Is it bad if I don’t find being in the OR very useful on surgery rotation? Not going into surgery

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Latteandaprayer

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I made a depressing/lazy post not that long ago talking about hating surgery and not doing anything to be proactive. After that vent post, I realized my mindset was off and I started focusing on what I’m *supposed* to get out of it.

Since then, I have been loving clinic and floor management. I am most interested in IM vs Neuro, and I love managing and assessing patients. I love determining if a patient has a surgical indication at all in new patient clinic, and then trying to determine if they *need* the surgery and if they can even have the surgery (usually I’m wrong haha but getting better). On the floor I like responding to patient complaints, and thinking about what complications they might have and why.

The OR however is where my soul dies. I don’t like standing there, retracting, driving the camera, suturing, cutting suture, etc. I like going to operations I haven’t seen before because I can at least gain an understanding of what the patient goes through. However, as I’m on peds Gen surg, lots of cases are repeats and bread and butter with very few complications. Ultimately I don’t find it super useful for me :(

I try to be proactive now; I read about all my patients as much as I can, and I read about the disease, the indication, the procedure, common complications, etc. However, this rarely helps in the OR because I’m ultimately standing there and ignored. If I try to ask questions, im treated like im asking the stupidest questions on earth. The attendings are also very focused on teaching the new fellows and the residents, so there isn’t much opportunity to ask during cases. I do ask later, typically the resident. Some of the attendings are also kinda rude. One asked me a bunch of questions about a patient, all of which I got right (and they were detailed!), then he asked me “what approach did the last surgeon use for [an unrelated procedure]?” I said I wasn’t sure, and he said “You need to read about your patients. You have a phone and you can Google anything you don’t understand. When I was a student, we would be kicked out if we didn’t know about our patients and our evaluations depended on these types of questions.” Even though I knew why we were in the OR, what the exact current procedure is, the complications, and how often the patient will need this procedure (among other things).

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I am sorry you're going through this. The only advice I have for you is what got me through a lot of MS3 - one of the ED docs I used to work with told me this: "You can do anything for [insert time]." It doesn't matter if it's a day, a week, or a month. It has an end.

The OR is a very specific and intense environment where the most primal instincts come to light. I have witnessed and been subject of everyone starting with scrub techs, over circulating nurses, residents, to attendings just plain simply being rude or malicious to us - students. I don't think there is any need for that but there also is little that can be done about it because we are at the bottom of the food chain. There is no pleasing these people. All you can do is get out of this rotation as much as you can and move on. Just to put things in perspective - I had an attending who would plain simply ignore medical students existence. No interaction whatsoever. No response to questions. Nothing. The only time he spoke to me was in the clinic when he was about to trash-talk a resident to another resident and said "Medical student, earmuffs!" While on that rotation, I have learned mainly how not to act. That is learning too...
 
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I made a depressing/lazy post not that long ago talking about hating surgery and not doing anything to be proactive. After that vent post, I realized my mindset was off and I started focusing on what I’m *supposed* to get out of it.

Since then, I have been loving clinic and floor management. I am most interested in IM vs Neuro, and I love managing and assessing patients. I love determining if a patient has a surgical indication at all in new patient clinic, and then trying to determine if they *need* the surgery and if they can even have the surgery (usually I’m wrong haha but getting better). On the floor I like responding to patient complaints, and thinking about what complications they might have and why.

The OR however is where my soul dies. I don’t like standing there, retracting, driving the camera, suturing, cutting suture, etc. I like going to operations I haven’t seen before because I can at least gain an understanding of what the patient goes through. However, as I’m on peds Gen surg, lots of cases are repeats and bread and butter with very few complications. Ultimately I don’t find it super useful for me :(

I try to be proactive now; I read about all my patients as much as I can, and I read about the disease, the indication, the procedure, common complications, etc. However, this rarely helps in the OR because I’m ultimately standing there and ignored. If I try to ask questions, im treated like im asking the stupidest questions on earth. The attendings are also very focused on teaching the new fellows and the residents, so there isn’t much opportunity to ask during cases. I do ask later, typically the resident. Some of the attendings are also kinda rude. One asked me a bunch of questions about a patient, all of which I got right (and they were detailed!), then he asked me “what approach did the last surgeon use for [an unrelated procedure]?” I said I wasn’t sure, and he said “You need to read about your patients. You have a phone and you can Google anything you don’t understand. When I was a student, we would be kicked out if we didn’t know about our patients and our evaluations depended on these types of questions.” Even though I knew why we were in the OR, what the exact current procedure is, the complications, and how often the patient will need this procedure (among other things).
Not at all. I honestly felt like I was dying inside during family medicine. I still showed up with a positive attitude and did my best for each patient but I definitely have zero interest in the field. I’m also realizing I don’t like the structure of clinic either and prefer inpatient. There’s nothing wrong with admitting to yourself that you’re not interested in the OR and as a student you’re not going to know everything. Just keep putting your best foot forward.
 
