How much of Surgery rotation is spent wasting time?

[sharklasers]

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I feel like I shouldn't be reading/doing some early shelf studying during the time I'm in the hospital.

When I'm not in the OR, what should I actually be doing? I've just been following residents around and asking if I could help them in any way (which usually involves some menial task like telling X person Y message).

I haven't even been told what patients are "mine." Is this something I need to be claim on my own? In morning rounds, they have never asked me to present any patient so its hard for me to even expect what they want from me.

 

[Kahreek]

if you dont have any patients assigned to you during your rotation, you are either blessed or screwed, it may mean you can have awsome hours and leave earlier (if I were you i would do the OR time and mind my own things the rest of the time) . Dont be the guy who does menial tasks, even delivering samples or or phoning for X or Y exam is a menial task, being a message mule is the worst, and asking for it is even worse.

 

[alpinism]

I feel like I shouldn't be reading/doing some early shelf studying during the time I'm in the hospital.

When I'm not in the OR, what should I actually be doing? I've just been following residents around and asking if I could help them in any way (which usually involves some menial task like telling X person Y message).

I haven't even been told what patients are "mine." Is this something I need to be claim on my own? In morning rounds, they have never asked me to present any patient so its hard for me to even expect what they want from me.

Doesn't sound good.

Do you preround? Write progress notes? Perform or assist w/ procedures? See pts in clinc? Call consults?

If you have a supervising resident their pts should be your pts.

 

[sharklasers]

if you dont have any patients assigned to you during your rotation, you are either blessed or screwed, it may mean you can have awsome hours and leave earlier (if I were you i would do the OR time and mind my own things the rest of the time) . Dont be the guy who does menial tasks, even delivering samples or or phoning for X or Y exam is a menial task, being a message mule is the worst, and asking for it is even worse.

i figure the menial tasks would just be so the resident likes me for good evalulations lol. i heard that med students don't do much at all except get in the way, so might as well try to make the life of the resident easier (when i'm not in the OR)

 

[sharklasers]

Doesn't sound good.

Do you preround? Write progress notes? Perform or assist w/ procedures? See pts in clinc? Call consults?

If you have a supervising resident their pts should be your pts.

the service i'm on specifically told us not to preround, but just to help out the overnight attending. do you preround on just your 2-3 patients or all patients on the service? does prerounding mean reading up on the patient and finding out about any changes or actually talking to the patient and doing a physical exam and stuff?

i mean its still early in my rotation, but i don't think the chief resident has told me anything that makes me feel like my rotation is going to change. i haven't written any progress notes or called consults.

in clinic is when we "are lucky enough" to spend time with the attending (which is actually not bad since they are the ones that evaluate us). so i don't see clinic patients alone.

i have scrubbed in on surgeries, helped out a bit (but i do see me being able to do more in the OR in the coming weeks).

 

[genswim24]

Dont be the guy who does menial tasks, even delivering samples or or phoning for X or Y exam is a menial task, being a message mule is the worst, and asking for it is even worse.

Making phone calls to other services, delivering messages to patients/nurses, and running samples when staff is taking forever can be a huge help to your team. Your job as a medical student is not only to learn medicine, but also learn how hospitals operate and how to get things done when they need to be. If you think those are too menial for you, you are going to hate residency because it will be full of those tasks. If you aren't willing to do those things to help your team out thats a poor reflection on you.

I am not saying you need to be there all day, but easing your residents load is always appreciated and can also help them have the time to teach you. If you do have down time, studying for the shelf or your next case is perfectly acceptable.

 

[ThoracicGuy]

if you dont have any patients assigned to you during your rotation, you are either blessed or screwed, it may mean you can have awsome hours and leave earlier (if I were you i would do the OR time and mind my own things the rest of the time) . Dont be the guy who does menial tasks, even delivering samples or or phoning for X or Y exam is a menial task, being a message mule is the worst, and asking for it is even worse.

As a surgical resident, it was great when we had a student that showed interest, even if it was just doing the menial tasks or being a message mule. Showing disinterest when there was work to be done or even studying when there was current patient work or surgeries going on what not viewed on favorably. Telling this student NOT to do tasks that help the residents out is not good advice.

 

[alpinism]

if you dont have any patients assigned to you during your rotation, you are either blessed or screwed, it may mean you can have awsome hours and leave earlier (if I were you i would do the OR time and mind my own things the rest of the time) . Dont be the guy who does menial tasks, even delivering samples or or phoning for X or Y exam is a menial task, being a message mule is the worst, and asking for it is even worse.

This is a good way to not get honors on rotations.

the service i'm on specifically told us not to preround, but just to help out the overnight attending. do you preround on just your 2-3 patients or all patients on the service? does prerounding mean reading up on the patient and finding out about any changes or actually talking to the patient and doing a physical exam and stuff?

i mean its still early in my rotation, but i don't think the chief resident has told me anything that makes me feel like my rotation is going to change. i haven't written any progress notes or called consults.

in clinic is when we "are lucky enough" to spend time with the attending (which is actually not bad since they are the ones that evaluate us). so i don't see clinic patients alone.

i have scrubbed in on surgeries, helped out a bit (but i do see me being able to do more in the OR in the coming weeks).

It depends on the service, but normally you just preround on your own pts.

