My surgery volume seems kinda low

[ciestar]

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.

Bane of my existence.

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[ciestar]

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

And that is more than i got to do lol
I only tried to close a couple of times, failed, and the residents didnt let me try again.

 

[ohmanwaddup]

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

Nope, at least not on my own. I get to tag along usually for the ones who are admitted but I never get to go on my own and then report, doesn't really acknowledge me while its going on. There is usually only 2-4 patients to see in that regard anyways. At this point all I know about admitted surgery patients is to ask if they are pooping and passing gas and then to check their labs.

IDK, He is training a new NP and seems to give her priority over me in most regards. He's forgotten me multiple times, even saying it to my face that he forgot I even exist. He's told me he doesn't let students see patients. I'm not some wallfower, I try my best to stay aware and follow him and forget about me, I ask questions when I'm confused. I found out today that I'm really the first time he has had a student. I'm only with him because my original preceptor became COVID positive.

If anything the biggest thing I have learned from this rotation is that I have to start standing up for myself. I've been cowed by this fear as coming off as unprofessional but It has really be to my detriment in regards to this rotation.

 

[Mad Jack]

Nope, at least not on my own. I get to tag along usually for the ones who are admitted but I never get to go on my own and then report, doesn't really acknowledge me while its going on. There is usually only 2-4 patients to see in that regard anyways. At this point all I know about admitted surgery patients is to ask if they are pooping and passing gas and then to check their labs.

IDK, He is training a new NP and seems to give her priority over me in most regards. He's forgotten me multiple times, even saying it to my face that he forgot I even exist. He's told me he doesn't let students see patients. I'm not some wallfower, I try my best to stay aware and follow him and forget about me, I ask questions when I'm confused. I found out today that I'm really the first time he has had a student. I'm only with him because my original preceptor became COVID positive.

If anything the biggest thing I have learned from this rotation is that I have to start standing up for myself. I've been cowed by this fear as coming off as unprofessional but It has really be to my detriment in regards to this rotation.

Yeah, sounds like this is more of a "this attending shouldn't be teaching" issue than anything. COVID has created a lot of problems with students being diverted to incapable attendings

 

[ohmanwaddup]

Yeah, sounds like this is more of a "this attending shouldn't be teaching" issue than anything. COVID has created a lot of problems with students being diverted to incapable attendings

I'm just grateful I don't want to go into surgery. If I did this would be 100X worse

 

[operaman]

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

Excellent question. There were definitely professionalism issue in a couple of them. One was straight up incompetence though. It can be hard to distinguish because the unprofessional behavior is often a defense mechanism for incompetence. Someone can’t work efficiently because they don’t have the basic skills so they cut corners and falsify things or get way behind and put off things they shouldn’t. They’re the ones who tend to be short with staff and rude to others because they basically live every day terrified of being found out. It’s like the imposter syndrome stuff we all feel at some point or another, but the weak residents actually have good reason to feel that way.

 

[odyssey2]

Excellent question. There were definitely professionalism issue in a couple of them. One was straight up incompetence though. It can be hard to distinguish because the unprofessional behavior is often a defense mechanism for incompetence. Someone can’t work efficiently because they don’t have the basic skills so they cut corners and falsify things or get way behind and put off things they shouldn’t. They’re the ones who tend to be short with staff and rude to others because they basically live every day terrified of being found out. It’s like the imposter syndrome stuff we all feel at some point or another, but the weak residents actually have good reason to feel that way.

If someone recognizes that they’re falling behind but doesn’t make a secret of it and makes a genuine effort to reach out for help, how far does that go in preventing situations like these?

 

[operaman]

If someone recognizes that they’re falling behind but doesn’t make a secret of it and makes a genuine effort to reach out for help, how far does that go in preventing situations like these?

Not sure because I haven’t seen that. Usually the kind of self unawareness that leads to this level of incompetence doesn’t lend itself to seeking help. As expected, these folks were certainly offered help and remediation and given extensive warnings. I don’t know why they didn’t make an effort to get it together. Maybe they did but it was too late, or maybe they had too much ego to admit their issues.

