How to be the aggressive student

[agranulocytosis]

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To put this all into context, I'm nearing the half-way point of my surgery rotation.

I talked with my chief resident the other day regarding my deficiencies and anything that needs to be worked on, and the only thing that came to his mind was that I should "be more aggressive. Be all up in everyone's business like a resident should. Since you told me you're thinking about Surgery as a career, I'm gonna hold you to Sub I-level expectations."

OK, that's good and all, but what does that really mean? I keep up on all of the patients during rounds, like what the senior resident says to order and what the plan for each patient on the service should be.

But I'm inherently not such an aggressive person. I have noticed that I am usually not one to speak up unless spoken to, and this is especially evident during outpatient clinics where the speed at which a patient leaves the clinic is dependent upon the students' timeliness and aggressiveness in getting a resident's or the attending's attention. Needless to say, my patients are usually waiting a long time.

On the other hand, there are days where I consciously try to be more aggressive and my patients are the first ones to be gone. But on those days, I feel like I'm stepping on the other students' toes and pushing their patients on the back burner.

At the risk of coming off as a prick to the other students in the rotation, what do you guys think I should do to overcome this lack of aggressiveness?

 

[QofQuimica]

I think the fair thing to do is to take turns being precepted with the other students. Work it out with the other students ahead of time so that you alternate and everyone knows when it's their turn. That way, all of you can look good and no one's patients will have to wait a lot longer than the others. While you're waiting, read up a little something on your patient's disease.

If you're also competing with residents to be precepted by the attending, you're probably SOL and will need to wait until after they present.

 

[smq123]

To put this all into context, I'm nearing the half-way point of my surgery rotation.

I talked with my chief resident the other day regarding my deficiencies and anything that needs to be worked on, and the only thing that came to his mind was that I should "be more aggressive. Be all up in everyone's business like a resident should. Since you told me you're thinking about Surgery as a career, I'm gonna hold you to Sub I-level expectations."

At the risk of coming off as a prick to the other students in the rotation, what do you guys think I should do to overcome this lack of aggressiveness?

Your chief isn't explaining himself very well. And there is more than 1 way to be "aggressive."

When he says to "be aggressive," he just means to make sure that you get your stuff done in a reasonable manner. You don't have to throw elbows and push everyone out of the way and step on everyone's toes to get that done.

It would also be "aggressive" if, instead of just waiting around for an attending to see your patient, to organize yourself AND your fellow students so that clinic flows more smoothly. How would you make it so that everyone's patients get seen in a timely manner, no one is waiting forever, and the flow is more efficient? If you can organize yourself and your fellow students, that would be seen as being a good, "aggressive" leader - exactly the kind of person you want as a surgery resident.

 

[Winged Scapula]

Agree with smq.

"Being all up in other's business" isn't really what surgical aggressiveness is about. We don't want you elbowing your fellows students out of the way, pushing your agenda over theirs. If your resident thinks this is the way a good surgical resident acts, he's guilty of the egoism that afflicts many surgical residents. Let him get over himself.

Being aggressive means doing things and following up on them. So when your resident tells you to order a CT scan, that means you check with Rads as to when its scheduled, make sure the patient gets down to CT (even if it means wheeling them down yourself), go over the read with the radiologist and inform the Chief ASAP of any worrisome findings.

It means pulling up the most recent carotid duplex results when seeing a patient with known carotid stenosis whom you are pre-opping for a different surgery (don't ask me about my patient who was cleared by his NP for surgery yesterday despite not having had a CTD since 2006 when he was 70%/50% stenosed. Brief TY to the vascular lab tech who came and did a stat duplex in the pre-op area for me). It means not waiting for things to be done for you or assuming others are doing them.

In the clinic, you have to learn to speak up and make things run smoothly so that EVERYONE gets out early. Be fair so that everyone gets facetime with the attending, but don't hang back if it really IS your turn to present. It means if your patient is doing poorly or needs something NOW, that you excuse yourself to the team and get it done. This is not being a gunner (as long as not everything you do ignores other's needs), but being aggressive.