Yes, both. Basically, talking to the nurses to see how the pt did overnight (any new changes or updates), reviewing the pt's chart (new VS and labs), talking to the pt (asking about pain/nausea/sleeping/bowels/urination/etc), doing a focused PE, checking drains, checking the wound for signs of infection... then writing a SOAP note and presenting the pt on rounds.

You should be seeing pts alone in clinic then presenting them to the attending.

 

[evilbooyaa]

You should be doing the following on surgery (especially if it's your first rotation):
1) Pre-rounding. Described very nicely in the above post. "Running the list" with the residents prior to the day's surgical schedule, updating them with any relevant info. By the time I was on Surgery (4th rotation of MS3) I saw my patients, presented them at rounds, then gave my completed SOAPs to the interns to sign off on. Unless something was acutely wrong with the patient, they would only poke their head in after resident rounds had ended [as surgical interns/pre-lims exclusively run the floors at my hospital].
2) Follow the chief/fellow through the OR schedule. If you're on a service that has multiple surgeries going on at once, pick the one that you will get to do the most in (avoid IR as there's an awful lot of hands in a very small area down there). Make sure you write down the next day's schedule the previous night (or earlier that morning) so you can plan out your OR day. Generally, staying in one room is recommended, but discuss with your senior/fellow about the most interesting surgeries (very service dependent).
3) You should be mostly in the OR from rounds until you go home. At some point between surgeries, you may round with the attending (or they may round without you, doesn't matter). Have a copy of the SOAP from any patient you saw that morning. On surgery they want you to read (if you have to) rather than memorize, so enjoy that luxury before you go to medicine.
4) If nothing is going on, then maybe go see what the interns are doing. Generally it's not a lot, and if there are no surgeries, you can usually get them to let you out a little earlier (assuming they're not dicks).
5) Don't fall asleep in a surgery, as boring and long as it may be.

 

[davefromcamp]

100%, even when students get to 'close' it wastes all OR time. Ha! Unless you want to do surgery then maybe 15% is wasted time. But you know, when you are all done you can then waste other people's time, its all earning your way. Unfortunately

 

[cyclopz]

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[D elegans]

The surgery rotation is basically a waste of time for med students. The hours are long but it's not difficult. Anyone who tells you otherwise is misleading you.

In the OR, you usually stand there and retract for 3-4 hours in order to do 5 minutes of suturing. The first time you see a surgery it's really cool, but after that it gets boring because your role doesn't usually change in the OR even though you've seen that procedure a few times now. You still usually retract for hours and get to do 5 minutes of suturing at the end. Since only 20% of the time will be "new" surgeries for you, I would say 80% of the time is a waste.

As for prerounding, each team has different expectations of med students. It just depends which residents you have. Some teams have you just show up for rounds and do nothing, some have you update the list before rounds start, and others make you preround on your own patients. In all honesty, no matter which of those 3 you do, you probably are getting about the same thing out of it. Pre-rounding mainly comprises of asking how about pain, BMs, urination, eating, a basic ROS and wound/drain checks. Surgery rounds are a joke compared to medicine rounds. The physical exam of the residents and attendings is usually a basic abdominal exam and nothing else.

Sounds pretty on the ball to me. The worst thing is the long hours. Most days for me go from 330-1800, which makes me feel like crap all the time. The day-to-day grind and BS that would normally not bother me does when I can't f'ing stay awake. Surgeries become bad too because just standing there forever makes me want to pass out.

Only 5 more weeks...

 

[Siggy]

the service i'm on specifically told us not to preround, but just to help out the overnight attending. do you preround on just your 2-3 patients or all patients on the service? does prerounding mean reading up on the patient and finding out about any changes or actually talking to the patient and doing a physical exam and stuff?

For where I did my gen surg rotation, you had up to 4 notes (depending on patient load) during the week and 6 patients on the weekend (if on call) to preround on. That meant you go, see the patient, fill out the progress note form ("med student proof"), and present the patient on rounds. The residents will at least check in on the patient and, if they have time and you've done the note, write an addendum and sign the note. During rounds, the attending amended the note and signed the note (there's a space both for the resident and the attending to make additional remarks).


Personally, for my gen surg rotation, I spent relatively little time in the OR (which is fine with me), but was constantly helping out with admissions and trauma alerts/activations.

 

[siliso]

Look out for number one. And that is You. If you get out of case 1 and need to page to see where to go next, make sure you eat, drink, sit down, and urinate before you page. I could make myself useful by writing all 10 cursory notes between cases, and the intern just cosigned. No prerounding, just AM communal rounding. Kosher? Who knows. But it worked. I was lucky to have a resident, intern, and four or five attendings, so my comings and goings were not at all times monitored. And there were the notes to write and consults to see and H&p...

 

[Law2Doc]

... I was lucky to have a resident, intern, and four or five attendings, so my comings and goings were not at all times monitored. And there were the notes to write and consults to see and H&p...

LOL. Dont sell your residents short. A lot of the time med students think they are under the radar, but rarely are. As an intern, we knew all the games people played in 3rd year -- we weren't that far removed. And we always had plenty of eyes around the hospital that reported back when they saw our med students hanging out in the cafeteria, lounge, library, etc when they were really supposed to be on rounds, at a didactic, doing something for a patient. There was rarely a day when a resident didn't say "where's X and Y, they should see/do this", and a nurse or tech or other resident would chime in "oh I think I just saw them at..." the hospital is a very small universe, and residents are better plugged in then the students. People rat you guys out on a regular basis.