Some may be program specific too. For example, I was looking at a legal filing the other day where a fired Ortho resident sued her Program and lost. She had started at Penn, got canned there. Hopkins picked her up and also canned her; from the filings it sounded like severe competence issues though obviously I wasn’t there. She transferred to a third Ortho program where she actually graduated, landed a good fellowship, and I think is now in practice or finishing fellowship. I have no idea how she managed to land so many competitive positions with those red flags but she’s lucky that she was essentially given 10 years to complete a 5 year program.

 

[fldoctorgirl]

Nope, at least not on my own. I get to tag along usually for the ones who are admitted but I never get to go on my own and then report, doesn't really acknowledge me while its going on. There is usually only 2-4 patients to see in that regard anyways. At this point all I know about admitted surgery patients is to ask if they are pooping and passing gas and then to check their labs.

IDK, He is training a new NP and seems to give her priority over me in most regards. He's forgotten me multiple times, even saying it to my face that he forgot I even exist. He's told me he doesn't let students see patients. I'm not some wallfower, I try my best to stay aware and follow him and forget about me, I ask questions when I'm confused. I found out today that I'm really the first time he has had a student. I'm only with him because my original preceptor became COVID positive.

If anything the biggest thing I have learned from this rotation is that I have to start standing up for myself. I've been cowed by this fear as coming off as unprofessional but It has really be to my detriment in regards to this rotation.

My first month of surgery was similar. It was at a site with residents and I barely interacted with the attending, he would show up for the surgery and pretty much ignore us 99% of the time and then leave when it was time to close until the next case. He had a first assist and an NP who would usually have priority for driving the camera or closing even above the resident lol. I just tried to follow the resident most of the time because I felt it would be more beneficial to see what a resident does than necessarily get to do much in the OR, especially since I'm not at all interested in surgery. I think the biggest problem with the rotation was the lack of structure, it seemed like no one knew what to do with us and we were constantly asking when/where we should be. We attended didactics but rounding was optional since the residents said they weren't told what they were supposed to do with us. It ended up being okay overall because there were a few residents who really liked teaching and took their time to work with us if we asked (one took us to their lab to teach us to suture etc). Eventually, these residents advocated for us in the OR and we were able to drive the camera a few times and be more involved in the OR. On clinic days we would take the HPI and then present to the attendings, but most patients are referred to GS after already having been diagnosed so there really wasn't much to do besides see if they would be a good fit for surgery.

I think SDN likes to focus too much on the importance of rounding/presenting/etc. I 100% think it's very important, and it's why I pushed to attend rounds and be more involved on this rotation since I had the opportunity to work with residents. But as long as you manage to get exposure to that at some point in 3rd year, I think you'll be fine. Like you said, you're using Dorian, so you're learning all about management and things like that. It's not like you're just sitting back chilling and doing nothing on rotation and then going home and doing the bare minimum. Just be more proactive about your learning-- even if I'm not directly asked "pimp" questions on my rotations, I try to think to myself what I think is going on, what I would do next, etc. I think surgery overall is just a crappy rotation for most med students because there's not much for us to do. Regardless, our school gives so much 4th year flexibility that you'll definitely be able to get solid rotations then if you find your 3rd year rotations never gave you the opportunity to round/present. I think you'll be fine, it's just imposter syndrome (I know I majorly have it lol)

 

[ciestar]

My first month of surgery was similar. It was at a site with residents and I barely interacted with the attending, he would show up for the surgery and pretty much ignore us 99% of the time and then leave when it was time to close until the next case. He had a first assist and an NP who would usually have priority for driving the camera or closing even above the resident lol. I just tried to follow the resident most of the time because I felt it would be more beneficial to see what a resident does than necessarily get to do much in the OR, especially since I'm not at all interested in surgery. I think the biggest problem with the rotation was the lack of structure, it seemed like no one knew what to do with us and we were constantly asking when/where we should be. We attended didactics but rounding was optional since the residents said they weren't told what they were supposed to do with us. It ended up being okay overall because there were a few residents who really liked teaching and took their time to work with us if we asked (one took us to their lab to teach us to suture etc). Eventually, these residents advocated for us in the OR and we were able to drive the camera a few times and be more involved in the OR. On clinic days we would take the HPI and then present to the attendings, but most patients are referred to GS after already having been diagnosed so there really wasn't much to do besides see if they would be a good fit for surgery.

