Improving on Surgery Rotation?

[The Knife & Gun Club]

Hi All, would love some advice about how to turn around my surgery rotation.

I’ve been on service for 7 days now, and I feel like I’m not experiencing anything.

I’m “following” 4 patients, but I’m not allowed to pre-round on them on my own in the mornings - I’m only allowed to observe the Cheif resident pre-round/examine them. I’m also not allowed to present any of the patients I’m following during rounds - the cheif just presents them. When I asked the cheif if I could examine/present, she said no because I’d “mess it up and make her look bad”.

Now I’m sure I would botch a few presentations, but I feel like I’ll never learn how to do it right if I don’t at least try. I asked if maybe I could just present to the cheif or an intern to get some practice, but that got shut down too.

I’ve tried helping with scut, which usually seems to work...but for some reason I just keep getting stonewalled. Post- op wound checks? Lists of I/Os? Follow up labs? Not allowed.

I Haven’t scrubbed yet, I’ve only been allowed to observe a couple times in the OR. That’s ok, I get that scrubbing is a privilege but I feel like I’ll never get a chance to justify scrubbing if I can’t at last show I care.

I guess my question is...what do you guys think I can do to show I care and want to be part of the team?

TLDR: cheif resident won’t let me get involved in patient care, what can I do to change that?

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[WedgeDawg]

Honestly it sounds like you’re not being given the opportunity to do literally anything. I would bring this up (respectfully) with the course director, explain the issue, what you’ve done to try to address it and the result of that (basically exactly what you said here) and then ask if he or she might be able to help you.

All of those things are normal things you should be able to do as a med student.

 

[CherryRedDracul]

Is this chief resident in hot water or something? I'd let my medical students do almost everything as an intern because I felt strongly that I taught them what they needed to know well.

If I sucked, I'd be worried like that resident, too.

Regardless, yeah, you're getting screwed, OP. As a med student, I was practically allowed to debride decubitus ulcers with a scalpel solo.

 

[21Rush12]

This is the type of thing that needs to go to the course director. If you don’t address it now you run the risk of this being the way your whole rotation is. Surgery rotation is supposed to be a hands on experience, and it sounds like you’re not getting that at all. I doubt this is what your school has in mind for the clerkship.

 

[MediCane2006]

It sounds like there may be issues happening at the resident/attending level that you may be experiencing the backlash from

 

[The Knife & Gun Club]

Thanks for all the responses, I really appreciate it. Also good to hear that I’m not crazy and that this is in fact not normal.

I’ll (tactfully) mention what’s going on to the course coordinator on Monday. Last thing I want to do is be the squeaky wheel, but if it really is abnormal then i guess they’ll be happy to hear about it.

 

[WedgeDawg]

Thanks for all the responses, I really appreciate it. Also good to hear that I’m not crazy and that this is in fact not normal.

I’ll (tactfully) mention what’s going on to the course coordinator on Monday. Last thing I want to do is be the squeaky wheel, but if it really is abnormal then i guess they’ll be happy to hear about it.

You won’t be a squeaky wheel. This is a legitimate issue. Talk to your course director.

 

[mimelim]

Chief

Sounds like a poor teacher. Most physicians are. So many different variables possibly at play. What to do really depends on your specific circumstances. If this is a relatively short stint, I'd just move on. I don't think complaining to course director or anyone else will improve your situation although it may make things better for future students with this individual.

 

[doc05]

Sounds like a horrible rotation. How many weeks left? Why aren't you scrubbing on every case?

 

[mw18]

Medical students at my school scrub every case. We get numbers in the am (usually by choice). We have the option of presenting, but this doesn't always happen just because of the pace of rounds. But the residents would always let us practice presenting during downtime if we wanted. If this is where you'll be for 4-8 weeks, I'd say something. If you have another week or something, I would say something afterward. You should be scrubbing and helping when you can with suctioning, cutting suture, retracting, and closing.

 

[takeurmeds02]

Hi All, would love some advice about how to turn around my surgery rotation.

I’ve been on service for 7 days now, and I feel like I’m not experiencing anything.