The reason you get away with it is we (residents) have other, more important things to do. We aren't your parents and really couldn't care less if you get some or no value out of a rotation. We are too busy with our own roles to let your antics get into our head, and you aren't adding much value for us most of the time anyhow. Probably won't even make it into an evaluation unless we are in a particularly bad mood that day. But you should definitely remember your post for when you are an intern and the med students think they are playing you - at the very same game you thought you were a master. You will see that you only got away with it because the previous masters let you.

(I think there is a "Real Med Students of Genius" sketch on YouTube from a long time ago of the "always disappearing guy" who pretty much does what you are describing as well).

 

[Suncrusher]

I'm only 2 weeks into my surg rotation and I've realized that it's really up to me how much I get out of it.

The first week was a blur of new faces and new technology and new surgery and trying to remember complicated anatomy. But during the second week, I started being brave enough to ask a lot of questions, ask to be walked-through how to perform certain procedures, ask to be more involved during the surgeries, etc. Everyone responded to this very positively. The surgeons love how involved I am and that I clearly want to learn everything they have to teach no matter how mundane, and they also actually believe me now when I say that I think surgery is really cool and that I want to be a surgeon. They see that I am enthusiastic, appreciative, and thankful I am whenever they let me perform a part of the surgery, so they let me do more and more on a daily basis (it used to be just retracting, suturing, and aiming laparoscopes; now they let me make certain incisions, dissect easy things out, and even make some important resections when the margins/anatomy are very clear and they can easily correct me). There are no residents at my hospital to get in my way and steal all the cool stuff away from me so I've really gotten a lot of great experience during the 21 surgeries I've been in so far. The PAs were just waiting to be asked to teach me how to tie or how my notes could be better. The Anesthesiologists and CRNAs were all very willing to teach me how to place an a-line, swan-ganz, NG tube, endotracheal tube, etc, and so I spend whatever "down time" I have between surgeries with Anesthesiology in the OR practicing these procedures on the patients before the surgeries start.

 

[Law2Doc]

I'm only 2 weeks into my surg rotation and I've realized that it's really up to me how much I get out of it...

I think this is largely true for most rotations, but particularly the procedure heavy ones. If you show an interest and make an effort, people will treat you very differently, ultimately let you do some hands on stuff. If you are just there hoping to endure/survive with the minimum amount if pain/effort, you are going to have a very different experience. Most rotations are really about having a good attitude and some initiative. If you look at surgery as a month of doing something cool you'll probably never likely get an opportunity to do again, you'll have a much better time than looking at it as something you just have to stomach. The people going into the rotation convinced they are going to hate it usually have a bad time, but there are plenty of non-future-surgeons who actually enjoyed that rotation. So it's really an issue of getting the right mindset.

 

[cyclopz]

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[Law2Doc]

I agree with most of this except for the nurses/techs ratting you out. They definitely have no idea who you are. The med students change out every month and no one pays attention except the residents. Not to mention you're only on the floor for 30 minutes so none of those staff know you...."

You'd be surprised. The nurses and support staff know you well enough to rat you out, even if not necessarily by name.

 

[Siggy]

(I think there is a "Real Med Students of Genius" sketch on YouTube from a long time ago of the "always disappearing guy" who pretty much does what you are describing as well).

[YOUTUBE]http://www.youtube.com/watch?v=r8mro4kcO4k[/YOUTUBE]

It's also one of the 12 Types of Medical Students.

 

[alpinism]

I'm only 2 weeks into my surg rotation and I've realized that it's really up to me how much I get out of it.

The first week was a blur of new faces and new technology and new surgery and trying to remember complicated anatomy. But during the second week, I started being brave enough to ask a lot of questions, ask to be walked-through how to perform certain procedures, ask to be more involved during the surgeries, etc. Everyone responded to this very positively. The surgeons love how involved I am and that I clearly want to learn everything they have to teach no matter how mundane, and they also actually believe me now when I say that I think surgery is really cool and that I want to be a surgeon. They see that I am enthusiastic, appreciative, and thankful I am whenever they let me perform a part of the surgery, so they let me do more and more on a daily basis (it used to be just retracting, suturing, and aiming laparoscopes; now they let me make certain incisions, dissect easy things out, and even make some important resections when the margins/anatomy are very clear and they can easily correct me). There are no residents at my hospital to get in my way and steal all the cool stuff away from me so I've really gotten a lot of great experience during the 21 surgeries I've been in so far. The PAs were just waiting to be asked to teach me how to tie or how my notes could be better. The Anesthesiologists and CRNAs were all very willing to teach me how to place an a-line, swan-ganz, NG tube, endotracheal tube, etc, and so I spend whatever "down time" I have between surgeries with Anesthesiology in the OR practicing these procedures on the patients before the surgeries start.

This. If all you're doing is retracting/suctioning/suturing in the OR, either you got really unlucky or you're just not trying. Most surgeons and anesthesiologists are more than willing to teach you and let you assist with procedures if you seem interested, ask questions, and offer to help.

Don't be afraid to ask to do more. You learn best by doing, not watching.

[YOUTUBE]http://www.youtube.com/watch?v=r8mro4kcO4k[/YOUTUBE]

It's also one of the 12 Types of Medical Students.

