My surgery volume seems kinda low

[ohmanwaddup]

3rd year on rotation at a community hospital. The entire year has Seemed way more chill than I was lead to beleive. Currently on surgery and we have like 3-4 procedures a day. Doc doesn’t let me do clinic work with him so I just study those days and he pimps me in between cases.
Straight up this has just not been the hell whole I was lead to believe it would be. Should I be worried I’m not getting enough done? I don’t have a interest in surgery but I’m worried about volume issues with my other rotations as well

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[DO2015CA]

If you don’t have any interest and you are learning enough to pass the shelf then enjoy. For me, the surgery experience that was hell was less of learning and more hell for hours sake.

 

[ciestar]

Be happy about that haha
If you’re not into surgery, at least for me, more cases was terrible for me.

 

[Fatalis]

3rd year on rotation at a community hospital. The entire year has Seemed way more chill than I was lead to beleive. Currently on surgery and we have like 3-4 procedures a day. Doc doesn’t let me do clinic work with him so I just study those days and he pimps me in between cases.
Straight up this has just not been the hell whole I was lead to believe it would be. Should I be worried I’m not getting enough done? I don’t have a interest in surgery but I’m worried about volume issues with my other rotations as well

Take it as a gift, study for the shelf [do uworld IM GI as well as that showed up a ton on surgery shelf] and move on. You don't have an interest in surgery... I would not be worried at all!

 

[Wordead]

Why would you not be allowed in clinic? If you are doing any specialty that refers to surgery like primary care that's the most useful part for you.

 

[ohmanwaddup]

Why would you not be allowed in clinic? If you are doing any specialty that refers to surgery like primary care that's the most useful part for you.

He doesn’t like taking students with him

 

[VA Hopeful Dr]

He doesn’t like taking students with him

Then he shouldn't have students, period.

 

[ohmanwaddup]

Then he shouldn't have students, period.

I don’t necessarily disagree, but he’s been good about teaching in the OR, and went out of his way to put me in contact with a meds peds doc he said I can spend time with whenever we don’t have OR duties or clinic duties, IE 6 ish hours a week. I wouldn’t otherwise have access to a meds peds doc so I’m grateful for that

 

[QuizzicalApe]

You are straight up living my med school dream. My surgical rotation was 3 months long. I would have had a knife fight to get your experience.

 

[ohmanwaddup]

Glad to hear I should not be concerned. I will accept my blessing. As someone who does not want to go into surgery but finds it interesting, the rotation is pretty swell time wise and what I'm allowed to do.

I just wanted to make sure I wasn't being screwed out of tuition money.

 

[Wordead]

I mean, obviously you're being screwed out of your tuition money. You're paying tens of thousands of dollars to be a retractor in the OR and have 6 hours a week of medpeds clinic. Lol.

 

[qwerty89]

I mean, obviously you're being screwed out of your tuition money. You're paying tens of thousands of dollars to be a retractor in the OR and have 6 hours a week of medpeds clinic. Lol.

He's paying tens of thousands of dollars to have the opportunity to have a coveted credential.

If he manages to get an education on top of that then great.

 

[Wordead]

He's paying tens of thousands of dollars to have the opportunity to have a coveted credential.

If he manages to get an education on top of that then great.

So the opportunity to take boards alone is worth tens of thousands of dollars and he's not getting screwed at all and the education is completely secondary? Man I thought I was cynical.

 

[ciestar]

I mean, obviously you're being screwed out of your tuition money. You're paying tens of thousands of dollars to be a retractor in the OR and have 6 hours a week of medpeds clinic. Lol.

Of course OP is being screwed out of tuition money. We all are screwed out of tuition money throughout med school though.

 

[MLNS]

Welcome to the **** rotations that most DO schools have

I’d hustle hard fourth year so you aren’t behind your US MD colleagues come intern year

 

[DO2015CA]

Welcome to the **** rotations that most DO schools have

I’d hustle hard fourth year so you aren’t behind your US MD colleagues come intern year

not for surgery. Don’t do that. Hustle in the specialty you want

 

[MLNS]

not for surgery. Don’t do that. Hustle in the specialty you want

That’s why I said fourth year...

 

[ohmanwaddup]

I mean, obviously you're being screwed out of your tuition money. You're paying tens of thousands of dollars to be a retractor in the OR and have 6 hours a week of medpeds clinic. Lol.

Well yeah lol, I guess I should have clarified as "more screwed over than usual"

 

[Tenk]

The only really useful parts of surgery clinic for someone not going into surgery is pre op diagnosis and post op wound care. Sometimes surgeons get referred patients that actually don’t need cut, so it’s good to know when and what to refer. In terms of wound care, the more normal wounds you see, the easier it is to spot an abnormal one. These won’t break you or anything but hopefully this surgeon can teach you some about good wound care.

