I hate my gen surg clinical rotation

[devildoc2]

OK so I'm a 3rd year. I didnt have any hatred of surgery beforehand, I was openminded. But now I'm miserable. I'm not one of those people who is very picky either, I can usually see the good parts of any field.

But surgery just plain sucks IMHO. I absolutely hate being in the OR. Most of the time I dont even scrub in, I just stand observing because there are already 5 or 6 people scrubbed in (attending, senior resident, intern, PA, etc) and there's no room to get close to the table. I cant tell you how incredibly boring that is.

The rounds suck too. On medicine rounds I actually learned a lot about patient care by hearing everybody's diagnosis and plans for their patient. On surg rounds we talk about them for 2 seconds and there's no attempt to do any teaching. My team isnt receptive to me asking questions either, we start at 5 am and everybody's cranky and irritable and just wants to get rounds over with as quickly as possible.

Basically I have no role on the surgery team. I'm expected to be at am rounds, pm rounds and in the OR but I dont actually DO anything at any of these events. In medicine, they expected me to be on roudns because it was IMPORTANT THAT I PRESENTED MY PATIENT BECAUSE I KNEW THEM TEH BEST OF ANYBODY ON THE TEAM. ON surgery, my presence is absolutely irrelevant, yet they blindly insist that I go thru all this rigamarole.

What I want to do is stay away from the team as much as possible and just read on my own. Being on rounds and in the OR does NOTHING to help me in terms of the shelf exam. I feel that my time is better spent reading shelf review books.

I come in at 5 AM and cant leave till 8 PM or later. Usually its for stupid BS too. I just follow the team around while they do crap that they absolutely dont need me for. Sometimes a trauma will come in, and of course I have no responsibility there either because there are 50 techs and nurses pushying me out of the way before I can help at all.

So the bottom line is that surgery is not for me. I dont understand why my team is so insistent on me being with them at all times when my presence is really irrelevant and they dont need any help, they already have like 4 PAs and a bunch of interns/residents. Hell I dont even get to change bandages, the PAs take all that. I feel like I would have to start pushign people out of the way to do anything. I dont understand why they made our surgery team so big. There's not enough work for everybody to do, so obviously as the med student I end up with zero responsibilities whatsoever.

I would much rather skip the OR time. The rounds I can handle, but I cant handle spending hours upon hours in the OR, not scrubbed in, just standing on a podium trying to watch over 5 surgeons heads as they do their stuff.

If I went to my team and told them that I dont like the OR and would just prefer to read during that time, will they fail me or what?

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[Tigger14]

Wow. I would not have chosen surgery either if that had been my experience. A couple of ideas: are any of your residents approachable? Or do you have a faculty student coordinator (usually one of the attendings)? I would choose someone I was comfortable with, explain in brief the problem... no role and minimal teaching... and ask what you can do to improve things. Someone else may be able to identify a different approach or offer ideas to make your experience more rewarding. Also, are there other OR's you can go to? Maybe another service has fewer people crowded around and you would be able to see more.

Good luck.

 

[Chinnychin]

Sorry to hear about your experience but it is all too common in this country with surgery-Often it is hit or miss. On my surgery rotation there are 4 teams and 2 of the chiefs are known by all students rotating through to be absolute biatches and I got stuck on her team. The other guys in my class had really laid back chiefs and teams and loved their rotation.

The kicker was I was AMPED on doing surgery for the first 2 years-I mean I studied my ass of thinking I had to do well to get into surgery blah blah-did my rotation and hated it after one week-here are a few highlites

-Resident would pimp me and I would not know the answer and then she would get pisssed and yell at me telling me that we went over this yesterday-however we never talked about it nor did I know what the answer was-I told her it must have been another student-and to that she got more mad-so I called her a biatch to her face and said think harder-sure enough she was wrong and it had been another student-Calling her a biatch however did not do much for my eval But I passed.

In the OR doing a million appies at the VA-being pimped over and over and over all case long, every case-not knowing a heck of a lot and the attending who was pimping and resident just laughed at me for not knowing asking how I made it through school this far.

Second half of the rotation-guess what I get stuck with the other horrific chief! I knew at this point God did not want me to do surgery-this chief who was obese and uglier than dirt-and ironically was going into plastics (good luck getting clients) but she was just a biatch too-never once even gave me any look other thana scowl. WOuld ignore me during our calls to the point where I would be in the call room and her and the resident would watch movies, talk in the downtime and I was sitting there not once even looked at-and I am a personable guy who is not shy and usually the jokester or life of the room so to me that was really bad.

So the common denominator was I had miserable chiefs who were both uglier than a gremlin and I had a horrible rotation. However the 3 other students had these SUPER fun teams who were laid back, encouraged them, never pimped them, took them out for lunch, did not scut them-and none of those students even considered surgery before and one now ended up going into it and the others did not but had great times. Ironic I was the only one all ready to do surgery and my experience turned me off.

