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Most surgeons don't actually teach while doing the surgery. And if you're stuck retracting and getting out of the way of more important people, you can't see much. Sometimes I feel I would learn more if I just watched a surgery on youtube with actual commentary.
 

vicinihil

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unless you enjoy watching surgeries, scrubbing in is a total waste of time in terms of learning. You are better off studying for the shelf on your own. Scrubbing does help your evals though because surgeons think you have an "interest." Striking the image that you care and actually doing well on the shelf is a fine line you have to walk.
 
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Well the problem isn't that I want to feign interest at this point. It's because they need free surgical assist = human retractor which is why I'm there. Not because I want to be but b/c resident told me to be. *sighs*

Yeah, I agree that it's a huge waste of my time.
 

cpants

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Maybe you would get more out of it if you actually were interested and attempting to learn something. As good an actor as you may think you are, you really aren't fooling anyone. Everyone sees you staring at the clock, generally not paying attention, hating every minute of it.
 

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unless you enjoy watching surgeries, scrubbing in is a total waste of time in terms of learning. You are better off studying for the shelf on your own. Scrubbing does help your evals though because surgeons think you have an "interest." Striking the image that you care and actually doing well on the shelf is a fine line you have to walk.
Scrubbing surgeries will not help your shelf score, but it will help your evaluations, especially if you come prepared, which is still a decent portion of your grade. The educational value is variable, but it is a part of your journey on becoming a competent, well-rounded physician....which I would opine is just as important as your shelf score.

Well the problem isn't that I want to feign interest at this point. It's because they need free surgical assist = human retractor which is why I'm there. Not because I want to be but b/c resident told me to be. *sighs*

Yeah, I agree that it's a huge waste of my time.
Well, you're not really needed in the OR. A bookwalter retractor or something similar is a much more effective retractor than the medical student. We are just naive enough to think that you want to be there, and that you are learning despite your crappy attitude. Also, our huge surgical egos need an audience....especially if we are going to tell some hilarious jokes or something.


The majority of students will not choose a surgical career, so the technical aspects of surgery may not have long-term applications, but the entire experience makes you a better overall doctor. I didn't want to do psychiatry, but I paid attention and participated in rounds. I didn't want to do OBGYN, but I still participated in deliveries and C-sections.

I think when people get done with med school and look back on their education, they see that there's much more to becoming a doctor than doing well on the shelf. There are lots of clinical things, including learning how to be part of a team, that are very very important.
 

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The only time I enjoyed surgery was actually in OB. And it came not from the surgery itself, but because I got along well with the residents, joking and enjoying our time together.

For the entirety of my surgery rotation, which is dispensed between the University Hospital through VA and Private institution, I did little more than be in the way. Even if I tried to get involved (on rotations where I was well liked by the attending) he was too busy teaching the fellow to bother to teach me.

I look at scrubbing in from a different perspective. It really does show who wants to be a surgeon and who doesnt. If you enjoy strapping on an extra layer, spending hours under the lights not being able to be seen, acting as a human retractor, and losing your entire day, you are a surgeon. It doesnt matter if you are learning, you are loving it. If you are like the other 80% of students, and really cant stand it, its ok, your experience is very similar to everyone who doesnt want to be a surgeon.

And finally, the things you learn in surgery have nothing to do with your shelf, nothing to do with your Step, and, unless you are surgeon, nothing to do with your career. Its all procedural information that becomes extremely relevant to the surgery, but utterly useless to the rest of the medical field. It is probably the only time where I say that medical students really "dont need" to learn what they are being taught.

Bottom line: If you feel like you're learning nothing being in surgery, dont be too worried. Most medical students agree with you.
 

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If you enjoy strapping on an extra layer, spending hours under the lights not being able to be seen, acting as a human retractor, and losing your entire day, you are a surgeon. It doesnt matter if you are learning, you are loving it.
Well, I don't think anyone, surgeon or otherwise, would enjoy the above-mentioned scenario....so I don't know if that really would help someone decide to be a surgeon....like they love the OR so much than even just standing there doing nothing is awesome.....usually those people end up being ill-fit for a surgical career.

Unfortunately these scenarios exist, and are not very high-yield learning experiences. However, if that's the only surgeries you are doing, then you are not really experiencing general surgery. Much of what we do is laparoscopic, which can be seen easily on the big screen. Open abdominal cases usually can accomodate a med student or two without eliminating their view of the surgery itself. And, most general surgery procedures take less than 2-3 hours.

To current med students: What surgeries are you doing where you have to retract for hours and see nothing? What percentage of the surgeries you scrub consist of this situation? If students do nothing but whipples all day on their rotation, that is a case of severe sample bias.
 

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Like most rotations it is really dependent on both the student and the rest of the team. During some surgeries I was confused and consequently bored (and given my experiences with those surgeons I was not comfortable asking questions which also sucks as I thought the reason we take a surgery rotation was to learn) but there were others (unfortunately the minority) where the surgeon or resident let me be involved and helped me learn.
 

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A lot of you guys are making it sound like you have a choice about scrubbing in. Is that how it works at your school/rotation? I was told I need to be scrubbed in on every case we do, no exceptions.
 

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To current med students: What surgeries are you doing where you have to retract for hours and see nothing? What percentage of the surgeries you scrub consist of this situation? If students do nothing but whipples all day on their rotation, that is a case of severe sample bias.
I've done quite a few parathyroidectomies, thyroidectomies, facial procedures, and vaginal surgeries that basically made me a retractor bitch for several hours at a time with minimal or no view of what was going on. I can't say I loved my surgery rotation, but I didn't really have a problem with it. Most of the attendings were pretty good about explaining what they were doing, so it wasn't nearly as miserable as it could've been.

