General Surgery LORs

[travelingdoctor]

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I am an M3 still deciding between general surgery and IM with possibilty of specializing. As an M3, I am forced to base many of my decisions based on my limited previous experiences. I really like the attendings and residents that I worked with during IM. They were compassionate people with very approachable personalities, so it was easy to get a LOR from them. However, the the pace of IM was something I didnt particularly enjoy, such as all the rounding.

As for GS, one thing that intimidates me is trying to get attendings to recongize me and get LOR. The ones that I worked with either so egotistical and could care less about students or they would just shun you away after you missed a pimping question.

So, I like surgery itself, but there seem to be quite a hierarchy system, so makes it difficult for me to get to know attendings. How do I go about getting LOR's if so many attendings are not approachable?

 

[drmjmh9999]

I am an M3 still deciding between general surgery and IM with possibilty of specializing. As an M3, I am forced to base many of my decisions based on my limited previous experiences. I really like the attendings and residents that I worked with during IM. They were compassionate people with very approachable personalities, so it was easy to get a LOR from them. However, the the pace of IM was something I didnt particularly enjoy, such as all the rounding.

As for GS, one thing that intimidates me is trying to get attendings to recongize me and get LOR. The ones that I worked with either so egotistical and could care less about students or they would just shun you away after you missed a pimping question.

So, I like surgery itself, but there seem to be quite a hierarchy system, so makes it difficult for me to get to know attendings. How do I go about getting LOR's if so many attendings are not approachable?

That's really good question. I faced that situation when I was rotating in surgery. Before you ask yourself that question, 1st ask yourself, what speciality you would like to be in? Then do whatever to reach your goal. That's life, nothing is easy. You have to train yourself on that type of attendings cause simply you don't know if you will have better attendings during residency. So, my opinion is that just be patient and try to proove yourself with hard working. Even they don't notice or don't appreciate it, just keep it up, and don't let them let you down till you get the letters you need.

Another thing, you also ask 4th y ms and how they would react to a similar sitiuation. Thus, you will be having more thoughts and ideas.

Good luck

 

[Gentle]

.
As for GS, one thing that intimidates me is trying to get attendings to recongize me and get LOR. The ones that I worked with either so egotistical and could care less about students or they would just shun you away after you missed a pimping question.

So, I like surgery itself, but there seem to be quite a hierarchy system, so makes it difficult for me to get to know attendings. How do I go about getting LOR's if so many attendings are not approachable?

I agree with the above advice especially on talking to upper class men.
Last year, I was in your shoes and I think what made it more intimidating at first was the fact that Surgery was my first rotation as an MS3.
Be sure to study hard. Know your surgical recall - cold! If you do well on rounds and in the OR, a good number of attendings will probably notice/recognize you. They may not say it but you'll know it. I know that there're probably those Surgery attendings who will completely ignore you no matter what but a good number of them will recognize how well you're doing. Also recognize that attendings will get feedback from residents, chief residents in particular, so keep working hard even when the attending is not there! This brings me to another point; if you have a good relationship with your chief/residents, you can ask what's the best way to approach the attending about a LOR.

I am not one of those students who do a** kissing in order to secure a LOR. Believe me or not, doing that makes it easier to get a LOR at least for a handful of attendings. Some will recognize it as BS especially if you're trying to throw your classmate under the bus - that irritates me. I just made sure that I came in early, did what I was supposed to do, studied hard on a daily basis. Even though all what you just mentioned may be intimidating at first, if you really enjoy surgery it'll become a no-brainer that you should overlook these things and keep your eye on the price - just be pleasant, hardworking, do not take reactions from attendings or residents personal. Say something like this to yourself whenever you think that you're being ignored ... "eventhough he/she is ignoring me and I feel like sh** right now, I will not let this get in my way of becoming a surgeon b/c I know that I'm not the first to feel this way and I can do it." Then take a deep breath and keep on going. Be persistent, if that's what you really want. I wouldn't let people's attitudes deter me.

Goodluck.
-Gentle-

 

[travelingdoctor]

Thanks to drmjmh9999 and Gentle for the previous posts. I will keep those remarks in mind and do my best at getting the LORs.