Then on the opposite end I had a great experience with psych (I also realized in surgery I was just too lazy for that field-I cannot hack being there at 5am and staying late and having call for my whole life that is not easy-and standing all day in the OR just SUCKED and hated it-so other factors contribued) But anyway I loved psych and had NEVER thought about going into it-and sure enough That is what I am doing. Plus I am lazy and psych is about the best lifestyle you can get plus everyone is rested and fun to be around-just a nice enviroment. But to each their own

 

[Winged Scapula]

-this chief who was obese and uglier than dirt-and ironically was going into plastics (good luck getting clients)

I'm sorry you're had a rough time on surgery, but I'm not sure why mentioning the above is important. It frankly tells more about you than it does about the Chief that you would think it worthwhile to comment on her appearance.

 

[surgical06]

i understand where you are coming from, I actually have had my best surgical experience at a community hospital with no residents. i go overthere voluntarily because there are no residents ect to dilute the experience. 3 people including me scrub.
so its actually not surgery that you hate, its being an irrelevant part of the team. it happens, and its even harder to deal with when you are a medical student who has looked forward to surgery all year, ready to get your hands bloody,. and it doesn't happen.
i would do an away at a busy community hospital if i were you, they will be glad you are there , put you to work. lines, tubes, quality scrub time. rounds are still weak, but you will enjoy it. good luck to you.

 

[supercut]

Sounds like you aren't getting a good enough experience to be able to decide if you like surgery.

Unfortunately team dynamics can make a student think a field is bad, when in fact the experince has nothing to do with the field. How could you possibly evaluate if doing surgery is something you miight enjoy if you don't get a chance to scrub? I agree, trying to see over a bunch of peoples heads isn't fun, especially if they are not trying to show you anything.

The first thing I thought when I read your post is WTF are PA's doing scrubbing a case in preferece to a med student? There are many places were a senior resident and junior resident are scrubbed, but the PA is not necessary unless there is no one else to cover the case.

You should go to your dean of students and register the complaint that you aren't getting to scrub but the PAs are.

Sounds like it might be a malignant program or rotation for the residents and they may be just trying to survive as well

In any case, skipping rounds and OR to go read will likely lead to bad or failing evaluations, so I wouldn't do that. Try to see what you can salvage from the rotation. Maybe you don't go into surgery...but will you know what to refer to a surgeon? Are you learning how to resusicate an exsanguiating pt? What will you do when you go into IM and you get a GI bleeder?

More often in surgery we expect med students to take responsibility for their own education and ask questions. The key is to do it at an approprate time and ask the approprate person.

Hang in there.

 

[Chinnychin]

I'm sorry you're had a rough time on surgery, but I'm not sure why mentioning the above is important. It frankly tells more about you than it does about the Chief that you would think it worthwhile to comment on her appearance.

Well to be perfectly honest I had a real interest in plastics and did quite a bit of research, shadowing, summer stuff etc with plastics guys/gals and they were ALL pretty well taken care of. They were not overweight, kept themselves nicely dressed when not operating and you have to have some sense of attractivness if you are going to be making others "attractive"-I mean what woman (or man) in their right mind would go to a 240 pound woman who literally was one of the least attractive people I have seen and had even a worse attitude. It was one thing if she was butt ugly but kept her weight under control and put SOME ounce of effort into her appearence-she was chief and had easy electives left and was NOT busy.

Anyway-you can be all PC but do a poll and see how many women in real life would go to a fat ugly lady surgeon-please

 

[Winged Scapula]

Anyway-you can be all PC but do a poll and see how many women in real life would go to a fat ugly lady surgeon-please

I agree that many, if not most, people going into PRS are attractive, neat and clean but I would venture that most consumers would prefer the surgeon with the best reputation, and would be less concerned about the surgeon's appearance. It IS true, however, that many PRS programs, and even my fellowship, rank applicants according to appearance, so it is important at least to other SURGEONS because of the presumed belief that a beautiful plastic surgeon or a derm with good skin are likely to be better doctors.

There is no data that I am aware of regarding this factor in patient choice, but attitude is - and despite what some may think, patients will put up with a surgeon with a bad attitude as long as they are skilled.

At any rate, I still fail to see what the resident's appearance has to do with any of your problems unless you are admitting that one of the reasons you didn't enjoy surgery was because you wanted to be surrounded by "beautiful" people.

 

[SLUser11]

Anyway-you can be all PC but do a poll and see how many women in real life would go to a fat ugly lady surgeon-please

Fat surgeons have plenty of business. Now ******ed surgeons, on the other hand, don't do well......so it's good you went into Psych.

 

[powermd]

At any rate, I still fail to see what the resident's appearance has to do with any of your problems unless you are admitting that one of the reasons you didn't enjoy surgery was because you wanted to be surrounded by "beautiful" people.

Clearly this med student is immature and lacks character for bringing up the unsightly appearance of his/her dreaded chief- but this person belitted, bullied, and set a BAD example of how a good doctor in a teaching position should behave. You can't expect this student to have a great attitude toward anyone in surgery after that treatment. To the OP- you need a better filter between the brain and the mouth (or keyboard). Criticizing anyone based on superficial characteristics is unfair, unless you have to sleep with that person!