 

[7331poas]

I mean, obviously you're being screwed out of your tuition money. You're paying tens of thousands of dollars to be a retractor in the OR and have 6 hours a week of medpeds clinic. Lol.

lmao what. I would have gladly paid to just skip 3rd year and pound uworld.

 

[DO2015CA]

lmao what. I would have gladly paid to just skip 3rd year and pound uworld.

What why? 3rd year is important. You don’t go in to 4th year having no clinical skills. Understanding what a murmur should sound like is different than catching one.

 

[7331poas]

What why? 3rd year is important. You don’t go in to 4th year having no clinical skills. Understanding what a murmur should sound like is different than catching one.

"catching a mumur" has mattered zero times in my entire clinical experience. 99.99999% of mumurs are aortic stenosis. When you report it to an attending the answer is always " shrug, they aren't short of breath so no big deal"

 

[Wordead]

lmao what. I would have gladly paid to just skip 3rd year and pound uworld.

Do you think any attending agrees with you

 

[Giovanotto]

"catching a mumur" has mattered zero times in my entire clinical experience. 99.99999% of mumurs are aortic stenosis. When you report it to an attending the answer is always " shrug, they aren't short of breath so no big deal"

Funny thing is, everyone loves to wax poetically about heart murmurs, and yet we get to other parts of the exam:

Abdomen: soft
Neuro: CN 2-12 in-tact. awake.

Give me a break people. If you're going to espouse the importance of a physical exam then be competent in all of it's domain.

 

[DO2015CA]

"catching a mumur" has mattered zero times in my entire clinical experience. 99.99999% of mumurs are aortic stenosis. When you report it to an attending the answer is always " shrug, they aren't short of breath so no big deal"

Funny thing is, everyone loves to wax poetically about heart murmurs, and yet we get to other parts of the exam:

Abdomen: soft
Neuro: CN 2-12 in-tact. awake.

Give me a break people. If you're going to espouse the importance of a physical exam then be competent in all of it's domain.

People go on and on about murmurs because they’re the hard ones to pick up in the beginning. But whatever. What your proposing is absolutely ******ed. Hammering UW for a second time just to score a great score is dumb. You literally need to learn to present. In peds you need to know what ears look like in toddlers. You need to know what a distended abdomen from obstruction looks like. You can absolutely tell which interns had a good clinical training vs crappy. And no not everyone catches up completely to a level playing field by the end of 1st year.

 

[You shall know the Truth]

3rd year on rotation at a community hospital. The entire year has Seemed way more chill than I was lead to beleive. Currently on surgery and we have like 3-4 procedures a day. Doc doesn’t let me do clinic work with him so I just study those days and he pimps me in between cases.
Straight up this has just not been the hell whole I was lead to believe it would be. Should I be worried I’m not getting enough done? I don’t have a interest in surgery but I’m worried about volume issues with my other rotations as well

This was my 3rd year, it puts you at a major disadvantage. very low volume small community hospital. I would go find docs that would let me hang out in the evenings and weekends.

 

[Mass Effect]

You have to be careful at those community hospitals. It's fine for surgery since you're not interested, but in your specialty of choice, you need to make up for a lackluster 3rd year with aways at more rigorous programs in 4th year.

 

[ohmanwaddup]

You have to be careful at those community hospitals. It's fine for surgery since you're not interested, but in your specialty of choice, you need to make up for a lackluster 3rd year with aways at more rigorous programs in 4th year.

That was my plan. I’ve had alright outpatient rotations in terms of volume and what I’ve gotten to see at my main site (still community but park of AHEC so it’s kinda academic idk that’s probably wrong). I was just sent here for half my surgery rotation (4 weeks here, 4 weeks back at my main site).

I’m planning trying to get a rough roadmap for 4th year hashed out this weekend. I know I’ll need to spend time at more rigorous programs and I want to. I don’t want to be lacking.

I’m kicking myself for choosing this community site. I kinda bought the talk of the clinical director hook line and sinker that I would always be treated like a sub-i and become very competent. I was dumb to believe him.

it was a good move for me since I cut the distance to my fiancé almost 100%. Of course due to covid my fiancé had to move several hours away because of work, so really 2020 is just kicking me in the butt over and over.

 

[ohmanwaddup]

People go on and on about murmurs because they’re the hard ones to pick up in the beginning. But whatever. What your proposing is absolutely ******ed. Hammering UW for a second time just to score a great score is dumb. You literally need to learn to present. In peds you need to know what ears look like in toddlers. You need to know what a distended abdomen from obstruction looks like. You can absolutely tell which interns had a good clinical training vs crappy. And no not everyone catches up completely to a level playing field by the end of 1st year.