Laparoscopic cases were the ones I hated the most since I always managed to get stuck driving the camera. To me, that's way worse than retracting since you're often in a really awkward position and have to remain perfectly still.

Like Perrotfish, if there was a surgery to be scrubbed into, I was there. It wasn't a choice I had, but I'd rather be there than doing floor work. I feel like I learned a ton on surgery, even if I wasn't doing much more than holding stuff the majority of the time. Unlike what someone else said, I learned lots of stuff for the shelf just through surgeries and listening to what people were saying. I didn't crush the shelf or anything, but I beat the national average and didn't study for it much at all. Given that I knew next to nothing about surgery coming into the year, that seems to speak well of our program (or at least of the rotations I did).
 

hot sauce

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A lot of you guys are making it sound like you have a choice about scrubbing in. Is that how it works at your school/rotation? I was told I need to be scrubbed in on every case we do, no exceptions.
Where I was you weren't exactly told to scrub in but it was generally understood that you would unless you were told not to. I suspect that if you didn't you would be viewed as a disinterested slacker.
 

SLUser11

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I've done quite a few parathyroidectomies, thyroidectomies, facial procedures, and vaginal surgeries that basically made me a retractor bitch for several hours at a time with minimal or no view of what was going on. I can't say I loved my surgery rotation, but I didn't really have a problem with it. Most of the attendings were pretty good about explaining what they were doing, so it wasn't nearly as miserable as it could've been.

Laparoscopic cases were the ones I hated the most since I always managed to get stuck driving the camera. To me, that's way worse than retracting since you're often in a really awkward position and have to remain perfectly still.
Facial procedures and vaginal surgeries are typically outside the realm of general surgery. While thyroids and parathyroids are common, they shouldn't make up a majority of your caseload as a student.

I agree with you that the resident and faculty buy-in to the student learning process is key to a positive experience. I also like that you saw the practical utility in scrubbing these cases, even though it wasn't very fun.

I'm still interested to hear from other MS3s. Is the majority of your time on the surgery rotation truly spent retracting with little or no view of the surgical field, or is this a small portion of your experience that has been amplified due to it's uncomfortable nature?
 

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I personally think its the experience as a whole that is invaluable. All the way from pre-oping a patient, knowing the history and physical, indications for surgery, surgical procedure, lab values all the way to the PACU and the floor.

I liked scrubbing in on a surgery of a patient of mine who I did all the aforementioned leg work because it gave me the whole picture of the patients time in the hospital. I think its extremely important knowing how the inside of an OR works because your patient in the future will end up in the OR at some point in their lives and YOU will have to comfort them, even if you're not the person performing the surgery. Also as far as the 'human retractor' bit goes, its true, but anymore than that could turn into a liability issue. I can't say I liked retracting, but I was able to see enough that I would be able watch a surgery video on mute and be able to point out specific structures. I felt it was the closest I could get without compromising the surgery or patient safety. I also had a chance to 'man' the laproscope which was an awesome experience, it was like driving a car inside the body haha. That plus suturing with the resident after the main portion of the surgery was done was kind of cool.

Overall, I had a great time in the OR, other than the personalities (nurses and attendings) at times. The residents I worked with were bad ass, so I had a great time just "hanging out" with them so that may be the reason why my experience was so positive. People should take it as a learning experience for 12 weeks or so and get a chance to do things that you might not be doing for the rest of your lives. I learned a ton from just being in the OR and hearing the resident get pimped by the attending and by reading up on the disease process/indication/procedure. I can't say how i will fare for the shelf, but reading NMS now is a breeze since I can imagine the process of how things were done in real time.

All that being said, I'm not even the surgical type, I like medicine haha
 

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I'm still interested to hear from other MS3s. Is the majority of your time on the surgery rotation truly spent retracting with little or no view of the surgical field, or is this a small portion of your experience that has been amplified due to it's uncomfortable nature?
I spent the majority of my time observing and listening to the surgeons explaining the procedure. When I did scrub in, it was to help (with some retracting) but also to be taught and sometimes do a few knots and such. I was mostly encouraged to scrub in so I could be closer to the procedure and see what was happening. Lap procedures were great because of the big screen view.

It was an amazing experience all around and I really respect surgeons and what they do, even though it is not my calling.
 

Smurfette

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Surgery rotations vary a lot by school---there are places where students are very involved and places where they are virtually ignored. That sucks.

When I was a student, we always got to sew a bit at the end (or staple, depending on attending) and occasionally got to do other things, like fire the bowel stapler, put in drains, etc. Other things I did as a student: evacuate a EDH and reattach the skull piece (not complicated but thought it was awesome at the time), put in trocars, tubal ligations, use a Gigli saw, plastics closures on the plastics service, some anorectal procedures (which seemed unappealing until I got to use the bovie). Not surprisingly, I choose to do surgery.

For those who want to do more, how many of you who are just retracting ask to do more? Generally I try to let students do more than just retract; it sucks to feel ignored for hours. Sometimes students are so quiet during a case (esp. laparoscopic cases) that a reminder that you are there and interested is all it takes to give you something more to do (or depending on the attending, the resident may be able to better engage you once the attending scrubs out---some attendings don't let students do as much as the resident will let you do). Also, scrubbing with more senior residents who have "been there, done that" is better than with junior residents who still feel that they need to practice and don't let students do as much. As a resident, the students who had no interest and seemed like they couldn't wait to leave were the ones I was less likely to have do more stuff in the OR (I've actually had students refuse to do more, as well as a couple who broke scrub when the attending did and would try to leave---who would have been able to do a fair amount with me had they not done that!); students who asked to do more were the ones that I would let do more.

