, I take calls on my patients from home.....
2. Operative experience- The stereotype is that you don't operate until you're a senior resident, and you have to go to a VA or county hospital to actually do anything besides assist the attending. Thus, you feel the need to do a fellowship to learn how to operate.
There are lots of program where you operate from day one until you graduate, with your caseload appropriate for your level (Appys, choles, hernias, etc for juniors, and colons, liver/panc, etc for seniors). In these surgeries, you do the operation, and you're not retracting for an attending. Academic surgeons and private practice guys will both allow you to do this if you find the right place to train.
I guess my main point, although probably lost in my ranting, is that we should all share experiences and give input, but we shouldn't act like the choices we made and the environment that we're in is the only way to do it. In surgery, there are plenty of choices, and the students should be presented with options instead of being told that the "horrors of surgery" are inevitable.
I've been on SDN for two years now, and I've noticed a very large population bias, with much less input from students and residents training in the Midwest, with most people who share their experiences being from the East or West coast. I understand that a part of this is the large ## of people training in these areas, but it still raises some issues for me.
I believe that a lot of our experience in surgery is limited to where we went to med school and where we trained for surgery. Still, since we're extroverts and know-it-alls (myself included), we still convey our limited experience as "the way it is." So, when SDNers come to this forum seeking information, they're told "this is what surgery is like, no exceptions," and it scares a lot of people away from our beloved field of medicine. Anyone who would make such an important decision based on an anonymous internet forum has their own problems, of course….
There is a small geographic area that is home to supposedly the "best schools in the country," and yet this is area from where I hear stories about:
1. the most outrageous physician mistakes
2. the worst student and resident behavior
3. the biggest violations of work hour regulations
4. the most deficient ancillary staff
5. the least autonomous and lowest volume of operative cases
6. etc, etc, etc.
However, these stories don't come off as cautionary. Instead, they sound like bragging or stating the surgical norm, with no desires or attempts to fix the problems. I believe everyone should express their opinions here, but I feel that those people who propagate negative stereotypes and facilitate bad behavior are not good for the field. We've cluttered this board with fallacies that impressionable students are accepting as fact. And, as soapbox-y as this sounds, we need to be instruments for change, not facilitators of outdated tradition.
To start, as a student, it is not necessary to do menial tasks unrelated to education to earn some teaching from the team. As a resident, it is not necessary to work 100+ hours/week, especially when a lot that time is spent doing low-yield work. It is not necessary to train at large big-name academic centers to get a good education and a strong fellowship, and so on.
Some other things that bother me:
1. The 80 hour rule- How many times have we heard students and residents alike state that this rule is some wild fantasy and is really non-existent. On SDN, we universally state that we lie on our timecards weekly, and we'd get in trouble with the program if we didn't.
This isn't true everywhere. There are plenty of programs, both big and small, that try their best to comply with the rules, and many who succeed. I average 80 hours, mostly thanks to night float. Granted, I take calls on my patients from home.....
2. Operative experience- The stereotype is that you don't operate until you're a senior resident, and you have to go to a VA or county hospital to actually do anything besides assist the attending. Thus, you feel the need to do a fellowship to learn how to operate.
There are lots of program where you operate from day one until you graduate, with your caseload appropriate for your level (Appys, choles, hernias, etc for juniors, and colons, liver/panc, etc for seniors). In these surgeries, you do the operation, and you're not retracting for an attending. Academic surgeons and private practice guys will both allow you to do this if you find the right place to train.
I guess my main point, although probably lost in my ranting, is that we should all share experiences and give input, but we shouldn't act like the choices we made and the environment that we're in is the only way to do it. In surgery, there are plenty of choices, and the students should be presented with options instead of being told that the "horrors of surgery" are inevitable.