How much did you like surgery as a student?

Discussion in 'Surgery and Surgical Subspecialties' started by bobjonesbob, Feb 9, 2019.

  1. bobjonesbob

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    3rd year student trying to figure out if I should take the plunge for surgery. I've been planning for a surgical sub - AOA, >260 step score, done some research, etc. but unsure about it now that it's time to plan my 4th year schedule. Overall I've really disliked the 3rd year of medical school. I feel like I spend a lot of time in the hospital but don't learn much and don't make meaningful contributions to pt care - basically feels like a waste of time.

    This includes my surgery rotations. When I've gotten to 1st assist, I really enjoyed it, but that was only a few times. I like the idea of doing surgery, but I'm bored watching during most cases. I would assume this is natural if you aren't participating beyond retracting, but I'm not really sure. The thought of continuing to be a bystander as a 4th year student, intern, and maybe even into PGY-2 sounds boring. Is this something most surgeons thought but just stuck it out for the end goal? Or is it a sign I should pursue something else?
     
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  2. doc05

    doc05 2K Member
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    Do you actually want to be a surgeon? Training takes forever, and you’ll make a ton of personal sacrifices.

    It’s not for everybody. Even among surgeons, burnout rates are very high, this is multifactorial but choosing the wrong specialty doesn’t help.

    Keep in mind, that if you haven’t really liked 3rd year of med school, maybe you shouldn’t do surgery. Ever consider radiology?
     
  3. Chillbo Baggins

    Chillbo Baggins HEYYEYAAEYAYAYA
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    3rd year sucks. Being a resident is way better. There's still all the grunt work, but your notes and orders actually count. And then of course you get more OR responsibility.
     
    #3 Chillbo Baggins, Feb 9, 2019
    Last edited: Feb 9, 2019
  4. VincentAdultman

    VincentAdultman Senior Member
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    TBH you kind of sound like someone who’s doing surgery because you know you’re competitive for it and who likes “the idea” of being a surgeon.

    Neither of which are super great reasons to be a surgeon.
     
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  5. akwho

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    I remember feeling how you felt as a MS-3. I choose a specific rural surgical rotation site as a MS-3 with no surgical residents so I would get to first assist every case with the attending. There is nothing more frustrating than being an observer for someone who likes working with their hands. Being a MS-3 on the surgery rotation is not representative of what being a resident or attending surgeon will be like, try to watch your attending's and see what their life is like and if you would like being them in the future. As someone in a surgical sub this the timeline to becoming a surgeon.
    • MS-3's are more work than they give back to the team 99% of the time. So if you feel like you are a burden as a third year that just means you have an accurate perception of your situation. That's okay, we all know and expect third years to be extra work, we are just happy if they have a good attitude and are on time. If we teach them something and they retain it, that's a bonus. We were all in their shoes at some time point. Some of us remember it better than others or just have more bandwidth to deal constructively with medical students. Other residents/attendings don't remember what it's like to be a MS-3 or are overwhelmed with their workload, as the student you should avoid these people as much as humanly possible - they don't teach and they usually just hurt you one way or another.
    • Sub-i's are when about 80% of people get it. We love having sub-i's on our team because they contribute in a meaningful way. They have the bandage bag ready for rounds without asking, they help the intern with the list. They set up and participate in doing ER procedures. They are an extra set of hands in the OR for retracting and splinting. They start to anticipate movements and shift their hands for retracting during surgery and splinting. They go out with us residents for dinners and social events. They study the material in their free time and ask intelligent questions that aren't googleable. We know most of them will be our future colleagues which changes the dynamic.
    • Intern year is your buy in year, you are still a lot of work for the rest of the team members. You mess things up. You need to learn a thousand little things to become good and efficient at your job. You do all the jobs none of the seniors want to deal with: nurse pages, admit orders, discharges, paperwork, med recons, follow up appointments, social work meetings, UR phone calls, and family discussions. You are spending more time in the hospital than you thought was humanly possible. Every day you have the best parking spot in the building because no one else except the other surgical interns are there. By midway through the year you start getting so efficient at the intern work that the work that use to take you til 8pm you are now finishing by 2pm. Then you start shadowing the R2 seeing consults and really getting ready to transition from intern to surgical resident.
    • R2 year you are seeing consults. The attendings start to learn your name and recognize you by face. You start to develop a reputation as someone is through, honest and hardworking, or the opposite. You start spending a little time in the OR when you aren't seeing consults. Learning how to safely position patients. How to help move the OR day along by having correct orders in. Making sure correct trays and instruments are there. You start seeing why some of the cases are operative vs non-operative in person which helps you better talk with patient's when you consent them for surgery. This is still a buy in year. You are putting massive amounts of work and time in doing jobs nobody else wants to do: ie in the ER seeing consults, dealing with pages from other services and consenting patients for surgery. You find out how exactly hard 30-hours in a row in the hospital is when you see the ER residents and nurses leaving from their second shift while you've been in the hospital the whole time. You Uber home from work because you are too tired to drive.
    • R3 year, you are often the most junior member of the surgical team operating. This means your chief and attendings are usually walking you through how to do the simple cases and you retract for them for complex cases. You may get bumped out of the more interesting cases by fellows (this is why you want a program with as few fellows as possible, surgery is still a hierarchy), and senior residents. This year you learn that 10 hour cases in lead will leave you drenched in sweat, dehydrated and test your bladder strength. You will see floor errors, consult errors and ER errors negatively affect your patient's care and you will start to understand the importance of the things you learned in your prior years. You will start to develop surgical skills you are proud of once you do enough cases. You will start teaching juniors on a regular basis once you feel comfortable with certain procedures. This year you really start to gain the technical skills of a surgeon. However, the responsibility for patient care on the rotation still falls to the chiefs and attendings so this is a nice year to learn technical skills without being under monumental amounts of stress that staffing intern questions, consult questions, and operating room staff questions brings.
    I'm in my R3 year, so I can't speak to future years yet, but as you can see, each year in the training of a surgeon brings new challenges, experiences, joys, and hardships. Hopefully this post will help you realize what a small percentage of surgery you experience as an MS-3, and how you shouldn't let a bad MS-3 rotation discourage you from being a surgeon.
     