 

[SLUser11]

Clearly this med student is immature and lacks character for bringing up the unsightly appearance of his/her dreaded chief- but this person belitted, bullied, and set a BAD example of how a good doctor in a teaching position should behave. You can't expect this student to have a great attitude toward anyone in surgery after that treatment. To the OP- you need a better filter between the brain and the mouth (or keyboard). Criticizing anyone based on superficial characteristics is unfair, unless you have to sleep with that person!

Well, it wasn't the OP, but you're right that it seems irrelevant how ugly the chief was...

 

[Winged Scapula]

It seems to me that the poster was using inappropriate personal attacks to express anger and frustration with the way he/she was treated. While it may not be particularly mature or appropriate, it is certainly understandable if the situation is as degrading as he/she says. Of course, the poster should never say things like that in the real world, but on an anonymous bulletin board, I think it qualifies as venting, and is probably okay.

I think its obvious that the poster is frustrated and you're right - we all say things we probably otherwise wouldn't in such a psychological state and on any anonymous internet BB.

Anway, I was probably too harsh on the poster but frankly, I had hoped for a more contrite response...eh, mebbe me expectations are too high.

 

[H_Caulfield]

Some of the best doctors I've known have completely neglected their own fitness and would no doubt be, if the OP were the declarator, considered "ugly." To the OP: Are you entirely sure that YOU aren't ugly? Or is it that you're afraid you might be? I'm not sure under what other conditions you'd call upon some irrelevant aspect of your chief's person.

As simple as that. The OP is ugly. The OP is working under the misconception that anyone who FLINGS "ugly" can't, at the same time, be in possession of "ugly." Similarly, just because I'm calling the OP jerk doesn't necessarily mean that I'm not one myself.

 

[ajlmd]

Having gone through 4 years of surgical residency being surrounded by 40+ other (mostly male) residents, I know there are the stereotypical overweight, angry females. However, the profession certainly doesn't lack the presence of physically and socially unattractive males, either!

To echo Kimberli's sentiments, the stereotype that female surgery residents are horrific, unbearable, angry, unattractive individuals unfortunately is still very prevalant and I think it is quick to appear when one of us does anything adversarial (deserving or not.) For those of us that take care of ourselves and are reasonable people to work with, this usually is one of our pet peeves.

On the other hand, I actually did not enjoy the first part of my surgical clerkship, either. Had a chief who was always yelling and seemed to only care where the students were going to go to pick up his dinner. I doubted my choice to pursue surgery but later did a rotation with someone who enjoyed teaching, I got to do things in the OR; it made me see that I actually really did like surgery, I just wasn't happy in the original environment that I was in.

 

[SLUser11]

Having gone through 4 years of surgical residency being surrounded by 40+ other (mostly male) residents, I know there are the stereotypical overweight, angry females.

Obviously you aren't training at Wisconsin:

http://www.surgery.wisc.edu/general/residents/current/sauerhammer.shtml

I remember somebody mentioning last year that a previous Miss Wisconsin was now a surgical intern....I'm guessing that's her.

 

[msl2007]

I interviewed at Wisconsin...all the female residents are attractive! Good luck, or advantageous ranking? I'm not sure.

(I'm not saying that it matters though, I just noticed. Although, there have been plenty of attractive residents all over on the trail.)

 

[Doc Ivy]

Wow. I would not have chosen surgery either if that had been my experience.

Really? Cuz when I read the OP's post I could totally relate. And I'm going into Gen Surg!!

I would say a good chunk of my M3 surgery rotation was spent trying to stay out of everyone's way, putting in a lot of "face time", and feeling completely useless on the team. It's hard as a student on surgery because there really isn't a lot you can "do". Especially when you are keen and motivated. Some of the patients are so sick/complex that they don't want you to waste time presenting on rounds, so it's hard to know why you're there. the intern gets paged about your patients so you're always the last to know what's going on. It's painful.

The problem is that most surgical residents are so busy that they find it easier to just do things themselves rather than take the time to tell students how they can be helpful. Here's my advice:

One thing you can do is always have scissors, Kerlex, 4x4s. You're already getting in early so help your intern by getting numbers on all the patients on the service not just your patients (get ranges of vital signs fyi your intern if anyone is tachycardic or hypotensive, drain outputs, note the color, urine outputs over the last 24 hours or over the last shift etc.). Do this without asking tommorow, and you will look like a rock star. Your intern will start to see you as an asset and not just another liability.

What I learned is that surgeons love efficiency. They love it when you can anticipate what they need and have it ready. You don't have to say much, just always be ready with a stethoscope, gloves, tape, alcohol swabs, staple remover etc-Listen on rounds, who's going home that day? Offer to take out their staples and pull drains. What's exciting for you is scut for them and they will start to appreciate your presence-- they might even speak to you and do a little teaching.

