BAD MOJO during M3 Clearkships

[tegs15]

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Let me preface this post by saying that I am not trying to start a flame war or piss any surgery residents off. I'm normally in the EM forum but recognize many names here from my premed searches and respect your opinions.

I'm wondering what the "norms" are for resident-student interactions in the OR during M3 surgery clerkships. My institution is extremely worried about inappropriate occurances that have transpired, b/c last years seniors reported greater than 10% of them were verbally or physically "abused" during their surgery clerkships by residents. These events happened at our own medical center and predominantly involved (here come the flames!) FMG residents. [To defend my statement of events, this information came to me during a small monthly lunch with one of the medical school deans, who by the way is preoccupied with the fall-out of these reports.]

Most of the event were reported as physical abuse involving shoving or the violent pushing of a student away from the table during surgery or slapping hands, fingers and arms with instruments. I'm not surprised that the fingers have been pointed at FMG residents just b/c 2/3 of our surg residents are foreign trained. The odds would speak for them self.

Are these event's normal? Should I expect this or be worried.😱

[I have no problem with being forcefully moved during a code or life/death treatment or yelled at to move. That makes sense, but for other reasons...?]

 

[tegs15]

I understand this might be a TOUCHY subject. If anyone has any insight or advice they would be willing to share PM me.

 

[SocialistMD]

No resident should ever physically touch a student, unless that touch is holding the student's hand in teaching how to suture/tie (or something along those lines) or to clap them on the back saying "good job."

The verbal abuse issue is a more difficult one to address, as some students are more sensitive than others. While I acknowledge there are instances of residents (or even attendings, for that matter) overstepping their bounds and saying mean/hurtful things that are incredibly unnecessary, I have seen many more instances in which students take things out of context or are hypersensitive.

 

[doc02]

I've heard stories of attendings hitting people with instruments or throwing instruments, but it's always second-hand. I've never met anyone who has actually been subjected to this behavior. It is most likely something that occurred about a decade ago but doesn't occur any more; however, it continues to be circulated.

In terms of "abuse," it is like what I say about what people call "malignant." The problem is there's no definition of it, unless it's an extreme. What I consider malignant another person will consider to be par for the course and vice versa. I've run into students where I give them advice to follow and even sit down for an hour or more to talk to them about how to improve and they ignore it, so after a while I ignore them and don't bother teaching or interacting with them because they're clearly wasting my time. I don't have an hour to waste on someone who is going to ignore me, therefore the student becomes a nuisance to me. You'd probably consider that to be malignant, if you were the student; I consider that to be practical and I have no qualms about doing it.

 

[tegs15]

I've heard stories of attendings hitting people with instruments or throwing instruments, but it's always second-hand. I've never met anyone who has actually been subjected to this behavior. It is most likely something that occurred about a decade ago but doesn't occur any more; however, it continues to be circulated.

As this information has come via the dean, I think it is real enough. Especially after seeing how concerned they (admin) are about the issue. They estimate (i don't know why or what protacol they use) that for every 1 individual that reports it 2 others don't! They are concerned that as many as 30-40 students per class enjoyed these experiences during the surgery clerkship. They have also decided to connect it to our declining numbers of students pursuing and matching surgery residencies. More and more of our students are doing Rads, Anesthesia, Psyc and IM (I realize there is a trend to life-style careers) even though our average step 1 scores are continueing to increase above the national mean. I just hope they have things ironed out next year.

 

[doc02]

Oh, well. If they think that so many people are getting stuff thrown at them and getting pummeled in the OR and they haven't been able to stop it, then you must go to a school that is run by ******s. Especially if the people doing the abuse are FMGs, where you can just tell them they'll get deported if it happens. Therefore, I find what you say to be highly unlikely unless, like I said, your school is run by ******s.

 

[tegs15]

Oh, well. If they think that so many people are getting stuff thrown at them and getting pummeled in the OR and they haven't been able to stop it, then you must go to a school that is run by ******s. Especially if the people doing the abuse are FMGs, where you can just tell them they'll get deported if it happens. Therefore, I find what you say to be highly unlikely unless, like I said, your school is run by ******s.

Maybe they are? I guess there could also be a disconnect between the physicians in charge of this clerkship and administrators over the curriculum. The PD isn't going to like to hear that his/her residents are misbehaving. The other thought I had was that they are trying to balance student needs and medical needs of patients. If they had enough money or fewer patients they could just deport them as you suggest but we are a private instituion w/o state tax funds, it would be difficult to see all the patients that request/need care and toss out free labor at the same time.

 

[Misterioso]

Get over it. This is surgery. You're not gonna be treated like a princess. If you can't man up then don't do surgery once you finish your rotation. Frickin' whiners.

 

[doc02]

Where do you go? Or at least what state are you in?

 

[tegs15]

Get over it. This is surgery. You're not gonna be treated like a princess. If you can't man up then don't do surgery once you finish your rotation. Frickin' whiners.

That's an idea........but what other careers (besides military) should one expect to be physical abused in? If it happened on the street corner would it be seen as battery? Better yet if your boss shoved you into the wall and verbally threatened you, might one consider it assult and battery?

