Are there any specific personality traits or "tells" that let you know that a student would never survive a surgical residency? How do you deal with them when they're on their rotations?
Are there any specific personality traits or "tells" that let you know that a student would never survive a surgical residency? How do you deal with them when they're on their rotations?
In the words of Justice Potter Stewart: "I know it when I see it."
And I think you would need to specificy whether this person is one whom is interested in pursuing surgery. If they aren't, then it's about finding the information/tasks that might be relevant to their actual interests. If they are interested in surgery, it's a bit more challenging. You have to "coach 'em up" as much as possible, but make it clear to the clerkship director that there may need to be a faculty-level discussion with them about their career plans.
But to answer your question, the main thing for me is of I get the sense that people aren't self-directed and/or internally motivated. There's a lot less handholding in surgical residencies, and I do think it takes a specific personality to succeed in that environment.
More people don’t have what it takes to match than don’t have what it takes to do the work of a surgeonI suppose I meant someone who's interested in surgery but just doesn't seem to have what it takes, since that's where the problem comes in.
I suppose I meant someone who's interested in surgery but just doesn't seem to have what it takes, since that's where the problem comes in.
On a related note, how do you deal with students not going into surgery who are overwhelmingly anxious about the OR and anything related to operating/clearly don't want to be involved in suturing/knot tying etc? Do you try to get them more comfortable or do you read the writing on the wall and stop getting them involved?
On a related note, how do you deal with students not going into surgery who are overwhelmingly anxious about the OR and anything related to operating/clearly don't want to be involved in suturing/knot tying etc? Do you try to get them more comfortable or do you read the writing on the wall and stop getting them involved?
3-components of a Henri Hartmann
He was French.
He was a Surgeon.
He's dead now.
This is a tough issue because you're taking people who have rarely ever failed in their lives and then telling them that this thing that they really want to do, isn't for them. Hard conversation to have regardless of who the student is. There are a couple of red flags that get me concerned (how they're numbered does not indicate order of importance):
1. They can't tie a basic knot.
- I know this may seem like a controversial point but I knew I wanted to be a surgeon before I stepped foot in med school. It took almost nothing for me to go on YouTube and learn how to tie two-handed and one-handed knots. I got good at learning how to do subcuticulars because that was going to be my primary job as a student. In my experience when I see an intern come onto the service and they can't tie a knot I start to get worried because there are so many other things that they need to learn how to do outside of the OR that I always figured this base should've already been covered when they had ample time as students. I also haven't seen interns coming in with bad hands and suddenly get great hands over the course of their residency. Usually bad interns turn into either bad residents or mediocre ones at best. The good interns are good from day one and it's so obvious they have their s**t together and that didn't happen just because they got a long white coat, they were good way before then. Time in the OR isn't enough in my opinion, there needs to be concerted thought and time spent outside of the OR on improving skills. Once again, this may cause some debate but it's just my opinion.
2. They miss the gimmes in general surgery (Hinchey classification, hernia anatomy, appendicitis management, basic gallbag ****, etc).
- You can't tell me you want to be a surgeon and then when I ask about the 3-components of a Henri Hartmann you stare at me with a blank face. It's fine if you can't really read the CT, that's what we're here for. But if we're doing a hernia and I ask direct vs indirect and you can't tell me, that's a problem of preparation and now I question your commitment to this.
3. They're late.
- I give everybody a mulligan because life happens. But you can't be coming in late every single day or unprepared and then wonder why I question your ability to be a surgeon.
4. They have an inability to self-evaluate.
- This is gonna sound mean but some kids just don't know how bad they are and when faced with constructive criticism just can't take it. Somewhere along the way, multiple people failed these kids by not helping them realize that they're not perfect and that we all have areas to improve in.
These are the main things that come to mind but I think it's necessary to say something. I think the worst thing we can do is take people who are incapable of self-reflection, have poor surgical technique and judgment, can't handle pressure and then just push them through residency. The real world doesn't care about any of this and at some point reality will come in the form of a lawsuit or hospitals pushing them out/not renewing contracts because they're just bad. And now what? They're 5-7 years invested in a field they were ill-suited for from the very beginning. Pull the band-aid quickly and tell them they're probably a better fit in a different field. If they ignore wise counsel and decide to go into surgery regardless, well that's on them but at least we tried. And that's all we can do. Cheers.
Time in the OR isn't enough in my opinion, there needs to be concerted thought and time spent outside of the OR on improving skills. Once again, this may cause some debate but it's just my opinion.
I've done both depending on the student, rotation, patients, etc. and have had really variable results.