Do you think I can make up for my 3rd year by spending almost the whole year doing always at better institutions? The ear thing really speaks to me. Just got off peds and I really struggled at first to get a good look at ears and differentiate different ear issues on kids. They move around a lot more than SPs among other difficulties. Same with telling viral from bacterial from allergy colds. I was able to get a decent hang of it by the end of the rotation, but I don’t want to suck at being a doctor/residency

 

[DO2015CA]

Do you think I can make up for my 3rd year by spending almost the whole year doing always at better institutions? The ear thing really speaks to me. Just got off peds and I really struggled at first to get a good look at ears and differentiate different ear issues on kids. They move around a lot more than SPs among other difficulties. Same with telling viral from bacterial from allergy colds. I was able to get a decent hang of it by the end of the rotation, but I don’t want to suck at being a doctor/residency

you will not suck at being a doctor. Physical exam skills, you don’t need a fantastic residency team based rotation to get better at. You just need to see patients. Any preceptor based one where you are seeing patients is enough. You put in the effort to show up and lay your stethoscope/hand on every single patient then the physical exam skills will come. You won’t always be right and that’s okay but you do need to be comfortable listening to and examining. My response was someone that said they don’t want to do clinical rotations and just to spam questions. That is the wrong move.

 

[Candidate2017]

OP, did you by any chance "pre-study" for med school?

 

[ohmanwaddup]

OP, did you by any chance "pre-study" for med school?

Nah. I know I come off as super anxious. I got the **** wrecked outta me in M1 and only improved slightly in M2. I’m talking almost failing practically every block m1.

It just turned me into an incredibly anxious person. I’m trying to get over it, but I also don’t want to get screwed over by being blissfully ignorant.

 

[Mad Jack]

Welcome to the **** rotations that most DO schools have

I’d hustle hard fourth year so you aren’t behind your US MD colleagues come intern year

I've done fine compared to the MDs in my program, the idea that you'll be behind because your rotations aren't working you to death is ridiculous. Everyone is basically a deer in the headlights on day 1, no amount of MS3/4 beatings will change that

 

[Candidate2017]

Nah. I know I come off as super anxious. I got the **** wrecked outta me in M1 and only improved slightly in M2. I’m talking almost failing practically every block m1.

It just turned me into an incredibly anxious person. I’m trying to get over it, but I also don’t want to get screwed over by being blissfully ignorant.

Be thankful you picked a chill hospital where you have time to study and not fail the surgery shelf.

 

[MLNS]

I've done fine compared to the MDs in my program, the idea that you'll be behind because your rotations aren't working you to death is ridiculous. Everyone is basically a deer in the headlights on day 1, no amount of MS3/4 beatings will change that

Nice straw-man. 100% not what I said. Keep up the good work, though.

 

[7331poas]

That was my plan. I’ve had alright outpatient rotations in terms of volume and what I’ve gotten to see at my main site (still community but park of AHEC so it’s kinda academic idk that’s probably wrong). I was just sent here for half my surgery rotation (4 weeks here, 4 weeks back at my main site).

I’m planning trying to get a rough roadmap for 4th year hashed out this weekend. I know I’ll need to spend time at more rigorous programs and I want to. I don’t want to be lacking.

I’m kicking myself for choosing this community site. I kinda bought the talk of the clinical director hook line and sinker that I would always be treated like a sub-i and become very competent. I was dumb to believe him.

it was a good move for me since I cut the distance to my fiancé almost 100%. Of course due to covid my fiancé had to move several hours away because of work, so really 2020 is just kicking me in the butt over and over.

Feel free, but just keep in mind that no amount of extra "weekend shifts" will change your preparedness for residency.

 

[DO2015CA]

Feel free, but just keep in mind that no amount of extra "weekend shifts" will change your preparedness for residency.

This is correct. Residency is a whole other beast nothing will make the transition easy. But seeing as many patients now means you are developing your physician management skills and not still learning techniques come intern year.

 

[ohmanwaddup]

Be thankful you picked a chill hospital where you have time to study and not fail the surgery shelf.

You right, it’s the little things

 

[Giovanotto]

I've done fine compared to the MDs in my program, the idea that you'll be behind because your rotations aren't working you to death is ridiculous. Everyone is basically a deer in the headlights on day 1, no amount of MS3/4 beatings will change that

Couldn't disagree more. Sure, day 1 everyone panics. Why not talk about Day 2-90? Bad rotations make bad residents, or rather, a string of bad rotations during M3-M4 means you're going to be a ways behind your peers come R1 time. That shouldn't even be up for debate. And a bad rotation is definitely one where you can clock out for 80% of the time you're there without any didactics whatsoever to make up for it.