I know it's hard. Especially for us who are shy. In terms of the OR always roll back with the patient, read the H&P, know the story. Help the patient transfer onto the bed, always be the first to slap on the SCDs. Once the resident sees you being a team player they might throw you a Foley and let you scrub in.

For me, it was a matter of looking into the future. The key question was did I like surgery, and not did I like being a med student on my surgery rotation. That's what you have to ask yourself.

Good Luck!

 

[Winged Scapula]

The problem is that most surgical residents are so busy that they find it easier to just do things themselves rather than take the time to tell students how they can be helpful. Here's my advice:

What I learned is that surgeons love efficiency. They love it when you can anticipate what they need and have it ready. You don't have to say much, just always be ready with a stethoscope, gloves, tape, alcohol swabs, staple remover etc-Listen on rounds, who's going home that day? Offer to take out their staples and pull drains. What's exciting for you is scut for them and they will start to appreciate your presence-- they might even speak to you and do a little teaching.

I know it's hard. Especially for us who are shy. In terms of the OR always roll back with the patient, read the H&P, know the story. Help the patient transfer onto the bed, always be the first to slap on the SCDs. Once the resident sees you being a team player they might throw you a Foley and let you scrub in. !

Excellent advice. We do love it when our needs are anticipated - in all aspects of life! And you impress everyone when you help in the OR - putting the SCDs on, getting the patient a warm blanket, making sure the circulator has your name for the computer, etc. It goes a long way toward making people feel positive toward your presence (I know, I know, they should be pleased to have you there anyway, but some people see medical students as interference).

its not about doing things to "get to" scrub in...my feeling is that students should scrub in for every case unless there really are too many people in the room, or they can see better unscrubbed. But being a team player goes a long way toward preparing you for the rest of your life where those skills are important, regardless of whether you are the private/intern or the CEO/attending.

 

[msl2007]

I hated and loved my surgery rotation. I wans't sure if I was happy- I certianly wasn't "peds happy"- but I was fulfilled, and I chose surgery.

However, some students just need to survive surgery.

As other posters have mentioned, or alluded to, you have to "earn" a lot on surgery, without knowing the qualifications or the prizes.

You can earn better (or worse) treatment with punctuality, knowing answers, knowing labs from yesterday to compare, and all the other suggestions. And when you get your reward, they won't tell you why. Same goes for "punsihment."

Two good examples: I satyed really late one night, until midnight when I wasn't on call becuase the resident I was with was on call and kept operating (a late case and then an emergency case) with our attending from the day. I could have left, but that didn't feel right. At midnight, the attending who doens't let med students touch his patients, asked me if I could sew, and then let me do the skin sutures. Next: I knew that the spinal accessory nerve could be damged in removing a lipoma off the back of the neck, and then my chief let me be lead surgeon on a lipoma removal on the back. He never said "this is becuase you read for the case and answered correctly." he just asked me if I wanted to.

Bad example: I didn't know our patients most recent labs which mattered for the surgery somewhat, and so the resident, a nice resident and one who likes me, had to look them up. Then she was rude and brusk to me in the OR. I realized that I had done something to earn her wrath. I was extra proactive, nice and helful and by the end of the case she let me bovie and suture.


So, I hpe that helps you see that you are not alone in the crazy politics and hierarchies of surgery, the unwritten rules and all that crap.
You can try to earn more teaching, or you can accept minimal teaching (but try to pay attention-you'll be surprised what you pick up), accept your role in the corner and just survive. That's a valid way to get through 3rd year too! (as long as you learn enough-and that might mean more reading. It's a trade off.)

my 2cents. and no, I don't mean to say that you are doing anything "wrong" nor that it is ok to be treated this way, it just is what it is.

The rest of the year will be better! And fourth year surgery will be better too!

 

[Chinnychin]

Um again, multiple people are going on about how not all female surgeons are ugly etc-I did NOT say that people-and like I always say there are exceptions to every rule. A broken clock is right twice a day-exceptions exist but for the vast majority plastic surgeons are decently attractive.

And whoever said a person picks a surgeon based on the best surgeon or reputation-well that is correct however their rep does not step from their skills-the lay people have NO clue where to find a good surgeon other than word of mouth and they really are oblivious to really researching their surgeon. Most women, since they make up the majorty-will find attractive guy plastic surgeons because they are often the best at PR and promoting and getting their name out there and creating a rep that is not necessarily based on their talen. I mean all plast surg I am sure are good anyway.

So do not try to make the world sound so nice and perfect-maybe you see surgeons in north dakota or wherever you are from. But cali, arizona, florida and NYC-where 90 percent of plastics is done-is done by attractive people.

And what relevence was their to calling the chief fat and ugly? I thought it was ironic that someone so fat and ugly was going into plastics-it had nothing to do with my rotation there. Whether I knew her or not and someone pointed her out and told me she matched in plastics I would get a laugh. Every student on the service had a good laugh about it-disgusting looking people just often do not set the standards for beautifying people. Sorry to burst all your bubbles and be real

 

[SLUser11]

maybe you see surgeons in north dakota or wherever you are from. But cali, arizona, florida and NYC-where 90 percent of plastics is done-is done by attractive people.