I’m “following” 4 patients, but I’m not allowed to pre-round on them on my own in the mornings - I’m only allowed to observe the Cheif resident pre-round/examine them. I’m also not allowed to present any of the patients I’m following during rounds - the cheif just presents them. When I asked the cheif if I could examine/present, she said no because I’d “mess it up and make her look bad”.

Now I’m sure I would botch a few presentations, but I feel like I’ll never learn how to do it right if I don’t at least try. I asked if maybe I could just present to the cheif or an intern to get some practice, but that got shut down too.

I’ve tried helping with scut, which usually seems to work...but for some reason I just keep getting stonewalled. Post- op wound checks? Lists of I/Os? Follow up labs? Not allowed.

I Haven’t scrubbed yet, I’ve only been allowed to observe a couple times in the OR. That’s ok, I get that scrubbing is a privilege but I feel like I’ll never get a chance to justify scrubbing if I can’t at last show I care.

I guess my question is...what do you guys think I can do to show I care and want to be part of the team?

TLDR: cheif resident won’t let me get involved in patient care, what can I do to change that?

Talk to clerkship director, that's not cool at all. Everyone who's with this person will get short-changed.

 

[Angus Avagadro]

Surgery is rough as an M3. You really dont know enough to be much help. Residents are hurrying to see consults, get to the OR and clinic. Teaching takes time, a premium on surgery. Note the painted expression on the anesthetists face as the med student puts in a skin suture, admires it, and slowly places the next. Having said all this, you are at a teaching institution, you are paying tuition, and every one of your superiors was an M3 once and should make efforts to get you up to speed. I agree with the above and believe the resident is a big part of the problem, and a polite word to the director might help future students. Hang in there. Good luck and best wishes. It gets better as a 4th yr.

 

[OrthoTraumaMD]

Correct, it is not normal. You should be presenting to the residents every day, and if possible the attending. That is part of their obligation to you as a statement. Speak with your course director.


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[The Knife & Gun Club]

Wow what a difference a different team can make. We had a new cheif covering today and it was like night and day.

I guess it really is just a problem with the current cheif. Ill go talk to someone Monday, trying not to step on any toes in the process.

 

[AnatomyGrey12]

I guess it really is just a problem with the current cheif

For the love of god it's "chief"

Ok I'm done. Carry on.

 

[The Knife & Gun Club]

For the love of god it's "chief"

Ok I'm done. Carry on.

 

[Matthew9Thirtyfive]

For the love of god it's "chief"

Ok I'm done. Carry on.

Except after C! Except after C, dammit!

 

[OrthoTraumaMD]

Except after C! Except after C, dammit!

“As it turns out, for every “ceiling” there's a “concierge,” a “conscience” and some “celibacies.” For every “deceit,” there are “deficiencies,” “delicacies” and a “dicier.” The iciest glaciers make idiocies out of the conceit of “except after c.”
Lol...

https://www.washingtonpost.com/news...ant-lie/?noredirect=on&utm_term=.0e261efffdcc

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[Matthew9Thirtyfive]

“As it turns out, for every “ceiling” there's a “concierge,” a “conscience” and some “celibacies.” For every “deceit,” there are “deficiencies,” “delicacies” and a “dicier.” The iciest glaciers make idiocies out of the conceit of “except after c.”
Lol...

https://www.washingtonpost.com/news...ant-lie/?noredirect=on&utm_term=.0e261efffdcc

Sent from my iPhone using SDN mobile

That's hilarious, but I hope you knew I was joking and that was my whole point lol.

 

[Winged Scapula]

Wow what a difference a different team can make. We had a new cheif covering today and it was like night and day.

I guess it really is just a problem with the current cheif. Ill go talk to someone Monday, trying not to step on any toes in the process.

Perfect.

Late to the discussion, but I was going to agree with the others, sounds like this ChIEf lacks confidence or isn't very strong (for whatever reason) because this is definitely abnormal. When I was a PGY-2, I wouldn't let the interns do anything because it was easier for me to do it and if they messed up, I would get yelled at. However, a wise senior resident explained that I had to let them learn and that taking the blame for their mistakes was part of the job; once they were trained well, this would lessen. Thus, when I became Chief I tried to let the medical students and junior residents do their work and learn how to manage patients, only stepping in if there was a significant issue or patient safety was at risk. This Chief never learned that lesson or isn't confident enough that she can fix your mistakes.