Lol. How have I not seen this before?

 

[tco]

This. If all you're doing is retracting/suctioning/suturing in the OR, either you got really unlucky or you're just not trying. Most surgeons and anesthesiologists are more than willing to teach you and let you assist with procedures if you seem interested, ask questions, and offer to help.

Don't be afraid to ask to do more. You learn best by doing, not watching.

This is HIGHLY dependent on where you are, and was not at all true for me on my surgery rotation.

I'm actually going to do an elective this year in vascular surgery, but before I committed to it, I emailed the doc in charge of the rotation, asking if I could expect to be more selective to which cases I went to and be more involved in the OR. She basically said, "Yes on all accounts, because we know you're interested in surgery."

Even if you're interested in it during your third year, they're probably not going to let you do much, at least here.

 

[cyclopz]

I'm only 2 weeks into my surg rotation and I've realized that it's really up to me how much I get out of it.

The first week was a blur of new faces and new technology and new surgery and trying to remember complicated anatomy. But during the second week, I started being brave enough to ask a lot of questions, ask to be walked-through how to perform certain procedures, ask to be more involved during the surgeries, etc. Everyone responded to this very positively. The surgeons love how involved I am and that I clearly want to learn everything they have to teach no matter how mundane, and they also actually believe me now when I say that I think surgery is really cool and that I want to be a surgeon. They see that I am enthusiastic, appreciative, and thankful I am whenever they let me perform a part of the surgery, so they let me do more and more on a daily basis (it used to be just retracting, suturing, and aiming laparoscopes; now they let me make certain incisions, dissect easy things out, and even make some important resections when the margins/anatomy are very clear and they can easily correct me). There are no residents at my hospital to get in my way and steal all the cool stuff away from me so I've really gotten a lot of great experience during the 21 surgeries I've been in so far. The PAs were just waiting to be asked to teach me how to tie or how my notes could be better. The Anesthesiologists and CRNAs were all very willing to teach me how to place an a-line, swan-ganz, NG tube, endotracheal tube, etc, and so I spend whatever "down time" I have between surgeries with Anesthesiology in the OR practicing these procedures on the patients before the surgeries start.

This. If all you're doing is retracting/suctioning/suturing in the OR, either you got really unlucky or you're just not trying. Most surgeons and anesthesiologists are more than willing to teach you and let you assist with procedures if you seem interested, ask questions, and offer to help.

Don't be afraid to ask to do more. You learn best by doing, not watching.

You don't get his experience at an academic hospital. He clearly said there are no residents to get in his way. At an academic hospital you have a million residents and fellows in front of you. He must be at a community hospital.

 

[VisionaryTics]

You don't get his experience at an academic hospital. He clearly said there are no residents to get in his way. At an academic hospital you have a million residents and fellows in front of you. He must be at a community hospital.

It's also the start of the year, when all of the residents are getting a little bit more autonomy and not sharing much.

I'm on my ENT subI on the general and otology services. I've done nothing in the last two weeks but retract and anchor one JP. I obviously can't do anything on ear cases, and the open cases are basically the juniors doing their first tonsils/traches/bits of thyroids. I mean, I can't ask residents to take me through anything when they're still struggling.

Next week I'm on sinus and laryngology (once again, can't do anything). I honestly can't see myself doing anything until I spend a couple of days on the H&N service. Really frustrating, but hey, only two more years until I start operating.

 

[Siggy]

You don't get his experience at an academic hospital. He clearly said there are no residents to get in his way. At an academic hospital you have a million residents and fellows in front of you. He must be at a community hospital.

Sounds likely. On my surgery rotation at a county hospital with a gen surg residency and surg fellowships I pretty much just retracted, cut sutures too long/short, and suctioned bovie smoke on all of the cases. Prior to that, on my psych rotation that was set up through a community hospital, I ended up having to do 2 general call shifts (mostly IM patients... but help out where needed. Don't ask why a student on a psych rotation is helping with surgeries or medicine patients. That's just the way that hospital is set up). I got shanghaied into a lap appy where I ended up driving the camera.

 

[ACSurgeon]

out of curiosity, what would make your experience more worthwhile? I'm genuinely interested to apply with my students.

 

[tco]

out of curiosity, what would make your experience more worthwhile? I'm genuinely interested to apply with my students.

Show them relevant anatomy. Explain to them or ask them about complications associated with the procedures in a non-threatening manner, "Do you know the main possible complications of this procedure?" vs "Name the complications of this procedure.". Let them do mundane things that you take for granted (anything other than retract, for example...I'm not saying don't make them retract, but let them do other things too). Let them help you close.

 

[Frazier]

[YOUTUBE]http://www.youtube.com/watch?v=r8mro4kcO4k[/YOUTUBE]

This is awesome. 👍

 

[ACSurgeon]

Show them relevant anatomy. Explain to them or ask them about complications associated with the procedures in a non-threatening manner, "Do you know the main possible complications of this procedure?" vs "Name the complications of this procedure.". Let them do mundane things that you take for granted (anything other than retract, for example). Let them help you close.

These are things I already do, especially since the end of intern year. Many students still feel like their time is wasted, but that's in part a universal thing in medical training. I agree though, it's not uncommon for residents to fail to do even the little things that can make it a little more worthwhile.