Sorry to burst all your bubbles and be real

Don't be sorry....I for one really appreciate you sharing your knowledge. Most of us here are very naive, and have benefitted from your reality check.

I've spent most of my life here in Fatville, Montana, and I've never actually been to a big city before......

You rocked my world, Chinnychin. Thank you.

 

[LanceArmstrong]

It's different to be a surgeon and a medical student, especially on this team that doesnt try to get you involved - maybe they think you should kinda elbow your way in but I would say dont put down the whole specialty because of your brief expereince there. I'd say if you like the idea of being a surgeon try to do a rotation on a smaller team maybe in a community hospital or face-to-face with an attending only. Sounds like you guys teams ore overfilled there.

OK so I'm a 3rd year. I didnt have any hatred of surgery beforehand, I was openminded. But now I'm miserable. I'm not one of those people who is very picky either, I can usually see the good parts of any field.

But surgery just plain sucks IMHO. I absolutely hate being in the OR. Most of the time I dont even scrub in, I just stand observing because there are already 5 or 6 people scrubbed in (attending, senior resident, intern, PA, etc) and there's no room to get close to the table. I cant tell you how incredibly boring that is.

The rounds suck too. On medicine rounds I actually learned a lot about patient care by hearing everybody's diagnosis and plans for their patient. On surg rounds we talk about them for 2 seconds and there's no attempt to do any teaching. My team isnt receptive to me asking questions either, we start at 5 am and everybody's cranky and irritable and just wants to get rounds over with as quickly as possible.

Basically I have no role on the surgery team. I'm expected to be at am rounds, pm rounds and in the OR but I dont actually DO anything at any of these events. In medicine, they expected me to be on roudns because it was IMPORTANT THAT I PRESENTED MY PATIENT BECAUSE I KNEW THEM TEH BEST OF ANYBODY ON THE TEAM. ON surgery, my presence is absolutely irrelevant, yet they blindly insist that I go thru all this rigamarole.

What I want to do is stay away from the team as much as possible and just read on my own. Being on rounds and in the OR does NOTHING to help me in terms of the shelf exam. I feel that my time is better spent reading shelf review books.

I come in at 5 AM and cant leave till 8 PM or later. Usually its for stupid BS too. I just follow the team around while they do crap that they absolutely dont need me for. Sometimes a trauma will come in, and of course I have no responsibility there either because there are 50 techs and nurses pushying me out of the way before I can help at all.

So the bottom line is that surgery is not for me. I dont understand why my team is so insistent on me being with them at all times when my presence is really irrelevant and they dont need any help, they already have like 4 PAs and a bunch of interns/residents. Hell I dont even get to change bandages, the PAs take all that. I feel like I would have to start pushign people out of the way to do anything. I dont understand why they made our surgery team so big. There's not enough work for everybody to do, so obviously as the med student I end up with zero responsibilities whatsoever.

I would much rather skip the OR time. The rounds I can handle, but I cant handle spending hours upon hours in the OR, not scrubbed in, just standing on a podium trying to watch over 5 surgeons heads as they do their stuff.

If I went to my team and told them that I dont like the OR and would just prefer to read during that time, will they fail me or what?

 

[H_Caulfield]

Every student on the service had a good laugh about it-disgusting looking people just often do not set the standards for beautifying people. Sorry to burst all your bubbles and be real

Yea, yo. "BE REAL." Thanks for keepin' it real, dawg. Now...obviously you have some kind of evidence, then, that beautiful people somehow cut and mold better than "digustingly ugly" people. We all feel newly educated, I'm sure, since I doubt many of us knew that you had to be beautiful to know how to make someone else beautiful. Makes sense, I guess, in sort of an abstract way.

 

[cdql]

Let me introduce you to my doctors

 

[Chinnychin]

Yea, yo. "BE REAL." Thanks for keepin' it real, dawg. Now...obviously you have some kind of evidence, then, that beautiful people somehow cut and mold better than "digustingly ugly" people. We all feel newly educated, I'm sure, since I doubt many of us knew that you had to be beautiful to know how to make someone else beautiful. Makes sense, I guess, in sort of an abstract way.

Well you do not sound very educated so it does not surprise me that you cannot read properly-I never said attractive people are better surgically skill wise-I said attractive people get better reputations and more clients because word of mouth in plastic surgery is everything. It is not like neuro surg or cardio thoracic surg-where all the primary docs know which ones are top in that field and send you there-

However plastics-clients seek out surgeons often based on friends, word of mouth and sadly the phone book/internet without having ANY knowledge of their skills. However a nice office with an attractive staff and doctor is the norm for the busiest plastic surgeons out west. You know just because a surgeon is the busiest-does not mean they are the best. Kind of like that old saying that the bottom third of law/med students are the most successful-because it is the whole image, business side, marketing of yourself and your business in plastics-and fat ugly bitchy females are not going to get far. The other thing I did not mention that factored in, not only was she litereally ugly but had an even uglier personality(as hard as it was to believe) and if anything plastics is all about people skills-putting patients at ease and have them come back for more-

So yes in the field of plastics which I was talking about-not other fields-attractive people with keen business sense and great people skills is the norm for anyone successful. There are TONS of starving struggling plastic surgeons out there trying to break into the cosmetic surg market. Now like I mentioned-nobody cares if your neuro surgeon looks like crap or has any personality skills-however still patients have very little knowledge or choice if they have a say in the surgeon-very few research their surgeons and it is hit or miss-So either way clients are ignorant but in plastics the next step is to use overall appearence of a doc's setup/office/self-to make that decision and that second step does not exist in all other surgical fields.