Not sure you can avoid being on service with him/her again, but at least you can the course director know who may speak with the PD about this particular resident.

 

[OrthoTraumaMD]

That's hilarious, but I hope you knew I was joking and that was my whole point lol.

I did. Doesn’t come across well on the interwebz!


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[The Knife & Gun Club]

Perfect.

Late to the discussion, but I was going to agree with the others, sounds like this ChIEf lacks confidence or isn't very strong (for whatever reason) because this is definitely abnormal. When I was a PGY-2, I wouldn't let the interns do anything because it was easier for me to do it and if they messed up, I would get yelled at. However, a wise senior resident explained that I had to let them learn and that taking the blame for their mistakes was part of the job; once they were trained well, this would lessen. Thus, when I became Chief I tried to let the medical students and junior residents do their work and learn how to manage patients, only stepping in if there was a significant issue or patient safety was at risk. This Chief never learned that lesson or isn't confident enough that she can fix your mistakes.

Not sure you can avoid being on service with him/her again, but at least you can the course director know who may speak with the PD about this particular resident.

After meeting with the course coordinator he thought it may be better if I moved to a different team - now 2 days into being on the new team and I definitely see what you all were talking about. I’ve got defined roles and responsibilities and it makes life so much better. I’ve scrubbed a few cases, presented some patients, and things are going well.

After a week of sputtering I finally feel like I’m learning, and really enjoying it. Thanks again to everyone for their advice, sdn never disappoints!

 

[Black Coffee 24/7]

After meeting with the course coordinator he thought it may be better if I moved to a different team - now 2 days into being on the new team and I definitely see what you all were talking about. I’ve got defined roles and responsibilities and it makes life so much better. I’ve scrubbed a few cases, presented some patients, and things are going well.

After a week of sputtering I finally feel like I’m learning, and really enjoying it. Thanks again to everyone for their advice, sdn never disappoints!

Be aggressive and keep yourself busy. That means preop with your Anesthesia and Surgery teams, intubate the pt with your Anesthesia physician, put in some lines, scrub in surgical cases, and do post-op stuff with your surgical team and Anesthesiology attending.

Got to max that OR opportunity instead of twiddling your thumbs like most MSIII. OR days always go by really quick for me bc I'm always super busy from start to finish with the exception of my 20 mins lunch break.

 

[21Rush12]

After meeting with the course coordinator he thought it may be better if I moved to a different team - now 2 days into being on the new team and I definitely see what you all were talking about. I’ve got defined roles and responsibilities and it makes life so much better. I’ve scrubbed a few cases, presented some patients, and things are going well.

After a week of sputtering I finally feel like I’m learning, and really enjoying it. Thanks again to everyone for their advice, sdn never disappoints!

Really glad to hear it worked out! Proof that speaking up when things aren’t right can actually improve your learning experience.

 

[The Knife & Gun Club]

Really glad to hear it worked out! Proof that speaking up when things aren’t right can actually improve your learning experience.

So true - in SDN we always see horror stories of students who’s schools seem “out to get them.”

Goes to show that if you’re respectful, admin can be huge allies in your corner. The CD wasn’t even the slightest bit upset if off-put, she just popped up the roster, clicked some boxes, and told me to report to a new floor the next day.

 

[Angus Avagadro]

My chief told us all on the first day, in no uncertain terms, we were to make every effort to teach and encourage our med students on service. He said he didnt want our best med students to go to another residency. Also, having been on service, these students were KNOWNS, where residency applicants for other med schools were mostly unknowns. He believed it best to hire known applicants when possible. I'm glad things worked out for OP.

 

[The Knife & Gun Club]

Be aggressive and keep yourself busy. That means preop with your Anesthesia and Surgery teams, intubate the pt with your Anesthesia physician, put in some lines, scrub in surgical cases, and do post-op stuff with your surgical team and Anesthesiology attending.

Got to max that OR opportunity instead of twiddling your thumbs like most MSIII. OR days always go by really quick for me bc I'm always super busy from start to finish with the exception of my 20 mins lunch break.

Lol maybe we work at different types of hospitals but where I am there’s an anesthesia resident and med student who would just as soon throw me out the room rather than see me steal their intubation.