However, the point of your surgery rotation is to get a sense of when a patient needs a surgery referral (surgical abdomen, common surgical problems, etc.) and a concept of what surgeons do. Learning what being in an OR is like is part of it, including scrubbing, maintaining sterility, the process of pre-op to OR to PACU, etc.
 

MilkmanAl

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Honestly, I feel like a big part of people being quiet on surgery is how prevalent pimping is. There are many times when I had questions but would keep my mouth shut just to avoid the Socratic BS sure to come my way. I usually fielded pimp questions pretty well, but it's a HUGE hassle having to weigh the pros and cons of figuring out the answer to your question and setting yourself up for a bunch of questions in return. It's much, much, much more helpful to just get an explanation. In other words, people just get intimidated and don't want to speak up. I never had a problem with asking to do stuff, but I can absolutely see why many would.
 

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You'll learn from the experience. But I have to say that after seeing over 30 lap choles, I'm not going to learn anymore until I actually get to use the trochars in residency, so it becomes useless to stand there after awhile.
 

Perrotfish

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You'll learn from the experience. But I have to say that after seeing over 30 lap choles, I'm not going to learn anymore until I actually get to use the trochars in residency, so it becomes useless to stand there after awhile.
+1. It should really be a rule that you can't scrub in to the same procedure more than 3 times.

Also I personally think its the experience as a whole that is invaluable. All the way from pre-oping a patient, knowing the history and physical, indications for surgery, surgical procedure, lab values all the way to the PACU and the floor.
All of this I learned in medicine. You learn all about the algorithims for calling a surgeon outside of surgery.

I liked scrubbing in on a surgery of a patient of mine who I did all the aforementioned leg work because it gave me the whole picture of the patients time in the hospital. I think its extremely important knowing how the inside of an OR works because your patient in the future will end up in the OR at some point in their lives and YOU will have to comfort them, even if you're not the person performing the surgery. Also as far as the 'human retractor' bit goes, its true, but anymore than that could turn into a liability issue. I can't say I liked retracting, but I was able to see enough that I would be able watch a surgery video on mute and be able to point out specific structures. I felt it was the closest I could get without compromising the surgery or patient safety. I also had a chance to 'man' the laproscope which was an awesome experience, it was like driving a car inside the body haha. That plus suturing with the resident after the main portion of the surgery was done was kind of cool.
I guess the real quesetion is why is this, of all the different parts of medicine, getsthe 8 week rotation (plus a 2 week elective). Every one of our patients will likely have come through an ER, but at my school we're only give 2 weeks to learn how that works. Everyone gets anesthesia but my school doesn't even have a rotation. Half of my patients will have some associated musculoskelatal pain but almost no allopathic school has a mandatory sports medicine procedure. Radiology and Pathology are 2 and 0 weeks respectively. So why is surgery, a field where almost every skill is COMPLETELY useless for any other specialty, is the one that we need 10 weeks of tourism in?
 
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Jolie South

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+1. It should really be a rule that you can't scrub in to the same procedure more than 3 times.

I guess the real quesetion is why is this, of all the different parts of medicine, getsthe 8 week rotation (plus a 2 week elective). Every one of our patients will likely have come through an ER, but at my school we're only give 2 weeks to learn how that works. Everyone gets anesthesia but my school doesn't even have a rotation. Half of my patients will have some associated musculoskelatal pain but almost no allopathic school has a mandatory sports medicine procedure. Radiology and Pathology are 2 and 0 weeks respectively. So why is surgery, a field where almost every skill is COMPLETELY useless for any other specialty, is the one that we need 10 weeks of tourism in?
Well, by that token, why should I have to work up more than a couple of "rule-out ACS" or "syncope"s? I find it completely useless (not to mention boring) as I'm not going into medicine.

The people that I've known that are the best doctors have a significant grasp on both medical and surgical sides of treatment. To say that you don't need surgery knowledge as a non-surgeon is kind of ridiculous. I've had upper levels that called surgery consults and said "Look, I don't care what you guys do for XX complaint. Just take care of it." I think that's completely inappropriate and just bad care. There were many times on medicine (especially GI) where my knowledge of surgery (including procedural knowledge) was important to taking care of a patient.

Maybe you don't need the skills but I think knowing how the anatomy is altered post-op, complications of procedures, and most importantly indications for surgery are really important. I definitely don't think that is addressed adequately from the medicine side of things. I don't know how your medicine teams worked, but surgery was usually the last thing we ever thought of as a treatment modality.
 
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Smurfette

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In the real world, most of your patients (unless you do ER/trauma surgery/are a hospitalist/minimal patient contact field like rads or path, etc.) will be OUTPATIENT and come to see you in your office, not through the ER. This is true in IM and its subspecialties, peds and surgical fields.

As for learning algorithms for surgery on other rotations, trust me, there's a lot of things that we get called for that we shouldn't be called for. Or called far too late for surgery to be helpful (i.e. patient not going to make it, but if I'd been called when the first H&P documenting peritonitis was written 24 hrs previous, they would've had a chance). It's hard to defend in court if the family sues b/c you failed to recognize a surgical emergency (regardless of your specialty).