I am sorry this is how it is-how many of you know much of anything about plastics? I have a whole family of plastic surgeons, I wanted to do plastics and worked with plastics docs since undergrad. So if you are not from cali, not familiar or just ignorant than dont bother adding anything since I just stop reading after one line. I am sorry if there are any fat ugly girls on here that were hoping to do plastics-there are ALWAYS exceptions.

 

[Winged Scapula]

While I do not deny that many plastic surgeons are physically appealing (having been born in Florida and lived most of my life in California as well as having a cable tv subscription to E! and Discovery, I well aware of what they can look like), I think we need to realize or mention that plastic surgery is not all aesthetics - in practice and in the practitioners.

Most academic plastic surgeons, who do little aesthetic surgery, are normal looking, maybe even nerdy looking. I have rarely seen a PRS working in a hospital setting who was drop-dead gorgeous. People who need facial reconstruction for a disfiguring cancer, a flap for their mastectomy/breast reconstruction or a craniofacial surgeon for their child, do NOT look for a gorgeous plastic surgeon. A PRS's reputation in the wide world of plastics is not based on his/her appearance.

I will grant you that in the world of aesthetic surgery in private practice, where most of the work is on facial rejuvenation or breast augmentation, patients do focus on things like the outer office, staff and the physical appearance of the surgeon. However, if he/she doesn't do good work, they won't return...except in the rare cases of the patient with a body dysmorphia who will continue to seek surgery for perceived flaws and doesn't recognize bad work when they see it.

The vast majority of plastic surgeons do NOT do soley aesthetic work despite what we see on E! or Discovery. Most are in an academic or community hospital setting and most are average looking.

So IMHO to make assertions that it is important for PRS to have a physically appealing face and body fails to recognize that this is really only a factor in surgeon choice by the public in aesthetic surgery and by a small segment of the public that finds such things important.

Being clean, professional and yes, approachable is important (I would be more worried about your Chief being unpleasant and unprofessional with patients than being obese and "ugly"), but having movie star looks is only important in the rarified world of Beverly Hills, Palm Beach, Manhattan and E TV.

 

[Amgen1]

just a side note associated with the wisconsin resident picture posted . . .

that is a very strong post-graduate match list for the UW program . . . i did not realize their graduates did so well . . .

 

[madtowngirl]

Its true, I think The University of Wisconsin program is a hidden gem. (I may be biased, however). They match incredibly well, and the program is full of happy residents. Madison's a fun city to live in, also. I didn't realize how great it was until I got onto the interview trail. I could go on and on about it, feel free to PM with any questions.

 

[factoid]

Well, it wasn't the OP, but you're right that it seems irrelevant how ugly the chief was...

but it's pretty funny.

 

[Tigger14]

Really? Cuz when I read the OP's post I could totally relate. And I'm going into Gen Surg!!

I would say a good chunk of my M3 surgery rotation was spent trying to stay out of everyone's way, putting in a lot of "face time", and feeling completely useless on the team. It's hard as a student on surgery because there really isn't a lot you can "do". Especially when you are keen and motivated. Some of the patients are so sick/complex that they don't want you to waste time presenting on rounds, so it's hard to know why you're there. the intern gets paged about your patients so you're always the last to know what's going on. It's painful.

The problem is that most surgical residents are so busy that they find it easier to just do things themselves rather than take the time to tell students how they can be helpful. Here's my advice:

One thing you can do is always have scissors, Kerlex, 4x4s. You're already getting in early so help your intern by getting numbers on all the patients on the service not just your patients (get ranges of vital signs fyi your intern if anyone is tachycardic or hypotensive, drain outputs, note the color, urine outputs over the last 24 hours or over the last shift etc.). Do this without asking tommorow, and you will look like a rock star. Your intern will start to see you as an asset and not just another liability.

What I learned is that surgeons love efficiency. They love it when you can anticipate what they need and have it ready. You don't have to say much, just always be ready with a stethoscope, gloves, tape, alcohol swabs, staple remover etc-Listen on rounds, who's going home that day? Offer to take out their staples and pull drains. What's exciting for you is scut for them and they will start to appreciate your presence-- they might even speak to you and do a little teaching.

I know it's hard. Especially for us who are shy. In terms of the OR always roll back with the patient, read the H&P, know the story. Help the patient transfer onto the bed, always be the first to slap on the SCDs. Once the resident sees you being a team player they might throw you a Foley and let you scrub in.