 

[BlondeDocteur]

Well... most of your letters will come from your fourth year sub-is. As a 4th year you'll be one of very few students on the service (perhaps the only one). Everyone will know you're applying in surgery. You'll be given a lot more responsibility, and being "noticed" will just be natural.

Also, shocking as it may seem, you can get the ball rolling yourself. You can actually talk in the OR without being asked a question (assuming you have normal social skills and can appreciate when this is welcome). You can ask for a meeting with a specific attending to discuss your application, your aspirations within the field, etc.

And honestly I can't think of any time I was asked anything remotely related to Surgical Recall. Sure, in third yr I carried it in my pocket and all, but most people are interested in the specifics of the case at hand. Read for that-- out of a textbook-- and know the patient's history, the pathophys of the condition, the treatment/procedure at hand, and any alternatives. That's a lot more important, and predictive of your residency performance IMHO, than spouting off "wind... water... walking... wound... wonder drugs."

 

[Musashi450]

That's a lot more important, and predictive of your residency performance IMHO, than spouting off "wind... water... walking... wound... wonder drugs."

Damnit...I keep forgetting walking.... = fails as future surgeon🙄

 

[Witch Doctor]

I agree with Blonde... Surgical recall is too superficial. I'd order something more substantial if you know you're going into surgery, such as a surgical atlas. Also, if you do your audition rotation at a smaller program or before the new residents arrive in July you can get more face time with the attending...

 

[Dr.LeoSpaceman]

Agree with the comments about how to get noticed (in a good way) by attendings in the OR. Yes, you need to know the basic stuff that comes out of recall when you get pimped. But if you really want them to take you seriously, read from things like ACS and Cameron's before you show up for the case. Then ask questions that demonstrate that you've thought critically about the case, and what's going on. Taken one step further, if you can find a recent article in a lit search that is applicable to the case, and you ask a question about it, even better.

Perhaps the best way to put it is to focus on asking "why" questions. So maybe if you're in a Whipple "Why did you choose end-to-side pancreaticojejunostomy as opposed to duct-to-mucosa?" Try to show that not only have you read about the steps involved in the operation (and understand what they entail), but you're also interested in understanding the surgical decision-making process.

Finally, as BlondeDocteur said, don't underestimate the value of being a normal person. It's obviously going to be attending-dependent, but many will appreciate someone that is capable of normal small talk. I think the attendings that gave me the best feedback were ones who I had regular conversations about things like golf, music, movies, etc.

And don't worry, if you decide on surgery, once you start telling attendings/residents that you are applying in surgery, many will make more of an effort when you're around.

 

[Gentle]

And honestly I can't think of any time I was asked anything remotely related to Surgical Recall. Sure, in third yr I carried it in my pocket and all, but most people are interested in the specifics of the case at hand. Read for that-- out of a textbook-- and know the patient's history, the pathophys of the condition, the treatment/procedure at hand, and any alternatives. That's a lot more important, and predictive of your residency performance IMHO, than spouting off "wind... water... walking... wound... wonder drugs."

I was in no way telling the OP to put all of his/her effort into surgical recall only. As much as it is very important to understand the pathophys, tx/procedure and alternatives, it is equally important to be able to know answers whenever you're pimped wh/ IMHO surg. recall does a good job with that. Yes, surgical recall is superficial but it is a great book for a quick review of important anatomical relationships commonly encountered in bread and butter surgery. You will sometimes have to scrub into cases that you didn't have time to prepare for at home either b/c it's an emergency case or b/c someone else was busy and you are called into scrub. With only about 10mins on hand prior to the case, u can quickly flip thru recall whereas you'll just get ur self confused by reading a text within that frame of time. I clearly told the OP to study daily. That is intense studying to me and I hope any medical student wouldn't only study surgical recall, which in the first place is a very small text.

Throughout med school, we all have studied by reading comprehensive text bks but we also have those study aids which are superficial but usually works great as a complementary to our texts. Same thing here!

-Gentle-

 

[surg]

Getting an LOR in surgery is not as hard as you think. Surgical attendings spend more time with a student in their presence in a week than many medicine attendings will get to spend with their students in a month, merely because you are cooped up with us in an OR for many hours of the day, every day.