A surgery rotation is mandatory for LCME accredited medical schools. So is medicine, peds, OB/Gyn, psych and some others (neuro?). You're not going to like all of them, but they all *should* add something to your education that the others don't quite cover as well or at all.
 

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+1. It should really be a rule that you can't scrub in to the same procedure more than 3 times.
There's almost nothing in medicine that you understand well after 3 observations.

All of this I learned in medicine. You learn all about the algorithims for calling a surgeon outside of surgery.
:laugh::laugh::laugh::laugh::laugh::laugh::laugh:
I just can't wait to hear some of your future consults.....

I guess the real quesetion is why is this, of all the different parts of medicine, getsthe 8 week rotation (plus a 2 week elective). Every one of our patients will likely have come through an ER, but at my school we're only give 2 weeks to learn how that works. Everyone gets anesthesia but my school doesn't even have a rotation. Half of my patients will have some associated musculoskelatal pain but almost no allopathic school has a mandatory sports medicine procedure. Radiology and Pathology are 2 and 0 weeks respectively. So why is surgery, a field where almost every skill is COMPLETELY useless for any other specialty, is the one that we need 10 weeks of tourism in?
That's fine that you hate surgery...it sounds like it's not a good fit on either side. However, it's ridiculous that you don't understand why it is considered a core clerkship.

Having this sort of attitude can lead to some severe tunnel vision as a resident, and you can end up being loathed by the other specialties due to your lack of insight.

The surgery rotation in itself is not "completely useless," but I do believe that it is useless to try explaining it to you.
 

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There's almost nothing in medicine that you understand well after 3 observations.
Well, as someone not going into surgery, just how well do I need to understand a lap-chole? What am I getting out of lap-chole 4-30 that will help me in any career but surgery? Now you could just smugly imply that the answer is self obvious (again) but I challenge you to provide a real coherent explanation of why I'm doing this. BTW if you fall back on 'understanding how the OR works' I want you to explain what, precisely, I am learning about how the OR works that would change how I practice medicine.
That's fine that you hate surgery...it sounds like it's not a good fit on either side. However, it's ridiculous that you don't understand why it is considered a core clerkship.
See, I understand exactly why it's a core clerkship. It's a core clerkship becaus the LCGME requirements for medical school were developed to produce an idealized version of a WW-II era general practicioner, and they have moved about an inch for every mile that medicine has moved since that time. A WW-II era medical school produced mostly GPs who, only a year after graduating, could be out in rural practice deliving children (with no hospital to run to if things got bad), performing open abdominal surgeries, setting bones, and even performing amputations on the same population they were the primary care physicians for. It therefore made perfect sense to spend a huge proportion of your clinical medical education learning Surgery and Ob/Gyn. Meanwhile specialties like EM, Rads, Gas, and Onc either barely existed or didn't exist at all and were therefore not part of the mandatory cirriculum. Now, of course, primary care is a shriking minority or practicioners and anyone who touched a Surgical, Obstetric, or (can you imagine?) Orthopaedic procedure without residency training would be sued into oblivion but we continue our wild overemphasis on those parts of our education because two generations is just way to fast for medical education to adapt.

The surgery rotation in itself is not "completely useless," but I do believe that it is useless to try explaining it to you
Generally when I think something in medicine is a bad idea the justification I get is that it isn't completely useless. For the record I don't think the rotation is completely useless for someone who doesn't want to be a surgeon (though I do think endlessly scrubbing in to a few procedures is). However I do think it's significantly less useful than other things I could be doing with my time. Like I said earlier, what I want is not an explanation of why OR time is better for my medical education than sitting on my couch and watching porn. What I want is an explanation of why this is better for my education than spending the two months on sports medicine, or infectious diseases, or Emergency Medicine, or Anesthesia, or really any other specialty. Because right now I'm really not seeing why this deserves 10 weeks. I'm thinking a maximum of 4, scrubbing into no more than one case a week.
 
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badasshairday

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As for learning algorithms for surgery on other rotations, trust me, there's a lot of things that we get called for that we shouldn't be called for. Or called far too late for surgery to be helpful (i.e. patient not going to make it, but if I'd been called when the first H&P documenting peritonitis was written 24 hrs previous, they would've had a chance). It's hard to defend in court if the family sues b/c you failed to recognize a surgical emergency (regardless of your specialty).
This is the importance of the surgery clerkship for those of us that are not going into surgery.
 

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Maybe you would get more out of it if you actually were interested and attempting to learn something. As good an actor as you may think you are, you really aren't fooling anyone. Everyone sees you staring at the clock, generally not paying attention, hating every minute of it.
+1.

The majority of the people who complain about not learning from some rotation (be it Surgery, Psych, Family, etc) just have bad attitudes. Just pretend you want to be a surgeon for 2 months, and enjoy what you're doing -- it's not that hard to learn.
 

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+1.

The majority of the people who complain about not learning from some rotation (be it Surgery, Psych, Family, etc) just have bad attitudes. Just pretend you want to be a surgeon for 2 months, and enjoy what you're doing -- it's not that hard to learn.
I don't know, I didn't like Family Medicine as either a rotation or a profession, and I still felt like those 6 weeks were very relevant and high yield in terms of my education. I knew pretty quickly that I wasn't going to be an FP but I also realized that I was learning a lot in clinic and that the things that I was learning were applicable to my future in another field. On the other hand on Surgery, and espically in the OR, I feel like I'm learning at a about 1/100th the speed I'd learning from being left alone with textbooks/the Internet/Discovery Health and that what I am learning is mostly irrelevant to my future practice.