For me, it was a matter of looking into the future. The key question was did I like surgery, and not did I like being a med student on my surgery rotation. That's what you have to ask yourself.

Good Luck!

Doc Ivy, I agree with what you said. My impression from the OP was not just feeling useless, but not getting any exposure/teaching, etc. I did not expect to be useful in my surgery rotation, and have told many of my students something similar to what you said... I love surgery, but did not love being a surgery student. If the OP expected to be a key part of the team... it is different between medicine and surgery. I do think, however, that being able to see an operation, having opportunities to ask questions, learning basics, like how to identify an acute abdomen, are reasonable, assuming the student shows up and demonstrates some interest. You hints for being a "rock star" are right on, though.

 

[Winged Scapula]

You hints for being a "rock star" are right on, though.

Wearing leather pants on your rotations helps too!

 

[devildoc2]

thanks for the responses, although I dont apprecitate the troll coming along threadjacking this into something totally irrelevant to my original post.

anyways, I guess I was dumb and naive and thought that surg rotation would be like other rotations in terms of having some responsibility. But at least here, thats not the case. There is absolutely zero ownership of any patients. The patient census is covered by the whole team, meaning that no one person is responsible for anything. I also think my team is too crowded. We have 4 med students, 2 PAs, 1 PA resident, 3 interns, and 2 seniors.

We only have like 3 cases a day, and the PAs, med students, and PA resident as well as intern and senior all go to the cases, which means of course the OR is way too crowded so the med students get shoved to the back of the room.

When procedures come up, the only way to even have a shot is to aggressively go after it, and since we're only med students, we get shot down by the PAs who get to do everything that the interns/residents dont want to do. After being denied about 4 times, I just gave up and stopped trying to do anything in terms of cental line pulls, chest tuble pulls, removing staples, etc. I dont expect to do a lot of procedures, but I should get to do at least one over a 9 week period and havent gotten to do any at all, even after asking if I could do some of htem. They arent major procedures either, real minor stuff that interns/residents dont really care about.

When I was on medicine, I was assigned specific patients that nobody else was covering except my intern. It was a fabulous setup, because I got to be an actual member of the team and had real responsibility. If a procedure came up, it was always the intern or me that got to do it, I didnt have to fight 10 people on the team to do a procedure because it was MY patient.

On medicine, if I decided to skip school that day, my team would notice immediately and wonder where I was. Furthermore, patient care would take a hit because I had time to learn my patients better than even the intern. Surgery is the exact opposite. I could skip the entire rotation and it wouldnt make a damn bit of difference because I have zero responsibilities and zero opportunities to participate in patient care.

 

[Winged Scapula]

The way you describe your medicine rotation is how your surgery rotation is SUPPOSED to be.

You SHOULD be assigned a few patients, round on them in the morning, do any procedures on them, know their labs, etc. Of course, the Chief or someone senior on the service still needs to see the patient to make sure everything is ok, but they should be reviewing your note with you, making suggestions, correcting things that you were off on, etc.

I'll concede that surgery am rounds can be so rushed that teaching can be at a minimum but often times just being there and observing the way patients are cared for and decisions made, is a learning opportunity.

But frankly, IMHO:

1) the hospital you are at (or medical school if its your school hospital) has NO BUSINESS teaching Surgery to that number of students on a rotation if they don't even have enough cases to go around. Once in awhile is ok, but if it is a daily thing, that is a real problem.

Are you on trauma service or something like transplant where there aren't a lot of scheduled cases? Even so, they should not have 3 students on service (along with everyone else) where there aren't enough opportunities to go to the OR and be first assist.

2) the issue with the PAs is common, as you may know. The problem as I see it is two-fold:

a) the PAs do not recognize their role in a teaching insitution which has as ITS primary goal (or should) the teaching of MEDICAL STUDENTS. In hospitals without teaching programs, PAs often assist surgeons and become quite capable in doing so. However, in a hospital with residents and medical students, they should not be in the OR doing cases when it takes away from the learning experience of the students and residents. I assume your residents as similarly angered about this?

b) the faculty do not recognize THEIR role in a teaching institution. To be frank, if the PA removes the chest tube, the attending can bill for it. I ran into the EXACT same problem as a junior resident on CT Surgery. We were suddenly told not to remove any more chest tubes, except of course, those they wanted out at midnight or 5 am. Turns out, that even though it might offer a learning experience for us or the medical students on service, they could get some $$ if the PAs or NPs did it. So, they did.

At any rate, the faculty has to be responsible for your teaching and that of their residents and needs to review the job description of the PAs and review it with them. I know the trauma PAs at my former residency were all excited about getting started going to the OR - I haven't heard how that has turned out.

If your faculty and the residency PD seem uninterested in listening to the problems you've described with the PAs or making changes which reflect the mission of the medical school, then you need to take your concerns to the medical school. It will not help you, but in the future they need to either put fewer students on that rotation at the same time (or perhaps as a show of displeasure with how they are treated), or search for another hospital where you can rotate.