    #5 akwho, Feb 9, 2019
    Last edited: Feb 9, 2019
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  6. Gurby

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    Thanks for taking the time to write this.
     
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  7. OP
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    bobjonesbob

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    Yeah, that's what I'm asking myself. I came to medical school to be a surgeon but 3rd year has me questioning that plan.

    There's a lot of rhetoric about surgery. "I'd leave medicine if I couldn't be a surgeon." "Don't do surgery if you can imagine yourself doing anything else." "As soon as I walked in the OR during 3rd year I knew surgery was for me." - these are all quotes from surgery residents I've interacted with. I get that's hard and that it's not for everyone. But, that type of attitude strikes me as rationalization. Residents are miserable in the middle of their training so it's easiest to convince themselves that surgery was their only option. If every day they woke up thinking they should have done gas or rads they couldn't live with themselves so they make up a story to make it more bearable.

    I actually have been thinking about rads recently. Unfortunately I can't squeeze in a rotation now so might try to get down to the reading room to shadow.

    Did you truly enjoy surgery as a student?
     
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  8. OP
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    bobjonesbob

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    You might be right which is what I'm trying to avoid. Don't want to be a victim of the sunk cost fallacy. Not sure how you interpreted what I meant by "the idea" but I was thinking more along the lines of mastering the craft, acquiring the technical skill, being an expert in a subject - obviously these are only things I can imagine as a student.

    How did you know ortho was for you? Did you really love watching people put in nails?
     
  9. OP
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    bobjonesbob

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    That's encouraging. Thanks for the input. I think knowing I was doing something useful would make it much more enjoyable.

    How did you decide ortho was for you?
     
  10. OP
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    bobjonesbob

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    Thanks for this. This seems reflective of what I've seen on my rotations but it's helpful to see it laid out like this.
     
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  11. VincentAdultman

    VincentAdultman Senior Member
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    Dude. I will NEVER forget the first time I watched a TKA. Amazing. That’s how I felt about most ortho cases tbh save the spine cases and acetabulum orifs that would take all day. I lived every minute of my ortho rotation as a third year med student. I felt like I was home.
     