 

[MedicineZ0Z]

you will not suck at being a doctor. Physical exam skills, you don’t need a fantastic residency team based rotation to get better at. You just need to see patients. Any preceptor based one where you are seeing patients is enough. You put in the effort to show up and lay your stethoscope/hand on every single patient then the physical exam skills will come. You won’t always be right and that’s okay but you do need to be comfortable listening to and examining. My response was someone that said they don’t want to do clinical rotations and just to spam questions. That is the wrong move.

Ah.. how often is the physical exam leading to a definitive treatment regime? It doesn't even lead to a proper diagnosis half the time.

Volume status? I'll rely on my ultrasound thanks. Not a barely accurate physical exam on an obese patient.
Murmur = echo, the specifics of the murmur rarely matter in the big picture since they're getting the echo regardless.
Abdomen? A crappy looking belly is getting some form of imaging no matter what.
Lungs? We're getting the xray if there's any remote suspicion even if the lungs sounds crystal clear.

I think the threshold of physical exam skills is pretty low and you don't need much volume to hit it. Med schools should invest more time in teaching ultrasound skills and reading films, this is far more useless at 3am on night call than good physical exam skills - especially when half your patients have colossal BMIs.

 

[operaman]

Couldn't disagree more. Sure, day 1 everyone panics. Why not talk about Day 2-90? Bad rotations make bad residents, or rather, a string of bad rotations during M3-M4 means you're going to be a ways behind your peers come R1 time. That shouldn't even be up for debate. And a bad rotation is definitely one where you can clock out for 80% of the time you're there without any didactics whatsoever to make up for it.

Spot on. I would add that being the weak link early on can get you put under the proverbial microscope and makes things much tougher. When a solid resident misses something, it gets chalked up to them just being a trainee and the difficulty of the situation. When the weak resident misses the same thing it’s “great, there they go again! So typical!” Sadly, it would be challenging for a strong resident to thrive under the microscope, but it can be crushing to a weak one.

In my training I saw a handful of residents get fired and I think this may have been in a factor in every case I can think of. I remember a couple of people fired as pgy2-3 who came from Top 5 medical schools and CVs that would blow your mind, but were just lost clinically and never recovered. Both had taken a couple extra research years between m3-4 so that may have also been a factor. But these were literal top of their class students from top schools and they got canned in large part because they showed up woefully unprepared.

 

[Mad Jack]

Couldn't disagree more. Sure, day 1 everyone panics. Why not talk about Day 2-90? Bad rotations make bad residents, or rather, a string of bad rotations during M3-M4 means you're going to be a ways behind your peers come R1 time. That shouldn't even be up for debate. And a bad rotation is definitely one where you can clock out for 80% of the time you're there without any didactics whatsoever to make up for it.

I was defending DO schools in general, as most rotations at most schools provide enough volume to be adequate. There are some inadequate rotations at some schools, of course, and those will definitely put you behind the 8 ball, such as ones that do almost entirely outpatient IM. My emphasis was that you don't need to be working 80 hours plus in MS3/4 to succeed as an intern, as there is a curve to how much value you get out of each patient and procedure beyond a certain amount, particularly in rotations that are not your field of choice. In general surgery I probably removed 40 gallbladders, for instance. Would I have been better served as a psychiatrist by removing 40, 60, or 100 more? Probably not.

 

[Wordead]

I was defending DO schools in general, as most rotations at most schools provide enough volume to be adequate. There are some inadequate rotations at some schools, of course, and those will definitely put you behind the 8 ball, such as ones that do almost entirely outpatient IM. My emphasis was that you don't need to be working 80 hours plus in MS3/4 to succeed as an intern, as there is a curve to how much value you get out of each patient and procedure beyond a certain amount, particularly in rotations that are not your field of choice. In general surgery I probably removed 40 gallbladders, for instance. Would I have been better served as a psychiatrist by removing 40, 60, or 100 more? Probably not.

I don't think anyone is saying that a psych resident being in the OR more is going to be enormously productive. But that psych resident rounding and understanding surgical management and pathology will be more prepared for their medicine year (even if it kind of goes by the wayside later).

Id also venture to say psych is a different beast altogether. But a medicine resident that does not have a good grasp of management of surgical patients, of surgical problems is more likely to call inappropriate consults, not know how to start workup/treatment of them, etc, which does make you a crappier doctor. Honestly the gap in competency of physician and midlevel referrals seems to be shrinking with every year Im in medicine and I don't think we need to contribute to that with okaying crap rotations.