 

[siliso]

I don't think I was really getting one over on anybody or getting away with anything shady. I worked plenty hard and learned a lot and got good comments and honors. Wasn't trying to go home and have a beer and watch TV. Just realized that no one else was going to make sure I ever got a chance to pee or eat (and why should they, they are busy) so I'd better do so myself. Actually on the advice of one of the attendings, upon finishing a case: eat first, then page.

Mostly I think "wasted time" is a matter of perception, though. You can be learning all the time by being curious about everything that you see and hear and asking about it or looking it up as appropriate, and seeking out things to do, or you can be expecting spoonfeeding and entertainment and feeling disappointed. Retracting: it ain't that bad. Especially as I never expected to be seeing people mucking around inside living human guts again outside of those 5.5 weeks, and never had before.

 

[deleted6669]

sounds like you got either a bad rotation or bad preceptors. as a student on my trauma surgery rotation(my first rotation) I spent my time with the team either in the o.r., rounding, or in the surgical clinic taking care of post-op patients. I had my own patients I was responsible for following. my preceptors were all residents on the navy trauma surgical team rotating through the medstar trauma unit in washington d.c. I was the only student on the team at the time although other teams had med students on them. they schedule 3 teams at a time who rotate first or second call while the third team has a rounding and clinic day(although you could still end up back in the o.r. if one of your floor pts was doing poorly and needed another procedure). most days when we were 2nd call we were still busy in the o.r. most of the day. it was washington d.c. in the 90's in the middle of summer...big time knife and gun club.
as a student on the rotation I did lots of suturing and had opportunities to put in chest tubes, central lines, do DPL's(it was a while ago), participate in medical and trauma codes,round in the icu, etc, etc. my preceptors were always pimping me(fairly gently actually) on relevant anatomy, differential dx, etc. it was a really great rotation in spite of the hours, alternating 24 and 12 hr shifts for 5 weeks. I had one day off on the whole rotation just because we admitted no one the night before and had previously discharged all our inpatients. if anyone is interested in the site they schedule PA and MD students interchangeably.

 

[alpinism]

This is HIGHLY dependent on where you are, and was not at all true for me on my surgery rotation.

I'm actually going to do an elective this year in vascular surgery, but before I committed to it, I emailed the doc in charge of the rotation, asking if I could expect to be more selective to which cases I went to and be more involved in the OR. She basically said, "Yes on all accounts, because we know you're interested in surgery."

Even if you're interested in it during your third year, they're probably not going to let you do much, at least here.

You don't get his experience at an academic hospital. He clearly said there are no residents to get in his way. At an academic hospital you have a million residents and fellows in front of you. He must be at a community hospital.

Even at a huge academic center w/ tons of residents, there's no reason why the senior resident can't walk you through the procedure and explain the relevant anatomy as you go along. In addition, they should already know how to perform the basic aspects of most surgeries, so they don't get any benefit from doing everything while you watch.

My point is that if you are proactive and straight up tell the resident that you want to operate and need to practice your surgical skills, often (but not always) they will let you make incisions, bovie some fascia, put in a drain, or pack the wound etc... small but simple procedures to keep you involved. This only applies to gen surgery for the most part.

It's obviously harder at academic centers w/ all residents/fellows around which is why you have to constantly ask to do stuff to get their attention and pick the cases w/ the best opportunities. Its easier at community hospitals b/c the attendings will ask you if you want to do procedures without you even trying (which is what most med students prefer).

Just my n=1 but when I was an M2 "shadowing" in surgery I got to do tons of stuff that even our M3s didn't normally do because I was so proactive (doing about half the cutting for of a couple above the knee guillotine amputations, driving the camera on lap-choles, putting in JP drains, taking biopsies, suturing, putting in art-lines and central lines) and this was at a huge academic surgery dept not a community hosp. Many of my classmates who also shadowed didn't even get to suture...because they just stood there silently the whole time.

 

[tco]

Even at a huge academic center w/ tons of residents, there's no reason why the senior resident can't walk you through the procedure and explain the relevant anatomy as you go along. In addition, they should already know how to perform the basic aspects of most surgeries, so they don't get any benefit from doing everything while you watch.

My point is that if you are proactive and straight up tell the resident that you want to operate and need to practice your surgical skills, often (but not always) they will let you make incisions, bovie some fascia, put in a drain, or pack the wound etc... small but simple procedures to keep you involved. This only applies to gen surgery for the most part.

It's obviously harder at academic centers w/ all residents/fellows around which is why you have to constantly ask to do stuff to get their attention and pick the cases w/ the best opportunities. Its easier at community hospitals b/c the attendings will ask you if you want to do procedures without you even trying (which is what most med students prefer).

Just my n=1 but when I was an M2 "shadowing" in surgery I got to do tons of stuff that even our M3s didn't normally do because I was so proactive (doing about half the cutting for of a couple above the knee guillotine amputations, driving the camera on lap-choles, putting in JP drains, taking biopsies, suturing, putting in art-lines and central lines) and this was at a huge academic surgery dept not a community hosp. Many of my classmates who also shadowed didn't even get to suture...because they just stood there silently the whole time.

I guess "getting to do a lot" is relative. I don't consider packing dressings, putting in drains, stapling incisions, and half of the other things you say are "being involved" of any significance. I did most of what you're saying, but the residents really didn't help me to do them...It was usually the attending jumping over the resident, telling me to do it.