It's one thing to have a bad attitude about things that are hard, it's another thing to be anrgy at coursework that's low yield. My experience has been that medical students have a very high tolerance for misery, so when they start complaining that something is a waste of their time (TBLs, medical student overnight call, Surgery rotations) that's generally not code for saying that it's hard or miserable, they're genuinely annoyed that their course is an inefficient way of getting an education.
 

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You'll learn from the experience. But I have to say that after seeing over 30 lap choles, I'm not going to learn anymore until I actually get to use the trochars in residency, so it becomes useless to stand there after awhile.

you didnt get to use the trochars as a med student? wow. i didnt for the first 7 or 8 or so, but after that we clipped off appendices and did tubal banding ourselves (obviously with the scrubbed attending and resident right there) etc. jeez where did you go to med school?
 

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My experience has been that medical students have a very high tolerance for misery, so when they start complaining that something is a waste of their time (TBLs, medical student overnight call, Surgery rotations) that's generally not code for saying that it's hard or miserable, they're genuinely annoyed that their course is an inefficient way of getting an education.
This might be true if this mythical "they" you speak of existed. On this thread it's primarily just been YOU saying you thought it was worthless. At my school surgery and medicine were the two most popular clerkships, people felt they learned the most on them. Granted, the clerkships were well designed to minimize some of the crappy things people have complained about here, but nobody was like "boy, everything from trauma surgery to otolaryngology is pretty unimportant compared to an ED or anesthesia rotation, we should definitely swap that out".
 

TheLesPaul

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I don't know, I didn't like Family Medicine as either a rotation or a profession, and I still felt like those 6 weeks were very relevant and high yield in terms of my education. I knew pretty quickly that I wasn't going to be an FP but I also realized that I was learning a lot in clinic and that the things that I was learning were applicable to my future in another field. On the other hand on Surgery, and espically in the OR, I feel like I'm learning at a about 1/100th the speed I'd learning from being left alone with textbooks/the Internet/Discovery Health and that what I am learning is mostly irrelevant to my future practice.

It's one thing to have a bad attitude about things that are hard, it's another thing to be anrgy at coursework that's low yield. My experience has been that medical students have a very high tolerance for misery, so when they start complaining that something is a waste of their time (TBLs, medical student overnight call, Surgery rotations) that's generally not code for saying that it's hard or miserable, they're genuinely annoyed that their course is an inefficient way of getting an education.
Maybe I'm just over-generalizing from my experience. I don't want to do surgery (I don't have the patience for long procedures that demand technical perfection), but I feel like the combination of clinics + OR time was invaluable for skills (sterile technique, suturing, abdominal exam, trauma, and actually seeing/feeling the anatomy -- things that might be present in other rotations but are MAJOR in surgery) that I would use for the rest of my career.

Maybe I just luckily had good attendings/clinics :shrug:.
 

turkeyjerky

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This might be true if this mythical "they" you speak of existed. On this thread it's primarily just been YOU saying you thought it was worthless. At my school surgery and medicine were the two most popular clerkships, people felt they learned the most on them. Granted, the clerkships were well designed to minimize some of the crappy things people have complained about here, but nobody was like "boy, everything from trauma surgery to otolaryngology is pretty unimportant compared to an ED or anesthesia rotation, we should definitely swap that out".
I think you are generalizing your good experience in surgery into thinking everyone else had a similiar rotation--they didn't, in fact for most of thE people complaining, it prolly consisted of 16 hour days spent watching other people work, without really being taught or learning anything. Yeah dude, that would suck.
 

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Maybe I'm just over-generalizing from my experience. I don't want to do surgery (I don't have the patience for long procedures that demand technical perfection), but I feel like the combination of clinics + OR time was invaluable for skills (sterile technique, suturing, abdominal exam, trauma, and actually seeing/feeling the anatomy -- things that might be present in other rotations but are MAJOR in surgery) that I would use for the rest of my career.

Maybe I just luckily had good attendings/clinics :shrug:.
I had a really good experience, too. :shrug:
 

silas2642

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Most surgeons don't actually teach while doing the surgery. And if you're stuck retracting and getting out of the way of more important people, you can't see much. Sometimes I feel I would learn more if I just watched a surgery on youtube with actual commentary.
Yes. I learned that I hate surgery.
 

psych

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I hate surgery too. So much. It's awful. Seriously counting the days til it's over. Not sure if I'll make it 3.5wks...
 

Knicks

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It's one thing to have a bad attitude about things that are hard, it's another thing to be anrgy at coursework that's low yield. My experience has been that medical students have a very high tolerance for misery, so when they start complaining that something is a waste of their time (TBLs, medical student overnight call, Surgery rotations) that's generally not code for saying that it's hard or miserable, they're genuinely annoyed that their course is an inefficient way of getting an education.
lol, SOO true. :thumbup:
 

SLUser11

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:laugh:

Perrotfish, I commend you for making me laugh on two separate occasions with the below-mentioned hilarious jokes:

My experience has been that medical students have a very high tolerance for misery, so when they start complaining that something is a waste of their time......
All of this I learned in medicine. You learn all about the algorithims for calling a surgeon outside of surgery.
Keep up the strong work, you crazy comedian....
 
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I learned how to sleep with one eye open while holding a retractor with the contralateral hand. I learned to automatically switch the appropriate eye and hand when the surgeon said "I need more exposure here".
 

coldweatherblue

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not a lot to add except..