People always say.."grow a pair" or "quit crying", but why do some attending/residents consider this appropriate behavior? Why would it be justified in the OR but not in McDonalds, a dentist's office or a court room?

 

[tegs15]

I guess it's ok in a Court Room, but it's normally not an employee and a taser is the tool put to use.😀

 

[doc02]

Where do you go? Or at least what state are you in?

 

[Pilot Doc]

I'm wondering what the "norms" are for resident-student interactions in the OR during M3 surgery clerkships. My institution is extremely worried about inappropriate occurances that have transpired, b/c last years seniors reported greater than 10% of them were verbally or physically "abused" during their surgery clerkships by residents.

What's appropriate is uniform nationally. What's normal varies widely.

It sounds like your administration is sensitive to the issue, so I wouldn't let it worry you too much beforehand. If somebody oversteps the line, tell your dean.

I very much doubt that any of the abuse is of a nature that is actually dangerous (purposeful needlesticks, rape, etc.).

 

[Pilot Doc]

I attached a pretty good synopsis on how to thrive in a malignant environment.

 

[tegs15]

Pilot Doc, I think your right, no significant physical harm is likely. But as a slightly older non-trad I find it extremely disconcerting that these residents would have such childish behavior and I might need to put up with it in the future. At home we work hard to teach our children not behaving this way!

Additionally, I feel for those students who were/will be interested in surgery and get a bad taste in their mouths. I'm sure our admin is working on out the needed solutions, they are normally very responsive to students needs.

My main reason for the post was just to see how prevalent these type of events/attitudes were throughout the country.

doc02 - I'm in the Midwest and there are a couple of medschools in our state.

 

[tegs15]

thx pilot doc - some interesting things to remember.

 

[OTD]

Well bottom line it comes down to "grow a pair.".

If they are shoving you out of the way because you are standing there with your thumb up your #$$ in the way while the patient urgently needs help, or if you are reaching for something dangerous in the OR and they slap your hands to keep you from harming you/the patient then grow a pair. Know that they are protecting the patient/you, it's not personal, and a good learning opportunity. It's surgery, you have to act and you can't take all day to do it. It's dangerous and you have to be aware of everything possible. Even then patients/caregivers still get hurt every day.

If it's just abuse, you know REAL abuse and not this made up PC crap about "not hurting my wittle feewwwlins" then GROW A PAIR and stand up for yourself and do what is needed and right. If you are comfortable with it then let the person involved know it's not acceptable to be abused. If you are not comfortable with it go over his/her head.

People can't teach you how to be an adult, you have to step out there and do it on your own.

I'm not meaning that in a bad way either, that's just life.

 

[Faebinder]

Just a random thought... You wont find many "nice" surgery residencies... Malignancy is like ****, it rolls down hill... meaning it starts at the chairman and the rest of the attendings, rolls down to residents and fellows, down to interns and eventually the students... You are feeling the setup of the program, not just the residents... The question is: Is the program so different than the rest of the other surgery programs out there? Lets put it this way, each specialty recruits its stereotypical personality. If a program notices you dont have the stereotype of a "surgeon" they wont be dying to recruit you as they will think you will be a "bad" surgeon.

If you are not interested in being a surgeon and its a minor thing then move on. If you do get abused, report it.

 

[SLUser11]

I attached a pretty good synopsis on how to thrive in a malignant environment.

A lot of that same advice was on "Grey's Anatomy" last season, and I think has similar value......

 

[SLUser11]

doc02 - I'm in the Midwest and there are a couple of medschools in our state.

Does it rhyme with Dayton?


Anyway, a realistic answer to your original question is that no, it's not normal, but yes, you should expect it, since apparently it's normal at your school.

That being said, it truly is better for yourself to not rock the boat too much. At the same time, if you don't stand up to someone being inappropriate, then the cycle will continue and your underclassmen have some bully-ish behavior coming....in broken english.....

 

[Pilot Doc]

I find it extremely disconcerting that these residents would have such childish behavior and I might need to put up with it in the future. At home we work hard to teach our children not behaving this way!

I think there are two issues here

1) How to survive (and hopefully derive some benefit) as a trainee with very little power in a malignant training environment. To a greater or lesser degree, this situation is very common and trainees (both students and residents) are poorly prepared for this, in my experience.

2) How to ultimately change a bad situation

In most cases, residents and particularly med students have very little ability to carry out #2. You can try, but the result is generally some combination of failing to change the situation and hurting yourself.

#1 is tricky. I'm not feeling like expounding on how to do it. The essence is to realize that you can learn from everything - even if some people are an example of how not to do things.

 

[doc02]

At home we work hard to teach our children not behaving this way!

That's a rather simplistic way of looking at things. If I put your children in the position of working between 90-100 hours a week in a high-stakes environment, I'm pretty sure they wouldn't be all sugar & spice and everything nice.

