Bump. Surgeons rule, students drool.
Have we lost perspective, or just evolved with experience?
- Thread starter SLUser11
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My experience on surgery was that trying was a good way of getting the other students to dislike you. Trying was a great way of raising your expectations just to see them dashed. Did I have educational experiences by residents who did give a damn? Sure. But by the time that occurred, Surgery was all but ruled out as a career choice, because how poorly they treated me was in direct correlation to how absolutely miserable they seemed with their own lives.
I've been ignored for entire DAYS in the OR by attendings-- one actually asked me to stand directly behind her, as my silhouette in her periphery annoyed her. I've been chewed out for not knowing where supplies are on the first day of my rotation. I've been asked to close without ever learning how to suture, and then when I admitted that, I was scolded, not taught. I've been dismissed 3 hours after signout, for no particular reason. I've been asked to do consults for patients who have had their consult cancelled, but nobody told me because I am irrelevant. I have been the subject of personal and non-professional ridicule. The list goes on, I'm just too tired to write some more about it.
I've seen a few surgery programs, and they simply can't all be like this, but of the ones I've seen, I'd rather quit medicine than practice it in those environments.
And that is why my days in surgery were, after the first couple of weeks, spent trying to figure out how to best survive, how to best avoid work, how to achieve the best grade while putting in the least work.
I found the entire thing to be absolutely tragic and depressing to think about. I kept telling myself it was just MY rotation site, but come on, these stories are everywhere. Even more widespread behind closed doors than they are on SDN. Before you even begin to evaluate the students, don't you think the residents, and the happiness of the residents, is a much bigger problem?
I've been ignored for entire DAYS in the OR by attendings-- one actually asked me to stand directly behind her, as my silhouette in her periphery annoyed her. I've been chewed out for not knowing where supplies are on the first day of my rotation. I've been asked to close without ever learning how to suture, and then when I admitted that, I was scolded, not taught. I've been dismissed 3 hours after signout, for no particular reason. I've been asked to do consults for patients who have had their consult cancelled, but nobody told me because I am irrelevant. I have been the subject of personal and non-professional ridicule. The list goes on, I'm just too tired to write some more about it.
I've seen a few surgery programs, and they simply can't all be like this, but of the ones I've seen, I'd rather quit medicine than practice it in those environments.
And that is why my days in surgery were, after the first couple of weeks, spent trying to figure out how to best survive, how to best avoid work, how to achieve the best grade while putting in the least work.
I found the entire thing to be absolutely tragic and depressing to think about. I kept telling myself it was just MY rotation site, but come on, these stories are everywhere. Even more widespread behind closed doors than they are on SDN. Before you even begin to evaluate the students, don't you think the residents, and the happiness of the residents, is a much bigger problem?
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I can tell you that my two midwest experiences are vastly different than what you describe… this behavior (by residents and even faculty) is not tolerated.
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For reference, I'm an intern.
I'm thankful I'm in a surgical subspecialty for many reasons, but one of them is that we deal with fewer students just passing time on a required clerkship. The M3s I encounter on general surgery and the general surgical specialties have been (perhaps with one or two exceptions out of my small sample size ~30), uniformly disinterested, uninvolved, and as a result, have a very poor surgical knowledge base.
On the other hand, the M3 and M4 elective rotators that I've worked with have been largely great, and that includes our students on ENT as well as gen surg applicants in SICU and elsewhere.
Same med school, same hospital.
I think the difference is 1. the expectations set by the clerkship director and 2. the expectations set by the residents. It's a fact that 10%-20% of students (thereabouts) will apply to a surgical field. There's maybe another group that size considering it, leaving the vast majority of students disinterested in surgery. So we've got a large chunk of students who will only meet expectations, and then we've got low or nebulous expectations for those students. It's unfair to expect them to be anything else than dumb and lazy in those circumstances.
The gen surg clerkship at my hospital is awful. The students get there at 6am, and have a lecture with an attending from 6am-7am (no rounding with residents in the AM, no pre-rounds. Jesus Christ, that's where you learn how to take care of wounds, look at wounds, diagnose complications, get somebody crapping and walking, etc). Then at 7am they go wherever they want. I have no idea where they go, because there are like 8-9 students on gen surg any given month, and I usually see 2-3 chilling in the surgeon's lounge eating bagels and maybe one per week in the OR. Their role in the OR tends to be pretty crappy since we have so little contact with them, and generally have little idea who they are. Retract, suck smoke.
They do a week of trauma in the four weeks at this hospital, and I'm not sure what their role is like on that service.
Now, some med students may look at that clerkship and say, "Great, that sounds perfect! I want to do as little as possible!" Well, the students don't like it. They complain about a lack of responsibility and involvement (and these are the students going into pathology and IM and radiology).