 

[Stellar Clouds]

I guess "getting to do a lot" is relative. I don't consider packing dressings, putting in drains, stapling incisions, and half of the other things you say are "being involved" of any significance. I did most of what you're saying, but the residents really didn't help me to do them...It was usually the attending jumping over the resident, telling me to do it.

Just out of curiosity, what would you like to do as a medical student in the OR that you would deem "significant?"

 

[tco]

Just out of curiosity, what would you like to do as a medical student in the OR that you would deem "significant?"

All that I really wanted to learn how to do was close a deep incision. It wasn't until OB/GYN that I got to do it...

I feel that the proper order should be learn to tie --> get to tie. Learn to suture --> get to suture. Meanwhile, you're doing the little things listed above.

I realize that it's difficult with residency programs at academic centers. Maybe those residents were like me, and didn't get an opportunity to do "simple" things that they would have learned from, so they have to play catch-up now.

It definitely seems like it's up to the attending as to how involved we get. One attending basically let me do an entire I and D with a ridiculous calf abscess. He walked me though it, right beside me, but it was like I was a junior resident. Crazy. I don't expect that in every single case, but if I'm doing your b**** work by getting to the hospital at 5:00 AM every morning to run around and undress patients wounds for you on vascular surgery before you get there, and then re-wrapping them after you see them, you better damn well let me throw a couple bites in an open leg. Yeah, I know, that's what "medical students are supposed to do," but teaching is also what residents are "supposed to do."

 

[survivordo]

If a patient you operated on stayed overnight, you could go round on them and write a note (if they don't let you leave it in the chart then keep it in your pocket) then when you are rounding ask if it is okay if you present that patient. At least practice presenting to a resident and get them to review your progress note. You might have to be a little self motivated on this rotation than others, take some initiative.

Survivor DO

 

[Stellar Clouds]

All that I really wanted to learn how to do was close a deep incision. It wasn't until OB/GYN that I got to do it...

I feel that the proper order should be learn to tie --> get to tie. Learn to suture --> get to suture. Meanwhile, you're doing the little things listed above.

I realize that it's difficult with residency programs at academic centers. Maybe those residents were like me, and didn't get an opportunity to do "simple" things that they would have learned from, so they have to play catch-up now.

It definitely seems like it's up to the attending as to how involved we get. One attending basically let me do an entire I and D with a ridiculous calf abscess. He walked me though it, right beside me, but it was like I was a junior resident. Crazy. I don't expect that in every single case, but if I'm doing your b**** work by getting to the hospital at 5:00 AM every morning to run around and undress patients wounds for you on vascular surgery before you get there, and then re-wrapping them after you see them, you better damn well let me throw a couple bites in an open leg. Yeah, I know, that's what "medical students are supposed to do," but teaching is also what residents are "supposed to do."

There's a reason why medical students rarely get to close the facia...it's the most crucial part of closure to prevent wound infection, but there's really no reason that the residents shouldn't allow you to close the superficial layers. As a student, I loved to scrub on mastectomies because I knew there was going to be a 7+ in incision that I would get a crack at closing.

 

[VisionaryTics]

I guess "getting to do a lot" is relative. I don't consider packing dressings, putting in drains, stapling incisions, and half of the other things you say are "being involved" of any significance. I did most of what you're saying, but the residents really didn't help me to do them...It was usually the attending jumping over the resident, telling me to do it.

I would be happier than hell if I got to do all of those things with any kind of regularity (aside from stapling, I guess). As it stands, doing most of those things is a rare treat.

Just out of curiosity, what would you like to do as a medical student in the OR that you would deem "significant?"

Using the Bovie or scalpel, suturing fascia, tying off/clipping vessels, etc. Sure, I don't trust myself to ligate the carotid, but how about letting me do a tie around a subQ bleeder that's been clamped?

All that I really wanted to learn how to do was close a deep incision. It wasn't until OB/GYN that I got to do it...

I feel that the proper order should be learn to tie --> get to tie. Learn to suture --> get to suture. Meanwhile, you're doing the little things listed above.

I realize that it's difficult with residency programs at academic centers. Maybe those residents were like me, and didn't get an opportunity to do "simple" things that they would have learned from, so they have to play catch-up now.

It definitely seems like it's up to the attending as to how involved we get. One attending basically let me do an entire I and D with a ridiculous calf abscess. He walked me though it, right beside me, but it was like I was a junior resident. Crazy. I don't expect that in every single case, but if I'm doing your b**** work by getting to the hospital at 5:00 AM every morning to run around and undress patients wounds for you on vascular surgery before you get there, and then re-wrapping them after you see them, you better damn well let me throw a couple bites in an open leg. Yeah, I know, that's what "medical students are supposed to do," but teaching is also what residents are "supposed to do."

I really sympathize with the juniors who aren't letting students do anything. I will go into residency with a skill set not much developed beyond cutting knots, suctioning smoke, retracting, and suturing the occasional lap port or small, straight incision in a cosmetically unimportant area. When I'm an intern, with my current skills, there's no way I'm letting a medical student drain an abscess or close anything more than a lap port. I badly need the practice for myself.

 

[KnuxNole]

I guess "getting to do a lot" is relative. I don't consider packing dressings, putting in drains, stapling incisions, and half of the other things you say are "being involved" of any significance. I did most of what you're saying, but the residents really didn't help me to do them...It was usually the attending jumping over the resident, telling me to do it.