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  12. TraumaLlamaMD

    TraumaLlamaMD Licensed to chill
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    YMMV based on program. I was in the OR pretty frequently as a second year (and 1-2 times a week as an intern) as surgeon junior - that is, working with an attending and not retracting. I wasn’t doing huge cases, but I didn’t have to retract in anything other than a case I chose to double scrub out of personal interest. We don’t have enough people that we can have a second year consult resident, because our PGY2s are often operating. Our interns learn to see consults from day 1, with less direct supervision as the year progresses.

    Yes, there is a lot of floor work to be done in the early years and it’s frustrating. But your classmates who tell you “if you’d be happy doing something else, do that” are probably right - another year or two of gradually increasing participation were well worth it for me in exchange for a career in surgery.

    As to your experiences as a student, your participation will increase as you demonstrate competence. I love teaching students to suture in the OR, to do bedside procedures, to make the incision, etc - but in order to earn the time investment, that student first needs to demonstrate that they’re engaged and learning. We have students on their cell phones or chatting during signout and on rounds, and those students aren’t getting any extra privileges in the OR. It’s the ones who come a little early to see and present a patient, who ask to come with me so they can see how to place an NG or remove a JP, who I take the time to involve in the OR. Try a busy service (when I did trauma as a 3rd and 4th year there were sometimes enough operative cases at once that it would be just me and a fellow), or scrub more with the upper year residents. As a 4, I’ve closed enough port sites that I’m more than happy to let a student do it. As a 1 or 2, I was less confident teaching someone else.
     
    #12 TraumaLlamaMD, Feb 10, 2019
    Last edited: Feb 10, 2019
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  13. Chillbo Baggins

    Chillbo Baggins HEYYEYAAEYAYAYA
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    Nothing too far from the usual: knew I wanted to fix rather than manage, and then the patient population, tools, cases, and people in ortho set it apart from the other surgical fields.
     
  14. ThoracicGuy

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    Admit it. You did it because you likes Bones. Long bones, short bones. Bones, bones, bones. And you also like the heart because it pumps the kefzol to the bones.
     
  15. Chillbo Baggins

    Chillbo Baggins HEYYEYAAEYAYAYA
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    Ancef, bone, cut
     
  16. LucidSplash

    LucidSplash Bloody Plumber
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    Except dirty flat bones. They do not like those.
     
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  17. OrthoTraumaMD

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    And teeth; they are bones but don’t look like bones.
    Bones.
    I like bones.
     
  18. OrthoTraumaMD

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    To the OP...
    I would suggest you go in on a random weekend and see if you can scrub a case with a surgery attending that does not have a resident. It sucks watching. I didn’t enjoy it very much. My most enjoyable time as a student was when I was on cardiothoracic and would close the saphenous vein graft wound, back when they used to be harvested open.
    I see what you’re talking about in terms of Stockholm syndrome, but the truth is, there are plenty of surgical residents who decided is not for them and then moved on into a medical field. I had several classmates from intern year who did that. There is always a risk. I think if on your surgery rotation you thought “these are my people,” it should be your benchmark.
     
  19. MediCane2006

    MediCane2006 Living the dream
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    Literally was scrolling to the end to post exactly this. Passively watching a six hour whipple when for most of the case you are staring at the back of the resident’s neck is not fun. Neither is waking up at 4am for punishingly early rounds. But I just had the realization during my rotation that the surgery folks were “my people” and that I really couldn’t imagine fitting in as well with any other group in the hospital.
     
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  20. eqkc

    eqkc Strangers call me Spitfire
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    I messaged my grandma after my surgery rotation: "I couldn't be happier. I feel like I truly belong, have a lifetime of room to evolve, and the support to do so from like-minded colleagues. It's pretty exciting."

    [btw, I'm NOT bubbly at baseline. the above is likely the most romantic thing I've ever written.]

    Will be a surgery intern at that same program this summer. :D
     
    #20 eqkc, Feb 15, 2019 at 7:31 PM
    Last edited: Feb 15, 2019 at 7:42 PM
  21. TypeADissection

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    Unfortunately (or fortunately), I really didn't know there was anything else other than surgery. So it made my decision easier in the sense that all I had to figure out was which surgery specialty was I going to go into. I had friends who truly had no idea what they wanted to do and I felt bad for them because I guess the decision can be overwhelming if you're being pulled towards multiple things. My Neanderthal brain is so simple that it made a lot of subsequent decisions much easier. If you know surgery is for you and you won't be happy doing anything else, don't fight it. Just come to the dark side. Cheers.
     

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