I'm on surgery now and aside from the long hours it's been a great rotation.. learning a lot every day, cases are interesting, cool residents/attendings (but I have thick skin and don't have a problem with the OR environment) and good skills to learn. Every physician should be able to suture, recognize a surgical emergency, intubate, and know enough about surgery to "speak the language" during consults/referrals.

I also def learned more on overnight calls than in any other part of third-year and in general think that a lot of med students complain too much (cause it's pretty fun). let's be honest a fair number of med students never had real jobs or really worked before third-year so it's a reality check. really, being an MS3 is NOT that hard.. ya it sucks sometimes but it's a hell of a lot easier than being an intern and it's quite a bit easier than being in college and working full-time as well (imo of course)
 

45408

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+1. It should really be a rule that you can't scrub in to the same procedure more than 3 times.
This is fairly valid, as long as you were paying attention and knew what the indications were for the operation. Most of my surgery rotations allowed me to sample a pretty wide variety by working with different people.

All of this I learned in medicine. You learn all about the algorithims for calling a surgeon outside of surgery.
Yeah, no. We get all kinds of unrealistic or unnecessary surgery consults from people in medicine who clearly have no idea what is an appropriate surgery consult or not. Other times, they don't call us until it's bordering on being far too late to help.

I guess the real quesetion is why is this, of all the different parts of medicine, getsthe 8 week rotation (plus a 2 week elective). Every one of our patients will likely have come through an ER, but at my school we're only give 2 weeks to learn how that works. Everyone gets anesthesia but my school doesn't even have a rotation. Half of my patients will have some associated musculoskelatal pain but almost no allopathic school has a mandatory sports medicine procedure. Radiology and Pathology are 2 and 0 weeks respectively. So why is surgery, a field where almost every skill is COMPLETELY useless for any other specialty, is the one that we need 10 weeks of tourism in?
Blame your school? I had two months of each: medicine (both inpatient wards), surgery (trauma and general), pediatrics (inpatient wards and outpatient clinic). As for not learning any useful skills on surgery, you probably missed a big opportunity to really brush up on your radiology skills. So many patients have so many scans and ultrasounds to review.

Your surgery rotation is really your best time to learn how to examine a patient's abdomen for something serious or minor. Someone in the ER or primary clinic will definitely need to know that one.


And why do I need a 6 week rotation on delivering babies and doing hysterectomies (retracting from an angle which completely obscures my view)? We could do this all day.
 

Perrotfish

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Yeah, no. We get all kinds of unrealistic or unnecessary surgery consults from people in medicine who clearly have no idea what is an appropriate surgery consult or not. Other times, they don't call us until it's bordering on being far too late to help.
That doesn't mean that a surgery rotation is a good place to learn when to do (or not to do) a surgery consult. There is nothing about the OR that particularly teaches you what is and is not critical, and there is very little about surgery rounds that teaches you when and when not to call. Maybe the reliance on surgery rotations for learning about acute surgical emergencies is the reason no one seems to know when to call surgery?

Blame your school? I had two months of each: medicine (both inpatient wards), surgery (trauma and general), pediatrics (inpatient wards and outpatient clinic). As for not learning any useful skills on surgery, you probably missed a big opportunity to really brush up on your radiology skills. So many patients have so many scans and ultrasounds to review.
We also have two months of both medicine and peds, but I saw the point of those rotations. My surgery is unfortunately all general, as I didn't draw trauma rotation, but otheise I have basically the same schedule. I'm only complaining about surgery because it's the only one I didn't see the point of. The scans I could learn on any rotation (medicine patients have scans to) and I think surgery is the least educational for radiology, since they're so busy that they never really stop to discuss/teach about the scans.

Your surgery rotation is really your best time to learn how to examine a patient's abdomen for something serious or minor. Someone in the ER or primary clinic will definitely need to know that one.
Again, I think a better way to learn that would be in the ER, or even on medicine. The issue is that about 60-80% of my surgery rotation is OR time, which to me is zero yield. The other 20-40% of prerounding, rounding, and clinic has some value (or it might have had some value, if my team spoke to me), but still not much.

And why do I need a 6 week rotation on delivering babies and doing hysterectomies (retracting from an angle which completely obscures my view)? We could do this all day
100% agree, and again I refer you to my WWII GP explanation. These days there is no good reason for anyone outside of FP, EM, or OB to know how to manage labor and at least a good chunk of that time would be better spent on other cores/electives.
 

SLUser11

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That doesn't mean that a surgery rotation is a good place to learn when to do (or not to do) a surgery consult. There is nothing about the OR that particularly teaches you what is and is not critical, and there is very little about surgery rounds that teaches you when and when not to call. Maybe the reliance on surgery rotations for learning about acute surgical emergencies is the reason no one seems to know when to call surgery?


We also have two months of both medicine and peds, but I saw the point of those rotations. My surgery is unfortunately all general, as I didn't draw trauma rotation, but otheise I have basically the same schedule. I'm only complaining about surgery because it's the only one I didn't see the point of. The scans I could learn on any rotation (medicine patients have scans to) and I think surgery is the least educational for radiology, since they're so busy that they never really stop to discuss/teach about the scans.



Again, I think a better way to learn that would be in the ER, or even on medicine. The issue is that about 60-80% of my surgery rotation is OR time, which to me is zero yield. The other 20-40% of prerounding, rounding, and clinic has some value (or it might have had some value, if my team spoke to me), but still not much.