That is being involved though :/

Obviously, as a third year, there's only so much they'll let you do at that level. I doubt most 3rd years would ever be holding a scalpel other than doing the first incision or using it for an I+D. Holding a laparoscopic camera is a very positive thing for a third year, which some places do.

Putting in drains and packing dressing are things which third years usually do, which is positive for getting hands on exposure and managing wound care. Stapling and suturing may not sound flashy, but is good for getting experience.

 

[ArcGurren]

As much as I hated my surgical rotation, I did enjoy doing small procedures when given the opportunity to do so (I&Ds, lines, etc) - which is why I partly want to do a procedure IM subspecialty. But it can definitely suck and seem like a total waste of time as a medical student. I also never got a real kick out of closing a wound for a half hour after several hours of surgery, but for people who are into that, hey, whatever floats your boat.

If you aren't interested in surgery, make the best out of your surgical rotation. Look interested even if you're not, volunteer to do small procedures so you get SOME experience, learn how to read films (I learned how to read CT scans fairly well during my trauma rotation), and learn about when you do and do not do surgery as well as who is a good surgical candidate and who isn't. These are basic things that you will need to know if you go into any specialty short of pathology.

I do remember being at one hospital for surg where the med student notes were counted in the chart and cosigned by the residents. That actually felt pretty good.

 

[cyclopz]

.

 

[ArcGurren]

The surgery rotation is basically a waste of time for med students. The hours are long but it's not difficult. Anyone who tells you otherwise is misleading you.

In the OR, you usually stand there and retract for 3-4 hours in order to do 5 minutes of suturing. The first time you see a surgery it's really cool, but after that it gets boring because your role doesn't usually change in the OR even though you've seen that procedure a few times now. You still usually retract for hours and get to do 5 minutes of suturing at the end. Since only 20% of the time will be "new" surgeries for you, I would say 80% of the time is a waste.

As for prerounding, each team has different expectations of med students. It just depends which residents you have. Some teams have you just show up for rounds and do nothing, some have you update the list before rounds start, and others make you preround on your own patients. In all honesty, no matter which of those 3 you do, you probably are getting about the same thing out of it. Pre-rounding mainly comprises of asking how about pain, BMs, urination, eating, a basic ROS and wound/drain checks. Surgery rounds are a joke compared to medicine rounds. The physical exam of the residents and attendings is usually a basic abdominal exam and nothing else.

I love surgery and am going into a surgical subspecialty, but I have no problem admitting that med student surgery rotations are a waste about 80% of the time. You will learn a lot through your shelf studying, though.

Just one of those requirements before you get to do cooler stuff in residency. I described how it is like at an academic institution. You'll probably get to do a lot more at a rural/community hospital, but then you also miss out on the residency recs from the more well known attendings.

I've seen long rounds on surgical patients and very short rounds on medical patients - I think this has a lot to do with the expertise of the surgeon/efficiency of the IM doc. This is coming from someone who's an IM intern and despises long rounds.

 

[KnuxNole]

Agreed. I also did most of things and don't consider it much.



Here's the thing tho. Doing that stuff is doing something but you only do it during the last 5 minutes of a 3-4 hr case. That's hardly worth your time after you've already done it once or twice. The rest of the surgery is only interesting the first time you see it.

Anyways, not sure why I'm arguing so much bc I'm done with 3rd yr and will never do another med student surgery rotation again. 😀 Med student ophtho rotations mainly keep you in clinic so its no big deal doing a few OR days. There's actually nothing for a med student to do in the ophtho OR, so they keep you mostly in clinic. And ophtho clinic is actually awesome unlike gen surg clinic.

True, which is what made my interest go way down after the first few weeks. After all, as a wee 3rd year, it shouldn't be too much of a surprise that you won't be doing much in the OR. Maybe as a sub-I or maybe even in small community hospitals where you first assist w/ no residents. I think the reality vs. expectations of a surgery rotation results in a disconnect.

For some places, they feel like they are doing you a favor by letting you close in the last few minutes...especially since the scrub techs thinks you're a waste of oxygen. But, like others said, if you truly want to get involved, ask and see what happens. If they let you do more, sweet! If they don't...well at least try to do/see what you can.

 

[siliso]

Why would anyone sane let a third year medical student do anything really surgically significant to their patient, or to themself? What are we expecting, here?

 

[Wordead]

Why would anyone sane let a third year medical student do anything really surgically significant to their patient, or to themself? What are we expecting, here?

😕 dafuq? How do you think the next generation learns?

 

[Stellar Clouds]

Why would anyone sane let a third year medical student do anything really surgically significant to their patient, or to themself? What are we expecting, here?

Haha. This is highly dependent on several variables: how hands on students are typically allowed to be at your institution, the resident/fellow/attending your work with, and that person's comfort level with you.

I was at a med school that traditionally allows medical students to be very hands on. I busted my ass off and was extremely enthusiastic on my surgery clerkship. Things I was allowed to do: bovie stuff, close lap ports, close other superficial incisions (with both suture and staples), cut suture the wrong length, drive the camera, place central lines, be the only person scrubbed for an I&D under GA, make opening incisions, perform sternotomies with the attending's hand on top of mine on top of the saw, bovie open the pericardium, defibrillate the heart with paddles in an open chest after coming off pump. Granted the last few things were quite rare and my attending may have been insane to let me do that stuff, but the first 5-6 any med student should be able to get to do on their surgery clerkship. Honestly if I were a PGY-4+ surgery resident or attending, I would probably let students that were good with their hands and showed interest perform any of the first 5-6 under close supervision. Most of these can be safely performed with little risk to the patient (save for a pneumothorax caused by an aberrant central line needle).