You don't have to be rude or pushy to be a surgeon, but you do have to be aggressive in terms of getting things done (the famous belief on surgery is that you don't wait for the path or rads report to come back, you GO looking for it. Hover over the microscope, hang around the boards, etc. Annoying as a student, necessary as a resident.)

 

[lilnoelle]

Could it also mean that he is telling you to request to do more procedures in the rotation? Thats what I think of concerning being aggressive in a surgery rotation... ask to draw blood, close, place the foley, etc.

I'm not aggressive either... but I don't want to do surgery.

 

[SoCuteMD]

(don't ask me about my patient who was cleared by his NP for surgery yesterday despite not having had a CTD since 2006 when he was 70%/50% stenosed. Brief TY to the vascular lab tech who came and did a stat duplex in the pre-op area for me)

Off-topic, but male patient in your field? Pretty rare or are you doing some GS as well?

 

[Winged Scapula]

Off-topic, but male patient in your field? Pretty rare or are you doing some GS as well?

Remember males get breast cancer as well, although clearly at a much lower rate than women. Since I have a specialized practice I get the rare birds.

In addition, I see a fair bit of men with benign gynecomastia and pretty much anyone with any sort of lump on their chest or axilla gets sent to me (so I have diagnosed melanoma, sebaceous cysts, hidradenitis, etc.).

 

[RxnMan]

To put this all into context, I'm nearing the half-way point of my surgery rotation.

I talked with my chief resident the other day regarding my deficiencies and anything that needs to be worked on, and the only thing that came to his mind was that I should "be more aggressive. Be all up in everyone's business like a resident should. Since you told me you're thinking about Surgery as a career, I'm gonna hold you to Sub I-level expectations."...

Write all notes and orders on pts. Work up all problems. Own a set of patients, and figure out what those pts need every day. If one goes home, pick up another. If you don't know how to do something, or know there's a problem with a pt, but not how to fix it, then seek superiors for help.

 

[45408]

Make sure you're the one presenting your patient on rounds. When I was on trauma, several people saw the patient each morning - the students saw a few patients each morning, the junior residents saw 6-8, and the chief saw everyone. The junior or the chief could present the patient to the attending, and unless you were opening your mouth to give your pitch when we walked by the room, the resident would just do it.

Come up with a plan for your patients - put it in your note and say it on rounds. It doesn't really matter if you're wrong, because they can write whatever orders they want, but it shows that you thought of something definitive.

 

[Ashers]

I'm going to echo what everyone else said.

Be on top of things. If you ever have free time, don't just sit around, find something to do.
-Check on the patients see how they're doing personally and their vitals/Is&Os especially if there was any slight concern about any one of them
-Write the post-op notes within the time period your team wants them done (in my gen surg rotation, it was 4 hours, on my ortho rotations it was in the PACU)
-Update the list (then you won't have to do it all at the end of the day)
-Know the labs of the patients, and if any were ordered earlier, be sure to look them up and tell the residents.

If everything that can be (by you) is done and you've updated the residents, then take time read while you're still at the hospital. I think I had parts of 3 days in 2 months of gen surg M3 year with >1 hour of "free" time when there was nothing else going on (and all the OR cases were covered), and I finished everything I could do, so I took time to read. It helps I hate having nothing to do, and I never want to sit down and read. I'd rather be around doing things.

 

[Tiger26]

Also, if you get the opportunity to do a procedure, never hesitate to say how much you want to do it unless you're truly scared about killing the patient. You want to have a quick, unwavering answer about doing whatever they're giving you the chance to do. Even if you don't get the chance, ask every time anyway, since you'd be amazed at what you can do--I was able to do colonoscopies, saw off legs, pull out saphenous veins, start epidurals, intubate, sew on skin grafts, do biopsies or I&Ds simply by expressing interest.

 

[funshi baba]

Also, if you get the opportunity to do a procedure, never hesitate to say how much you want to do it unless you're truly scared about killing the patient. You want to have a quick, unwavering answer about doing whatever they're giving you the chance to do. Even if you don't get the chance, ask every time anyway, since you'd be amazed at what you can do--I was able to do colonoscopies, saw off legs, pull out saphenous veins, start epidurals, intubate, sew on skin grafts, do biopsies or I&Ds simply by expressing interest.