You said you want to go into EM. I can tell you right now that, not as a defense of how surgeons act but just as an independent observation, if I had kids and they acted like most EM people that I knew I'd have them horsewhipped. Not because EM people are mean ol' bad people because they're not, but as I have said before they have an almost callous disregard for practicing medicine in favor of simply moving a patient to someone else. Personally, I find that more distasteful, but that's just me.

 

[Pilot Doc]

That's a rather simplistic way of looking at things. If I put your children in the position of working between 90-100 hours a week in a high-stakes environment, I'm pretty sure they wouldn't be all sugar & spice and everything nice.

Oh come on. Giving the OP the benefit of the doubt, he was describing behavior that is at least boorish and possibly criminal. Hitting and shoving students is not acceptable in any circumstance.

 

[tegs15]

Thanks everybody for the great responses. I guess to summerize; 1-Abuse happens but it shouldn't. 2-Be prepared to deal with it in your own way. 3- And balance acceptance of these events with willingness to help change them & live with the consequences. Seems reasonable.

I wonder if anyone has ever "dealt" with abuse similiarly to they way they recieved it? You know like taking the resident aside after the procedure and convencing him that castration with a pair of rusty pliers is a REAL possibilty?😱 This would most certainly have associated consequences, but might be enjoyable for a few short minutes.

 

[tegs15]

That's a rather simplistic way of looking at things. If I put your children in the position of working between 90-100 hours a week in a high-stakes environment, I'm pretty sure they wouldn't be all sugar & spice and everything nice.

You are most certainly right! However, I wouldn't place patients lives in the hands of children either. These "adults" failed to learn how to play well with others and keep their hands to themselves, something that is reinforced daily throughout elementary school. "Excusses are like... well you know the rest. The advice of "growing a pair" is easily applied to abusive residents, they need to learn how to control themselves and their emotions. Self control does require intestinal fortitude! Part of me thinks that these principles might not have been taught to these residents, as they are foreign and predominately from a single region of the world. Maybe their cultural norms accept and encourage this type of behaviour in the medical field. (INCOMING FLAMES...glad I own nomex underware) In all seriousness It might just be a cultural difference of how students and residents are trained in differing parts of the world.

You said you want to go into EM. I can tell you right now that, not as a defense of how surgeons act but just as an independent observation, if I had kids and they acted like most EM people that I knew I'd have them horsewhipped. Not because EM people are mean ol' bad people because they're not, but as I have said before they have an almost callous disregard for practicing medicine in favor of simply moving a patient to someone else. Personally, I find that more distasteful, but that's just me.

Are you saying they (EM-residents) are not "touchy-feely" with their patients and this lack of feeling is translated into a unprofessional movement of patients to other specialists?😕 My understanding (mind you I'm just M2 and only worked FT as a ED-tech for 3 years) of the concept of the ED is that acutely ill patients are stablized and then moved to a specialist who can better provide care to the patient? Patients w/less emergent conditions are treated, released and refered to a specialist (FP, IM) that can work longterm on behalf of the pt. Correct me if I'm wrong and feel free to clarify your quote above, I certainly could be mistaken.🙂

 

[doc02]

Are you saying they (EM-residents) are not "touchy-feely" with their patients and this lack of feeling is translated into a unprofessional movement of patients to other specialists?

Nope. EM residents and attendings are often extremely nice people. Of course, as I always say, it's easy to be extremely nice when you're not doing anything other than being extremely nice. I mean, I could be extremely nice, too, if my morning rounds consisted of "OK, this is bed 8, he's waiting for Surgery to see him. This is bed 9, he's been cleared for discharge. This is bed 10, she was seen by Surgery and they don't want her, so we're waiting for OB to see her ..."

 

[DrDawg]

So what do the surgical house staff have to say? What is their side?

 

[SLUser11]

Nope. EM residents and attendings are often extremely nice people. Of course, as I always say, it's easy to be extremely nice when you're not doing anything other than being extremely nice. I mean, I could be extremely nice, too, if my morning rounds consisted of "OK, this is bed 8, he's waiting for Surgery to see him. This is bed 9, he's been cleared for discharge. This is bed 10, she was seen by Surgery and they don't want her, so we're waiting for OB to see her ..."

Open and honest question: Have you ever done an ER rotation, either as a student or resident?

I honestly think all students should do a month of ER, as it provides some much-needed perspective.

 

[doc02]

Open and honest question: Have you ever done an ER rotation, either as a student or resident?

I honestly think all students should do a month of ER, as it provides some much-needed perspective.

Yes, I've done a rotation as a student and in residency. In either case, it was great in that the hours were very good. It was better as a student because I never had to call in the consults. As a resident, I had to call in consults when the attendings told me to, rather than after what I personally felt the workup should involve. This often led to me (usually deservedly) getting reamed out. I know other people in other specialties and hospitals, too, who have to do ER rotations and it's funny because they'll go down there and basically practice like them and the Chiefs will go, "what are you doing? Sheesh!" when they get their calls. I personally hated it, but some residents enjoy it because it's a laid-back atmosphere and a change from the normal routine. The good part for us is that we get to avoid stuff that's not in our specialty (e.g., vag bleeds).