 

[Mad Jack]

I don't think anyone is saying that a psych resident being in the OR more is going to be enormously productive. But that psych resident rounding and understanding surgical management and pathology will be more prepared for their medicine year (even if it kind of goes by the wayside later).

Id also venture to say psych is a different beast altogether. But a medicine resident that does not have a good grasp of management of surgical patients, of surgical problems is more likely to call inappropriate consults, not know how to start workup/treatment of them, etc, which does make you a crappier doctor. Honestly the gap in competency of physician and midlevel referrals seems to be shrinking with every year Im in medicine and I don't think we need to contribute to that with okaying crap rotations.

Did I ever say crap rotations were okay? I just said there's a curve. Most rotations at most places are going to get you the experience you need to not order stupid things if you're paying attention and to know how to manage the basics with regard to things like surgical patients. Bad consults (and believe me, I receive many of them) are usually a result of either not caring enough to deal with something oneself (because it's either a hassle or the primary team doesn't care enough to learn it) or covering one's own ass. It's more a cultural problem than a medical education issue.

 

[odyssey2]

Spot on. I would add that being the weak link early on can get you put under the proverbial microscope and makes things much tougher. When a solid resident misses something, it gets chalked up to them just being a trainee and the difficulty of the situation. When the weak resident misses the same thing it’s “great, there they go again! So typical!” Sadly, it would be challenging for a strong resident to thrive under the microscope, but it can be crushing to a weak one.

In my training I saw a handful of residents get fired and I think this may have been in a factor in every case I can think of. I remember a couple of people fired as pgy2-3 who came from Top 5 medical schools and CVs that would blow your mind, but were just lost clinically and never recovered. Both had taken a couple extra research years between m3-4 so that may have also been a factor. But these were literal top of their class students from top schools and they got canned in large part because they showed up woefully unprepared.

Were there overlapping professionalism issues in some of these cases or were these all straight-up competence problems?

 

[mehc012]

Did I ever say crap rotations were okay? I just said there's a curve. Most rotations at most places are going to get you the experience you need to not order stupid things if you're paying attention and to know how to manage the basics with regard to things like surgical patients. Bad consults (and believe me, I receive many of them) are usually a result of either not caring enough to deal with something oneself (because it's either a hassle or the primary team doesn't care enough to learn it) or covering one's own ass. It's more a cultural problem than a medical education issue.

Also, the intern isn't deciding who to consult. The intern makes the call whether they agree with the consult or not, based on whether their attending or senior wants it.

 

[ohmanwaddup]

I was defending DO schools in general, as most rotations at most schools provide enough volume to be adequate. There are some inadequate rotations at some schools, of course, and those will definitely put you behind the 8 ball, such as ones that do almost entirely outpatient IM. My emphasis was that you don't need to be working 80 hours plus in MS3/4 to succeed as an intern, as there is a curve to how much value you get out of each patient and procedure beyond a certain amount, particularly in rotations that are not your field of choice. In general surgery I probably removed 40 gallbladders, for instance. Would I have been better served as a psychiatrist by removing 40, 60, or 100 more? Probably not.

You removed ****? all I do is suture and staple

 

[ohmanwaddup]

Did I ever say crap rotations were okay? I just said there's a curve. Most rotations at most places are going to get you the experience you need to not order stupid things if you're paying attention and to know how to manage the basics with regard to things like surgical patients. Bad consults (and believe me, I receive many of them) are usually a result of either not caring enough to deal with something oneself (because it's either a hassle or the primary team doesn't care enough to learn it) or covering one's own ass. It's more a cultural problem than a medical education issue.

This is what I worry about. I'm basically getting zero patient interaction. I don't feel like I'm learning much of anything.

I'm doing the dorian surgery deck, reading de virgillio and I've got 4 weeks of ortho rotations back at my main core site right after this one ends next week. I Just hope that will be enough.

 

[Mad Jack]

You removed ****? all I do is suture and staple

The surgeon would do the cutting and main work, and I'd sometimes get to figure out how to bag and remove the gallbladder. Lots of fun, it's like a video game where a the controls are in reverse (we did them all via e-lap). We didn't have surgical residents at my site, so medical students got to first assist on everything aside from ortho cases if we wanted.

 

[Mad Jack]

This is what I worry about. I'm basically getting zero patient interaction. I don't feel like I'm learning much of anything.

I'm doing the dorian surgery deck, reading de virgillio and I've got 4 weeks of ortho rotations back at my main core site right after this one ends next week. I Just hope that will be enough.

You don't round on patients in the morning and afternoon?