 

[siliso]

😕 dafuq? How do you think the next generation learns?

By standing there holding the old retractor and seeing how it's done. If you want to do significant surgery, probably you should do a significant surgery residency and you will get to...once you are several years in. Bovieing, cutting suture, snipping at the edges of a breast mass (and even making the triumphant final cut, once), retracting, camera driving, putting in a PIV or maybe if youre lucky an art line, sewing up a lap port or subq closure or two, using the gallbladder fishing net under intensive supervision, firing the GIA stapler also under intensive supervision, infiltrating local, sucking pus out of a perirectal abscess, getting the patient cleaned up after: these were plenty of "real" things for a junior student to do. Are you ever going to do critical operative maneuvers as a junior medical student? God, I hope not, for everyone's sake.

 

[JP2740]

By standing there holding the old retractor and seeing how it's done. If you want to do significant surgery, probably you should do a significant surgery residency and you will get to...once you are several years in. Bovieing, snipping at the edges of a breast mass (and even making the triumphant final cut, once), retracting, camera driving, putting in a PIV or maybe if youre lucky and art line, sewing up a lap port or subq closure or two, using the gallbladder fishing net under intensive supervision, infiltrating local, sucking pus out of a perirectal abscess, getting the patient cleaned up after: these were plenty of "real" things for a junior student to do. Are you ever going to do critical operative maneuvers as a junior medical student? God, I hope not, for everyone's sake.

Whatever the first time you do something is the first time you do something whether you're a med student or a resident.

 

[evilbooyaa]

I'm fine with waiting until people are residents to allow them to start doing surgery. Maybe it was because I told people that I was interested in a non-surgical field, but I definitely got to do less than SOME classmates (who want to go into gen surg [or neurosurg, holy crap students got to actually do surgery in NSG] and told their residents). That being said, due to my enthusiasm, I got to do more than most everyone else that didn't want to go into surgery..

However, when your chief is the PGY-4 that is just starting to be consistently in the OR all day, she gets to pick what you do. Let me close half the lap port sites.

What really annoyed me was on OB/GYN, when the residents always had an excuse to not let me close subQ (usually due to some BS time issue about how someone's half hour note was due in the next 5 minutes, even though there were other residents on the floor). One of the attendings let me close fascia (when he asked me, I was so surprised that I said "are you serious?", initially}.

And I did OB/GYN after surgery, so I knew how to close skin. Was doing the 1-handed ties (that I was forced to become proficient at during surgeries) on a subQ when the OB intern yelled at me for not doing 2-handed. Said I didn't want to waste suture and attending said just let him do 1-handed if that's what he's used to. So I did. And it looked awesome.

 

[ihearttriangles]

sounds like you got either a bad rotation or bad preceptors. as a student on my trauma surgery rotation(my first rotation) I spent my time with the team either in the o.r., rounding, or in the surgical clinic taking care of post-op patients. I had my own patients I was responsible for following. my preceptors were all residents on the navy trauma surgical team rotating through the medstar trauma unit in washington d.c. I was the only student on the team at the time although other teams had med students on them. they schedule 3 teams at a time who rotate first or second call while the third team has a rounding and clinic day(although you could still end up back in the o.r. if one of your floor pts was doing poorly and needed another procedure). most days when we were 2nd call we were still busy in the o.r. most of the day. it was washington d.c. in the 90's in the middle of summer...big time knife and gun club.
as a student on the rotation I did lots of suturing and had opportunities to put in chest tubes, central lines, do DPL's(it was a while ago), participate in medical and trauma codes,round in the icu, etc, etc. my preceptors were always pimping me(fairly gently actually) on relevant anatomy, differential dx, etc. it was a really great rotation in spite of the hours, alternating 24 and 12 hr shifts for 5 weeks. I had one day off on the whole rotation just because we admitted no one the night before and had previously discharged all our inpatients. if anyone is interested in the site they schedule PA and MD students interchangeably.

This is the heart of why PAs have made such in roads into the field of medicine. Medical school is a massive waste of time and money. While PA education tends to be more streamlined and cost-effective. My surgery rotation was a perfect example of this. I spent 2 months with 60 hour work weeks, which given my $56,000/year tuition, cost me about $9,330, and all I did was close a couple of lap holes and staple some wounds shut. MASSIVE...WASTE...OF...TIME...AND...MONEY. Meanwhile, EMPED is running around putting in chest tubes. I keep asking myself, who benefits from this system? My dean, for one, makes 850K a year, but besides him? I hear medical schools in general are not profitable, but come on, if ever there was a fat bloated cow that need to be put down it is the current medical education system in America.

And I really don't buy the argument that you need to be a surgical intern before you should be able to do risky procedures. You don't suddenly become more competent because you're an intern. In fact, July 1 interns are probably a lot more likely to be rusty than a late 3rd year med student. No matter your title, your first few times doing a procedure are risky. The only way you get better is by practice.