100% agree, and again I refer you to my WWII GP explanation. These days there is no good reason for anyone outside of FP, EM, or OB to know how to manage labor and at least a good chunk of that time would be better spent on other cores/electives.
I want to start by saying that I read your other thread where you voice a strong interest in trauma. I think once you are on those rotations, you'll have a better appreciation for your surgery rotation.

All of the things you mention seem to be a problem with your specific clerkship, not a fundamental flaw in surgery clerkships everywhere. If you spent all your time in long tedious cases with little visibility, you only tasted a small fraction of what general surgery is all about. The operating room is only a part of what we do, and most surgeons spend equal or more time outside the operating room in other clinical activities.

A well-structured surgery clerkship should provide not only experience in the OR, but also plenty of time in clinic, seeing consults in the ER, doing H and Ps, looking at CTs/x-rays, doing bedside procedures (CVLs, chest tubes), etc etc. All of these things help to develop a well-balanced physician regardless of specialty choice.

The system is not broken, and many schools offer excellent surgery clerkships that are well worth the 2 months they are allotted. A good general surgeon is the last true man-of-all-seasons in the hospital, and I still think it's ridiculous that you feel there is little to be learned from him.
 

Perrotfish

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All of the things you mention seem to be a problem with your specific clerkship, not a fundamental flaw in surgery clerkships everywhere. If you spent all your time in long tedious cases with little visibility, you only tasted a small fraction of what general surgery is all about. The operating room is only a part of what we do, and most surgeons spend equal or more time outside the operating room in other clinical activities.

A well-structured surgery clerkship should provide not only experience in the OR, but also plenty of time in clinic, seeing consults in the ER, doing H and Ps, looking at CTs/x-rays, doing bedside procedures (CVLs, chest tubes), etc etc. All of these things help to develop a well-balanced physician regardless of specialty choice.
While I won't argue that I drew the short straw for surgery rotaions I still think tha surgery tends to have two components: the OR, and things that are just as easy to learn on another roation where your time doesn't revolve around the OR. Like I've said earlier radiology, bedside procedures, clinic, consults, and admissions are standard on any rotaion and I think that they're better learned from attendings that are less busy than surgeons. I know that there are good and bad attendings on any service but the proportion of bad attendings does seem to be higher on surgery and I think that's mostly due to the fact that surgeons are generally more pressed for time than their colleagues in other professions. I also do thinnk you are underemphasizing the amount of time that surgeons spend in the OR when you say that it's 50% or less of their day. Even with my school's better sites/attendings students are in the OR for most of the day and they drag the medical studens in with them. Honestly even 50% of the day in the OR (which I think is a floor) is a lot on a 16 hour day, since I still can't figure out why a student who is not planning on surgery should spend any time at all in the OR. I see your point about there being some absolute value (compared to doing nothing) for surgical floor work, but what does a non surgeon get out being in the OR? What skills am I learning there that I could transfer to psych or medicine?

The system is not broken, and many schools offer excellent surgery clerkships that are well worth the 2 months they are allotted. A good general surgeon is the last true man-of-all-seasons in the hospital, and I still think it's ridiculous that you feel there is little to be learned from him
I do want to make it clear that I'm not disparaging surgeons. I think they're some of the smartest and hardest working people in the hospital. However as a medical student not going into surgery I tend to view them much as an engineer views a quantum physicist: while their field is tangentially related to mine most of what they do is both irrelevant to my practice and beyond my talents. I respect your right to your opinion (and if you want you can have the last word after this) but nothing you've said has convinced me that there's a more valid reason for Surgery to have a 2 month rotation and EM to have two weeks, rather than the other way around, other than a stubborn adherence to tradition.
 
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coralfangs

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Like any other field, you have to pay your dues before you are successful.
Doing scut work around the OR and retraction is part of paying our dues as well as learning process. Tom Ford worked as a entry public relation after graduating from Parson and worked as a design assistant for a while before he was given any "significant" role in any lines. Peter North worked as a gay porn actor in numerous films before he performed in major heterosexual pictures.

Kids these days. They always think that they are med students and all that, and don't want to help out and pay their dues. I have encountered quite a few med students who complained about doing scut work and wondered why the nurses couldn't have performed those tasks. (even stuff like calling for lab results or ordering some fluids, etc). These kids need to know that you can learn from everything, even when you are retracting. When you retract, you are not just holding back a chunk of meat - you are actually retracting at different levels... you know... different fascias, different cavities, etc.

Personally, I want to lock these arrogant kids up in cages and blast them with ice-cold water to teach them proper humility.
 

Perrotfish

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Like any other field, you have to pay your dues before you are successful.
Doing scut work around the OR and retraction is part of paying our dues as well as learning process. Tom Ford worked as a entry public relation after graduating from Parson and worked as a design assistant for a while before he was given any "significant" role in any lines. Peter North worked as a gay porn actor in numerous films before he performed in major heterosexual pictures.

Kids these days. They always think that they are med students and all that, and don't want to help out and pay their dues. I have encountered quite a few med students who complained about doing scut work and wondered why the nurses couldn't have performed those tasks. (even stuff like calling for lab results or ordering some fluids, etc). These kids need to know that you can learn from everything, even when you are retracting. When you retract, you are not just holding back a chunk of meat - you are actually retracting at different levels... you know... different fascias, different cavities, etc.

Personally, I want to lock these arrogant kids up in cages and blast them with ice-cold water to teach them proper humility.
1) No there is not anything you can learn from retracting in silence, or fetching lab values.