Because of that, we get a lot of observation time, even when we aren't pimping you incessantly. Being normal will go a long way. Being interested will get you even farther. Nothing bugs me more than people scrubbing into my cases and asking me questions like "Why is this person getting this surgery?" That should be a question I ask you, not the other way around. You'll find that surgeons, in particular, hate spoon-feeding you the information. It's just the way we are built mentally, in terms of expecting a lot of initiative and self-reliance.

Want to impress me? Know the patients well, know what's relevant from a disease point of view and an anatomy point of view, and know when is a good time to ask a good question. What's a good question? One that shows that you are seeking more than a superficial understanding of the situation, both medically and socially. Asking in the middle of me riding the resident for making a crummy anastamosis is a bad time. Asking later as we are getting ready to close? probably a good time. Making sure you see the pathology, and get a chance to feel it if possible, particularly, once it is out of the body, shows interest. Doing this at the expense of keeping the case moving or while you are doing something critical, like holding exposure while the resident is sewing is a bad social call.

Try to get a fair bit of time in the OR and clinic with those you are clicking with. You should be able to rack up at least 40-50 contact hours in 4 weeks with any attending that you are even the slightest bit interested in getting an LOR from. If nothing is going on that you are involved in, go down to the OR and watch cases by your attendings, even if another student is scrubbed in. Be prepared, if possible, but less so if you aren't scrubbed in is ok. In clinic, ask if you can see patients by yourself and present to the attending. I get a good idea of your ability to handle each patient's issues by how well your presentations go in terms of getting the relevant information out there.

Finally, as egotistical as we are (or seem to be), nothing really breaks the ice faster than coming by the office and saying that you are interested in doing surgery, and you'd be interested in my feedback and an LOR or something along that line, if that's really true. It's human nature to want people to be like you, and you'll get a better LOR if I get to know you and your goals better.

Good luck on deciding your specialty.

 

[Gentle]

Getting an LOR in surgery is not as hard as you think. Surgical attendings spend more time with a student in their presence in a week than many medicine attendings will get to spend with their students in a month, merely because you are cooped up with us in an OR for many hours of the day, every day.

Because of that, we get a lot of observation time, even when we aren't pimping you incessantly. Being normal will go a long way. Being interested will get you even farther. Nothing bugs me more than people scrubbing into my cases and asking me questions like "Why is this person getting this surgery?" That should be a question I ask you, not the other way around. You'll find that surgeons, in particular, hate spoon-feeding you the information. It's just the way we are built mentally, in terms of expecting a lot of initiative and self-reliance.

Want to impress me? Know the patients well, know what's relevant from a disease point of view and an anatomy point of view, and know when is a good time to ask a good question. What's a good question? One that shows that you are seeking more than a superficial understanding of the situation, both medically and socially. Asking in the middle of me riding the resident for making a crummy anastamosis is a bad time. Asking later as we are getting ready to close? probably a good time. Making sure you see the pathology, and get a chance to feel it if possible, particularly, once it is out of the body, shows interest. Doing this at the expense of keeping the case moving or while you are doing something critical, like holding exposure while the resident is sewing is a bad social call.

Try to get a fair bit of time in the OR and clinic with those you are clicking with. You should be able to rack up at least 40-50 contact hours in 4 weeks with any attending that you are even the slightest bit interested in getting an LOR from. If nothing is going on that you are involved in, go down to the OR and watch cases by your attendings, even if another student is scrubbed in. Be prepared, if possible, but less so if you aren't scrubbed in is ok. In clinic, ask if you can see patients by yourself and present to the attending. I get a good idea of your ability to handle each patient's issues by how well your presentations go in terms of getting the relevant information out there.

Finally, as egotistical as we are (or seem to be), nothing really breaks the ice faster than coming by the office and saying that you are interested in doing surgery, and you'd be interested in my feedback and an LOR or something along that line, if that's really true. It's human nature to want people to be like you, and you'll get a better LOR if I get to know you and your goals better.

Good luck on deciding your specialty.

This should be quite helpful to the OP ... at least I think.