I guarantee, if the clerkship director had it set up so that students were rounding with us in the am, and all gen surg ORs required student coverage if available, the quality of the clerkship would rise exponentially. Give them roles, even what they consider scut (and what I consider what I'm paid 50k a year for): get the numbers, pull up and look at films, get the wound bag ready, help with dressing changes. Do a morning a week where they have consolidated lecture time (ours was Friday at 8am after rounds were finished on my surgery clerkship), and let surgery students be surgery students.
I'm thankful I'm in a surgical subspecialty for many reasons, but one of them is that we deal with fewer students just passing time on a required clerkship. The M3s I encounter on general surgery and the general surgical specialties have been (perhaps with one or two exceptions out of my small sample size ~30), uniformly disinterested, uninvolved, and as a result, have a very poor surgical knowledge base.
On the other hand, the M3 and M4 elective rotators that I've worked with have been largely great, and that includes our students on ENT as well as gen surg applicants in SICU and elsewhere.
Same med school, same hospital.
I think the difference is 1. the expectations set by the clerkship director and 2. the expectations set by the residents. It's a fact that 10%-20% of students (thereabouts) will apply to a surgical field. There's maybe another group that size considering it, leaving the vast majority of students disinterested in surgery. So we've got a large chunk of students who will only meet expectations, and then we've got low or nebulous expectations for those students. It's unfair to expect them to be anything else than dumb and lazy in those circumstances.
The gen surg clerkship at my hospital is awful. The students get there at 6am, and have a lecture with an attending from 6am-7am (no rounding with residents in the AM, no pre-rounds. Jesus Christ, that's where you learn how to take care of wounds, look at wounds, diagnose complications, get somebody crapping and walking, etc). Then at 7am they go wherever they want. I have no idea where they go, because there are like 8-9 students on gen surg any given month, and I usually see 2-3 chilling in the surgeon's lounge eating bagels and maybe one per week in the OR. Their role in the OR tends to be pretty crappy since we have so little contact with them, and generally have little idea who they are. Retract, suck smoke.
They do a week of trauma in the four weeks at this hospital, and I'm not sure what their role is like on that service.
Now, some med students may look at that clerkship and say, "Great, that sounds perfect! I want to do as little as possible!" Well, the students don't like it. They complain about a lack of responsibility and involvement (and these are the students going into pathology and IM and radiology).
I guarantee, if the clerkship director had it set up so that students were rounding with us in the am, and all gen surg ORs required student coverage if available, the quality of the clerkship would rise exponentially. Give them roles, even what they consider scut (and what I consider what I'm paid 50k a year for): get the numbers, pull up and look at films, get the wound bag ready, help with dressing changes. Do a morning a week where they have consolidated lecture time (ours was Friday at 8am after rounds were finished on my surgery clerkship), and let surgery students be surgery students.
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Perhaps people can offer examples of what works in modern surgical education?
My experience was very positive. At the start of the rotation, the clerkship director sat down with the five students, explained that it was expected that:
1. Every general surgery OR should have student coverage, and after that, we can either help on floors with intern or go to specialty OR at our discretion
2. A student should be on call every night except the two nights prior to our shelf exam
3. We could choose to do a week of trauma or vascular surgery, in addition to the mandated six weeks of gen surg and one week of ped surg.
4. We were expected to attend lectures from 8am through ~12pm on Fridays, and grand rounds Wednesday mornings
5. Aside from this, the particulars and day-to-day expectations are up to the discretion of the chief on each service
We worked hard, got to know the residents very well, and were given a good amount of responsibility (seeing consults first, active role in the OR and trauma bay, active on rounds). We still had paper charting so we wrote notes while the residents co-signed them, and that was the note in the record.
I thought the system worked because expectations were clear, educational activities did not interfere with clinical duties, and we were on a single service for a long period of time. This facilitated students becoming "part of the team", being given roles, and subsequently seeing surgical disease and practice.
I don't think any specific feature of my experience is impossible to replicate elsewhere, even as bad EMR/increased oversight threaten student education.
My experience was very positive. At the start of the rotation, the clerkship director sat down with the five students, explained that it was expected that:
1. Every general surgery OR should have student coverage, and after that, we can either help on floors with intern or go to specialty OR at our discretion
2. A student should be on call every night except the two nights prior to our shelf exam
3. We could choose to do a week of trauma or vascular surgery, in addition to the mandated six weeks of gen surg and one week of ped surg.
4. We were expected to attend lectures from 8am through ~12pm on Fridays, and grand rounds Wednesday mornings
5. Aside from this, the particulars and day-to-day expectations are up to the discretion of the chief on each service
We worked hard, got to know the residents very well, and were given a good amount of responsibility (seeing consults first, active role in the OR and trauma bay, active on rounds). We still had paper charting so we wrote notes while the residents co-signed them, and that was the note in the record.
I thought the system worked because expectations were clear, educational activities did not interfere with clinical duties, and we were on a single service for a long period of time. This facilitated students becoming "part of the team", being given roles, and subsequently seeing surgical disease and practice.
I don't think any specific feature of my experience is impossible to replicate elsewhere, even as bad EMR/increased oversight threaten student education.
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