2) This is the only system in the world that thinks it's reasonable for you to be paying 'your dues' to the same people you are paying cold hard cash. I am not an employee on the bottom rung of the corperate ladder, I am a customer paying Ritz Carlton prices to a system that is, in exchange, supposed to be teaching me medicine in the most efficient way possible. If all that means is fetching charts, getting lab values, and silently retracting while I learn medicine on my own time in he library then f- it, the PAs and NPs are right, there is nothing to medical school and no reason that any midlevel shouldn't have equal practice rights. After all, they've done twice as much of this pointless crap as we have, right?
.
 
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SLUser11

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While I won't argue that I drew the short straw for surgery rotaions I still think tha surgery tends to have two components: the OR, and things that are just as easy to learn on another roation where your time doesn't revolve around the OR.

I also do thinnk you are underemphasizing the amount of time that surgeons spend in the OR when you say that it's 50% or less of their day. Even with my school's better sites/attendings students are in the OR for most of the day and they drag the medical studens in with them.
I agree with you that we are unlikely to come to a resolution on this topic. You are also correct in identifying me as a last word freak. However, there is much more to general surgery than operating, and you just don't seem to understand that. Perioperative disease management, surgical decision making, and surgical critical care are just a few of the things that definitely can't be taught better by another specialty. You seem interested in trauma, which is a surgical specialty, and the vast majority of major traumas are cared for by surgeons, not ER docs.

Your comment that bedside procedures are better taught by other specialties is also way off, as skills with central lines, art lines, chest tubes, etc come with volume, and surgeons have just done way more of those than most ER docs.

As for saying I underemphasizing the time spent in the OR, I have a significant amount of experience in the area, and I see how surgical practice actually works.

1) No there is not anything you can learn from retracting in silence, or fetching lab values.

2) This is the only system in the world that thinks it's reasonable for you to be paying 'your dues' to the same people you are paying cold hard cash. I am not an employee on the bottom rung of the corperate ladder, I am a customer paying Ritz Carlton prices to a system that is, in exchange, supposed to be teaching me medicine in the most efficient way possible. If all that means is fetching charts, getting lab values, and silently retracting while I learn medicine on my own time in he library then f- it, the PAs and NPs are right, there is nothing to medical school and no reason that any midlevel shouldn't have equal practice rights. After all, they've done twice as much of this pointless crap as we have, right?
.
I understand your frustration, but you are giving off a vibe of overwhelming self-entitlement. One of the big things you learn as a student is how to be an effective team player. Those "low yield" tasks don't go away when you're a resident.

At the med student level, there are lots of tasks with utility that you are too inexperienced to understand. To quote a previous mentor, "It's not scut unless it's old hat." If you've never collected vitals, drawn blood, placed a foley, transported a patient, etc, then you are not above it.
 

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I'm still a second year so I may be totally off base about all this. When I do rotations I plan on having a good attitude regardless of the specialty I rotate in. Even if I'm not interested I believe that having a good attitude is the professional thing to do. I also believe it will be my responsibility to try and ask for more things to do if they aren't just being handed to me.

That said, isn't it part of the job of the residents and attendings to teach medical students? I saw several people post that "if a medical student doesn't seem motivated I'm likely not going to give him much to do." To me, that is a bad attitude and shouldn't be excused either. I believe it is the responsibility of the more senior members of the staff to make an effort to educate the student.

Like I said, though, I'm only a second year so my impressions could be completely wrong.
 

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Perioperative disease management, surgical decision making, and surgical critical care are just a few of the things that definitely can't be taught better by another specialty. You seem interested in trauma, which is a surgical specialty, and the vast majority of major traumas are cared for by surgeons, not ER docs.

Your comment that bedside procedures are better taught by other specialties is also way off, as skills with central lines, art lines, chest tubes, etc come with volume, and surgeons have just done way more of those than most ER docs.
These are exceedingly important points. While you can be taught the abdominal examination or placement of central lines by a non-surgeon, most would agree that being taught by someone who does infinitely more of these is better. Perrotfish is not going to agree with you SLUser but others should see that surgery is not just operating and that there are valuable skills that one can and should learn during their surgical rotation which makes them a better physician.

Those "low yield" tasks don't go away when you're a resident.
Let's also not forget that those low yield tasks don't go away as an attending. Who do you think is looking up lab values, writing orders, seeing the consults, placing the Foley, etc. in PP?
 

xanthomondo

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I'm still a second year so I may be totally off base about all this. When I do rotations I plan on having a good attitude regardless of the specialty I rotate in. Even if I'm not interested I believe that having a good attitude is the professional thing to do. I also believe it will be my responsibility to try and ask for more things to do if they aren't just being handed to me.

That said, isn't it part of the job of the residents and attendings to teach medical students? I saw several people post that "if a medical student doesn't seem motivated I'm likely not going to give him much to do." To me, that is a bad attitude and shouldn't be excused either. I believe it is the responsibility of the more senior members of the staff to make an effort to educate the student.

Like I said, though, I'm only a second year so my impressions could be completely wrong.

Save this to see how long this attitude lasts for. When residents tell you "we don't waste our time unless you're going into OB/GYN" when referring to teaching you you'll become as jaded as the rest.
 

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Personally, as an M3, I like placing foley's. It is the most "procedure" I am going to get at this point. It's not like I am going to be doing an aortic valve repair by myself. And we need to be able to do "nursing tasks." I think it is extremly important for medical students to be able to place foley's, put down NG tubes, place IV's.

Perrotfish. Trauma is surgery. So it is sort of interesting you hate surgery rotation, because trauma is a surgery rotation.