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I love surgery and am a surgeon and was bored to tears as a med student and even early resident when in the OR, you’re just a statue there. Even worse when you don’t want to do surgery and have little to no impetus to make a good impression. But you just have to power through to get the grade that you need
 
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Yeah OP sounds like you’ve got a crap rotation and surgery just isn’t your jam on top of that. Sadly this happens far too often. I’ve always made a point to engage students on rotation and welcome them in and introduce them to staff and try to make it a good experience so even if they leave without any desire to be a surgeon, they at least leave with a good impression of us, aren’t afraid to call us for help, and have some idea of how we think.

I always make a point to let students do absolutely anything they’re comfortable doing and that I’m comfortable letting them do. Sometimes that may not be much, but then something more idiot proof with a wound I will never close like a trach, I hand them the knife and bovie and let them do all the cutting. Of course I’m kinda moving the patient underneath them, but they feel like they’re doing the case. Always let them close a bit too with the old “I close 75% and you do as much of the other 25% as you can before I finish my portion.” And then for some of my more single operator cases I at least try to get them under the microscope or using the endoscope and have them do something else that can’t be messed up and that I can watch like a hawk. But they all seem to enjoy it and appreciate the involvement, and I feel like it gives them a better sense of what I do.

It sounds like your future may lie more on the medical side and lord knows we need lots of good people there too. So keep doing your best in the OR but shine in clinic and on the floor. Honestly attendings learn more about students in the clinic than anywhere, so you’re hopefully making good impressions there. In the end you want to end up with a decent grade and evals that said you worked hard and were interested even though you weren’t planning for a career in surgery.
 
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this rarely helps in the OR because I’m ultimately standing there and ignored. If I try to ask questions, im treated like im asking the stupidest questions on earth. The attendings are also very focused on teaching the new fellows and the residents, so there isn’t much opportunity to ask during cases. I do ask later, typically the resident. Some of the attendings are also kinda rude. One asked me a bunch of questions about a patient, all of which I got right (and they were detailed!), then he asked me “what approach did the last surgeon use for [an unrelated procedure]?” I said I wasn’t sure, and he said “You need to read about your patients. You have a phone and you can Google anything you don’t understand. When I was a student, we would be kicked out if we didn’t know about our patients and our evaluations depended on these types of questions.” Even though I knew why we were in the OR, what the exact current procedure is, the complications, and how often the patient will need this procedure (among other things).
Writing this between cases on the worst OR day so far: This is absolutely spot on. Looking past the bad personalities, I could say I almost enjoy the OR. It's pretty interesting, time flies while you're in there, get to use fun skills. But you couldn't pay me to spend an extra minute on this rotation. The fact that this rotation requires the most time of all is just salt in the wound.

I always knew I didn't like surgery, but holy hell, I hate surgeons and surgery residents with a fiery passion. Seems like every one I've met hates their lives and wants me to hate it, too. I'm somehow similtaneously neglected from all learning/growth opportunities, while also micromanaged for any minor mistakes. It's unbelievable. I will never understand how these residents went through hell/are going through hell and still decide to let the **** run downhill for all future generations.

We'll make it through this rotation, bud. At the end of the month, I get to move on to better things and they're stuck here, and that's all that matters.
 
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I’ll throw a bit of context - I’ve got a unique background as I always dreamed of being a surgeon only to find I hated the OR and switching to EM. Now doing a surgical critical care fellowship at a big trauma center.

It’s totally fine not to like the OR. There are other people out there that find surgical diseases and surgical management interesting without liking the actual act of doing surgery. Theres a lot of phenomenally interesting management of these cases that happens outside the OR and the medical world needs people who like doing that job so the surgeons can keep operating.

From a practical aspect one thing I’ve found relevant to your situation is that I don’t shy away in the face of surgeons asking annoying but picky questions. I tell them I have no idea and will go check the chart.

Surgeons like to yell. I think it’s dumb. Once they realize you are legit interested but won’t play the game, because you have no desire to operate, lots of them are just happy to have someone around who’s interested and asks questions about an aspect of their job. Operative fields are a vicious pecking order but if you make it clear that’s not your goal your just interest in the pathology the tone changes.

N=1, your results may vary.
 
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If you're not going into surgery, you don't have to like the OR. What you should take away from your surgery rotation is what you're saying - figuring out how to manage the post-surgical patients (because you will do that even on IM), what surgical indications are generally and how to work up a surgical problem. If you're in IM and you consult general surgery to rule out a bowel obstruction with no data to work that up other than "patient can't poop," people will not like you. People won't ask you as an IM or neuro resident to do surgery. They will, however, ask how you've worked up a problem that's potentially surgical.

Second, you should definitely get some hands on procedural experience. The time in the OR may seem boring but even IM and neuro docs do procedures so it's important to understand sterile technique and get some hand-eye coordination. IM docs will do thoracenteses, paracenteses, central line placements on ICU rotations, etc. Neurologists will do LPs.
 
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My soul dies when I’m rounding on patients and managing them long term. We all have rotations that suck for us. Just power through and do your best to be helpful when you can. Get a good grade and never look back.
 
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