One person who had no business ever stepping foot in an OR, I tried to take on consults, show how to suture, took on a personal tour of the operative area twice to calm nerves, showed several times how to scrub and gown, praised them to the scrubs, and tried to highlight "Hey, I know you don't want to do surgery, but these things are great for you to know going into XYZ field for how/when to consult us." Really tried to be nice and help with the anxiety....and for my troubles got called a big fat meanie by that med student. Another med student with the same demeanor really appreciated the extra time and teaching, wrote a thank you note etc. *Shrug*
One med student that was pretty verbal about never doing surgery, I told them "Cool. You're an adult and paying for this. Come when you want, leave when you want. See what you can. Let me know if you have any questions. Don't worry about rounding. I won't evaluate you." They really liked this approach and spent their time studying for boards. Another med student said they weren't interested and I said the exact same thing, bought them coffee and told them to enjoy themselves; and the med student came to a few cases and deliberately tried to pick all the cases where I wasn't because the student was intimidated. *Shrug*.
Ideally, I try to highlight salient points and tailor for what they are interested in; but that's tough if they have no clue other than 'not surgery.' I think how to hold a needle driver and how to place an interrupted suture is a basic skill that I try to teach. Try to cover the main complications of the big surgeries and the anatomy when we're looking at it. And try to say "here is how and when to consult us."
This is a tough issue because you're taking people who have rarely ever failed in their lives and then telling them that this thing that they really want to do, isn't for them. Hard conversation to have regardless of who the student is. There are a couple of red flags that get me concerned (how they're numbered does not indicate order of importance):
1. They can't tie a basic knot.
- I know this may seem like a controversial point but I knew I wanted to be a surgeon before I stepped foot in med school. It took almost nothing for me to go on YouTube and learn how to tie two-handed and one-handed knots. I got good at learning how to do subcuticulars because that was going to be my primary job as a student. In my experience when I see an intern come onto the service and they can't tie a knot I start to get worried because there are so many other things that they need to learn how to do outside of the OR that I always figured this base should've already been covered when they had ample time as students. I also haven't seen interns coming in with bad hands and suddenly get great hands over the course of their residency. Usually bad interns turn into either bad residents or mediocre ones at best. The good interns are good from day one and it's so obvious they have their s**t together and that didn't happen just because they got a long white coat, they were good way before then. Time in the OR isn't enough in my opinion, there needs to be concerted thought and time spent outside of the OR on improving skills. Once again, this may cause some debate but it's just my opinion.
2. They miss the gimmes in general surgery (Hinchey classification, hernia anatomy, appendicitis management, basic gallbag ****, etc).
- You can't tell me you want to be a surgeon and then when I ask about the 3-components of a Henri Hartmann you stare at me with a blank face. It's fine if you can't really read the CT, that's what we're here for. But if we're doing a hernia and I ask direct vs indirect and you can't tell me, that's a problem of preparation and now I question your commitment to this.
3. They're late.
- I give everybody a mulligan because life happens. But you can't be coming in late every single day or unprepared and then wonder why I question your ability to be a surgeon.
4. They have an inability to self-evaluate.
- This is gonna sound mean but some kids just don't know how bad they are and when faced with constructive criticism just can't take it. Somewhere along the way, multiple people failed these kids by not helping them realize that they're not perfect and that we all have areas to improve in.
These are the main things that come to mind but I think it's necessary to say something. I think the worst thing we can do is take people who are incapable of self-reflection, have poor surgical technique and judgment, can't handle pressure and then just push them through residency. The real world doesn't care about any of this and at some point reality will come in the form of a lawsuit or hospitals pushing them out/not renewing contracts because they're just bad. And now what? They're 5-7 years invested in a field they were ill-suited for from the very beginning. Pull the band-aid quickly and tell them they're probably a better fit in a different field. If they ignore wise counsel and decide to go into surgery regardless, well that's on them but at least we tried. And that's all we can do. Cheers.
I had a student that was dead set on GS and #1,2 and 4 was a problem.For the first time ever with a student, I pulled him aside and said, I really don't think you're cut out for this and gave some examples. He said thank you and still applied for the match and went unmatched. (not even a prelim spot out of a US med school).
Nowadays with med school being so different (work hours, no call, lectures) vs when I was a MS3 in 2010 (still call, med students got paged, paper notes and orders) I just try to lay out the realities of the field and make sure students are prepared for the commitment of surgery. Then I tell them how much I love my life, field of work, future salary, that we get to listen to music all day and wear pajamas and cut people open.
The level of entitlement that I have seen in med students and junior residents is astounding to me at times.
Are there any specific personality traits or "tells" that let you know that a student would never survive a surgical residency? How do you deal with them when they're on their rotations?