I will echo this post too. I found that saying yes to a procedure before actually thinking about it or whether i can do it or not helped be get a lot of hands-on on my surgery rotation.

 

[DrJosephKim]

You can be aggressive, but make sure you're not being pushy, annoying, arrogant, or egotistical. Take some initiative and do things when you're not asked to do them. Show that you're assertive and that you're willing to be proactive.

 

[Winged Scapula]

I will echo this post too. I found that saying yes to a procedure before actually thinking about it or whether i can do it or not helped be get a lot of hands-on on my surgery rotation.

Definitely true. Most students like to do procedures and we like to show them how to do them.

 

[SouthernSurgeon]

Make sure you're the one presenting your patient on rounds. When I was on trauma, several people saw the patient each morning - the students saw a few patients each morning, the junior residents saw 6-8, and the chief saw everyone. The junior or the chief could present the patient to the attending, and unless you were opening your mouth to give your pitch when we walked by the room, the resident would just do it.

Come up with a plan for your patients - put it in your note and say it on rounds. It doesn't really matter if you're wrong, because they can write whatever orders they want, but it shows that you thought of something definitive.

I think this is a big one...early on in my surgery rotation, my chief stopped me and the other med student and said "why are you only following one patient? you should be able to handle more than that?" - we both told him that we were each following 3-4 at a time, but we would often the interns would unknowingly take over and present those patients instead. The chief encouraged us to be more assertive and to communicate ahead of time with the interns which patients we were seeing.

 

[JenHeart]

I agree... make sure you are asking if you can be of additional help, if there is anything you can do, present the patients, etc. Just go out of your way to make sure you're noticed.

 

[MasterShakeDO]

My surgery attending always said, "Page 4", when I asked how I can be a better surgery student. I found out he meant Page 4 of Surgical Recall "How to be the Perfect Surgery Student".

I was one of the hardest workers, but I too was told to be more aggressive and to speak up more. Most surgeons are loud and confident. If you appear timid in any way you will get overlooked. Even as a third year medical student answer questions confidently even if you're wrong. Don't be sheepish when asking to scrub in, or in grabbing your attending to precept a patient. It's a hard thing to learn if it does not come naturally...but you can do it!

 

[agranulocytosis]

Thanks for the responses guys!

When I initially talked to my chief, I specifically asked about my presentation skills, my initiative, foresight, etc. and even after that, he said I just needed to work on my aggressiveness. So sorry for not clarifying earlier.

I have since tried being a little more assertive in terms of talking and speaking my mind to the attendings and other residents, and the chief has responded positively. I guess what he was looking for was what MasterShakeDO mentioned, and that was being more like the attendings, loud and confident.

 

[Buckeye(OH)]

Learn the lingo, like "pull my gloves"

Sorry, I had to!

 

[agranulocytosis]

Learn the lingo, like "pull my gloves"

Sorry, I had to!

Haha, fair enough.

 

[Lamborghini1315]

My surgery attending always said, "Page 4", when I asked how I can be a better surgery student. I found out he meant Page 4 of Surgical Recall "How to be the Perfect Surgery Student".

I was one of the hardest workers, but I too was told to be more aggressive and to speak up more. Most surgeons are loud and confident. If you appear timid in any way you will get overlooked. Even as a third year medical student answer questions confidently even if you're wrong. Don't be sheepish when asking to scrub in, or in grabbing your attending to precept a patient. It's a hard thing to learn if it does not come naturally...but you can do it!

Unfortunately there's a fine line...when you are genuinely passionate about things you will come across folks who aren't and will label you as whatever. I still think its not always about being wrong or right..but if you can put the effort to speak your mind and be able to rise during a difficult situation. I always say this to people that if you feel like you can't handle something then you have already given up, no point in trying to making changes to better accommodate yourself for a possible scenario. Its those who know that can handle what ever they are faced with can make the adjustments as they go along.

 

[getunconcsious]

Surgery seems to almost select for antisocial traits. If you're a genuinely nice, caring, considerate individual maybe you should think about cultivating that and putting it to use elsewhere. Is it really worth giving up your whole life and personality to become a surgeon? I realize this will be unpopular as responses go, but it's worth considering a counterpoint.