I have no problem at all with PAs and the valuable service they offer, but when they are interferring with the learning of medical students and residents, that is a problem. I'm not saying they should never be in the OR, and it is appropriate for them to be first assist when no resident is available, with you as second assist.

So after your rotation is over, you and your fellow students should approach the dean of the medical school and ask for a meeting with him/her and the Chief of Surgery and perhaps the surgery residency program director. Air your concerns in a mature, professional manner and express your concern that your educational needs are not being met. Do not blame the residents or say that, "no one cares whether I am there or not". Focus on being in the OR, getting feedback on your performance and the fact that there are too many team members to be efficient of get some educational opportunities. And mention the PAs - again not acrimoniously, but rather as a problem with getting into the OR and to learn to do floor procedures. Even non-surgeons should learn to remove drains, staples, etc.

Finally, do not believe that it (surgery) is that way everywhere, it is not and your medical school is doing you a disservice by not allowing you to have the opportunity to experience a rotation fully (goes without saying that surgery residents, etc. can be uninterested in teaching or students wherever, but your problem goes beyond that - it is a system problem).

 

[Legion560]

My experience with PAs have been mixed. Some are very good at what they do, like take care of floor work, however my CT experience has been totally ruined by having PAs in the OR. At my place, the PAs get to harvest vein and essentaially first assist when the fellow isnt around. This means that the senior on CT gets stuck doing intern level menial tasks in SICU or the floors. And as far as the interns go, the only time I ever saw the inside of an OR on CT is when I had to go and ask the attending something. Being on a CT rotation for an entire month and not scrubbing in ONCE on an open heart is unacceptable. I asked the CT fellow about this and he said something like-if the PAs were to run the service outside the OR there would be chaos. To an extent he is right because the PAs quite frankly f#ck up a lot when it comes to floor work and the service would suffer greatly. In fact, the residents often are spending more time double checking what the PAs are doing instead of being efficient, getting the work done, and trying to learn something. I even got in trouble once for asking a PA to discharge someone because I was busy rounding with the attendings in SICU. Imagine being yelled at for asking someone to do the job they were paid to do!

Legion

 

[Winged Scapula]

My experience with PAs have been mixed. Some are very good at what they do, like take care of floor work, however my CT experience has been totally ruined by having PAs in the OR. At my place, the PAs get to harvest vein and essentaially first assist when the fellow isnt around. This means that the senior on CT gets stuck doing intern level menial tasks in SICU or the floors. And as far as the interns go, the only time I ever saw the inside of an OR on CT is when I had to go and ask the attending something. Being on a CT rotation for an entire month and not scrubbing in ONCE on an open heart is unacceptable. I asked the CT fellow about this and he said something like-if the PAs were to run the service outside the OR there would be chaos. To an extent he is right because the PAs quite frankly f#ck up a lot when it comes to floor work and the service would suffer greatly. In fact, the residents often are spending more time double checking what the PAs are doing instead of being efficient, getting the work done, and trying to learn something. I even got in trouble once for asking a PA to discharge someone because I was busy rounding with the attendings in SICU. Imagine being yelled at for asking someone to do the job they were paid to do!

Legion

Did we do residency at the same place? Same EXACT experience with PAs on CT except that they pulled the seniors off CT since we didn't do anything.

 

[RajMahal]

SUCK IT UP. it's surgery. If you love surgery and want to do surgery, the hours suck and you wish you got to do more. If you hate surgery and don't want to do it, the hours suck and you wish you got to do more.
What it comes down to is your grade. I HATED peds. i wanted to shoot myself every day of that rotations. looking in ears. circumcisions. diarrhea. molluscum. But I got a kick-ass eval from my attending, because I pretended to be interested, showed up early, stayed late, worked hard, read, and rocked my shelf exam.
A wise man once told me that regardless of what you're applying for, you ought to have 3 letters. A medicine letter shows that you're smart. A surgery letter shows that you are willing to work hard. and a letter in the field you're applying for shows both proficiency and interest. It sucks being at a major teaching institution. There are tons of people ahead of you, and they get to do stuff. It's more important for them to learn than you at that point, especially with procedures and scrubbing in. I'm sure you'd love to do the case with the attending as a 3rd year, and sometimes you get lucky, but let's face it: the intern needs to learn to put in central lines more than you do. suck it up. work hard, act interested, do as you're told and don't complain. you know what will happen--they'll throw you a bone, eventually. I busted my ass on trauma, got procedure after procedure stolen from me by ER residents. but i showed up early and prerounded every day. knew everything about every patient on service. they let me do 3 a-lines, 3 central lines, and a chest tube. in surgery, hard work is rewarded, and whining is punished with a poor grade on the clerkship.
Everyone has had residents that they hate. i always had something bad to say about them. a hick, stupid, fat, ugly, smelly. The fact is, who gives a crap about your chief? they're gone next year. If they teach you, great. if not, hit up the juniors to teach you. chiefs have a lot of responsibility.

Raj