First of all, the literature shows clearly that, as educators, we are very bad at determining who is going to survive residency and make a great surgeon. Therefore, I have to swiftly invalidate everyone's opinion here, including my own.
Secondly, the technical abilities of a student, or any secondary marker of it like video games, etc, means almost nothing. Regardless of where they start, almost every chief resident is technically proficient and lies within 1 standard deviation of the mean. Additionally, technical abilities are nowhere near the most important part of a surgeon's job. Plenty of surgeons have "gifted hands" but don't make correct decisions, and can't troubleshoot problems well, and they are THE MOST dangerous because they don't have self-awareness.
If you want to do surgery, then almost certainly you are not "wrong for surgery." There are plenty of people who don't have an adequate work ethic, adequate hard drive, or adequate pressure under fire, but if you got into med school, you have the hard drive, and the rest is up to you, not the program director.
The secret to surgery is simpler than you think: hard work. There's no substitute. There's no magic pill. Hard work pays off.
Miss you guys. I'm glad to see SDN is holding strong.
SLUser
First of all, the literature shows clearly that, as educators, we are very bad at determining who is going to survive residency and make a great surgeon. Therefore, I have to swiftly invalidate everyone's opinion here, including my own.
Secondly, the technical abilities of a student, or any secondary marker of it like video games, etc, means almost nothing. Regardless of where they start, almost every chief resident is technically proficient and lies within 1 standard deviation of the mean. Additionally, technical abilities are nowhere near the most important part of a surgeon's job. Plenty of surgeons have "gifted hands" but don't make correct decisions, and can't troubleshoot problems well, and they are THE MOST dangerous because they don't have self-awareness.
If you want to do surgery, then almost certainly you are not "wrong for surgery." There are plenty of people who don't have an adequate work ethic, adequate hard drive, or adequate pressure under fire, but if you got into med school, you have the hard drive, and the rest is up to you, not the program director.
The secret to surgery is simpler than you think: hard work. There's no substitute. There's no magic pill. Hard work pays off.
Miss you guys. I'm glad to see SDN is holding strong.
SLUser
In most of the situations, there is only one choice to do in an operation.
One caveat: does not apply in a lot of vascular surgery.
I don’t necessarily think that it makes sense to throw things to the wind because “no one knows” what makes a student a good surgeon.
I don't think it applies to anything more complex than "lumps and bumps". Many people can memorize the steps of an operation. Making it happen (safely) is a different story.
I'm with you here. I think that suggests we aren't good at identifying (or choose not to focus on) the relevant qualities. And as long as we're focusing on board scores, how many publications you have, or whom can answer the most pimp questions in the OR, that's almost certainly the case. We can't identify these students because it's impossible, but because the current paradigm for medical education isn't necessarily built to meet that goal.
I don't think it applies to anything more complex than "lumps and bumps". Many people can memorize the steps of an operation. Making it happen (safely) is a different story.
I'm with you here. I think that suggests we aren't good at identifying (or choose not to focus on) the relevant qualities. And as long as we're focusing on board scores, how many publications you have, or whom can answer the most pimp questions in the OR, that's almost certainly the case. We can't identify these students because it's impossible, but because the current paradigm for medical education isn't necessarily built to meet that goal.
I guess I was thinking from the perspective of general surgery, since I’m also technically a general surgeon even though I don’t practice that side.
There’s generally very limited “correct” options for dealing with a perforated viscous, abdominal cancer, trauma, breast, etc.
One of the reasons I liked vascular was that there are so many ways to skin a cat.
Not putting anyone/any other specialties down. Just I guess my own bias of why I chose my particular specialty based staying in general surgery (which I also enjoyed, but not as much).
After training general surgery, plastic surgery, PA, NP, RNFA, and dermatology residents for 15 years
1) you can train most people to operate competently as it's a repetitive skill to acquire, but there are some people whom are hopeless technically
2) there are some surgery residents whom will never, ever learn to "think right" about surgical patients and understand the how's and why's of how things should be done.
3) most resident whom fall into group 1 and/or 2 are usually identified within 6 months of starting residency by their peers
When we have someone on our service, I don't pimp at all about anything. I'll find a YouTube video for them to watch and then explain during the case why we do things and the important concepts to internalize (say like about a breast or abdominal wall case) and then proctor them through the mechanics of how to close a wound, use a cautery, choose what suture materials to use, etc..... That works so much better and is less intimidating then say. asking stupid things about who Theodore Kocher, Halstead, Galen,etc... was and do you know some esoteric classification system of condition X. Without fail, our residents tell me they learned more from us in 1 month of their intern year about how to do a mastectomy correctly, how to process the important information on a breast cancer path report, and what the considerations are on adjuvant therapy decisions then they learn the rest of the residency.