I think SDN likes to focus too much on the importance of rounding/presenting/etc. I 100% think it's very important, and it's why I pushed to attend rounds and be more involved on this rotation since I had the opportunity to work with residents. But as long as you manage to get exposure to that at some point in 3rd year, I think you'll be fine. Like you said, you're using Dorian, so you're learning all about management and things like that. It's not like you're just sitting back chilling and doing nothing on rotation and then going home and doing the bare minimum. Just be more proactive about your learning-- even if I'm not directly asked "pimp" questions on my rotations, I try to think to myself what I think is going on, what I would do next, etc. I think surgery overall is just a crappy rotation for most med students because there's not much for us to do. Regardless, our school gives so much 4th year flexibility that you'll definitely be able to get solid rotations then if you find your 3rd year rotations never gave you the opportunity to round/present. I think you'll be fine, it's just imposter syndrome (I know I majorly have it lol)

I have to do surgery as an intern and ive yet to meet a few attendings who sign my notes daily because they don’t want to round with interns...

Sometimes, it doesnt get better as a resident. The students spend the whole day in the OR. I sit and wait for consults and write notes because the seniors dont want to.

 

[ohmanwaddup]

My first month of surgery was similar. It was at a site with residents and I barely interacted with the attending, he would show up for the surgery and pretty much ignore us 99% of the time and then leave when it was time to close until the next case. He had a first assist and an NP who would usually have priority for driving the camera or closing even above the resident lol. I just tried to follow the resident most of the time because I felt it would be more beneficial to see what a resident does than necessarily get to do much in the OR, especially since I'm not at all interested in surgery. I think the biggest problem with the rotation was the lack of structure, it seemed like no one knew what to do with us and we were constantly asking when/where we should be. We attended didactics but rounding was optional since the residents said they weren't told what they were supposed to do with us. It ended up being okay overall because there were a few residents who really liked teaching and took their time to work with us if we asked (one took us to their lab to teach us to suture etc). Eventually, these residents advocated for us in the OR and we were able to drive the camera a few times and be more involved in the OR. On clinic days we would take the HPI and then present to the attendings, but most patients are referred to GS after already having been diagnosed so there really wasn't much to do besides see if they would be a good fit for surgery.

I think SDN likes to focus too much on the importance of rounding/presenting/etc. I 100% think it's very important, and it's why I pushed to attend rounds and be more involved on this rotation since I had the opportunity to work with residents. But as long as you manage to get exposure to that at some point in 3rd year, I think you'll be fine. Like you said, you're using Dorian, so you're learning all about management and things like that. It's not like you're just sitting back chilling and doing nothing on rotation and then going home and doing the bare minimum. Just be more proactive about your learning-- even if I'm not directly asked "pimp" questions on my rotations, I try to think to myself what I think is going on, what I would do next, etc. I think surgery overall is just a crappy rotation for most med students because there's not much for us to do. Regardless, our school gives so much 4th year flexibility that you'll definitely be able to get solid rotations then if you find your 3rd year rotations never gave you the opportunity to round/present. I think you'll be fine, it's just imposter syndrome (I know I majorly have it lol)

Thanks for the words you are 100% right. I start my next 4 weeks of surgery back at my main hospital and I am definitely going to try and advocate for myself more to hopefully get some better experience with presenting and rounding.

Hopefully being back at my core site will let me have some more ammunition in my corner too. As a visitor at another hospital I feel a little helpless.

 

[FrkyBgStok]

I think it is funny reading the comments on the goods and bads about rotations, the waste of tuition, the disservice, etc.

I am a PGY-5 now and I can say, with confidence, that I have never come across a medical student after my intern year where I would say, "wow they know a lot about medicine." You don't. The person who stated that you go to medical school for the credentials is pretty much correct. Because you don't really learn any real practical medicine until you are a resident. And the third years that think they are "making a difference," you probably aren't. I give you just enough responsibility to make you feel important, but I don't rely on you in any way. you aren't learning surgeries in your third year. 10 cases per day and 2 cases per day isn't likely to matter at all.

so enjoy your rotation, and those of you on crappy rotations, try to get the best out of it and prepare yourself in other ways. When people start intern year, knowing the EMR and not knowing any medicine at all will make you appear significantly stronger than the person who graduated number one in their class and has never used the EMR. So it balances out after a couple months.

You guys are arguing the minuscule benefits on something that doesn't really matter.

 

[ohmanwaddup]

I think it is funny reading the comments on the goods and bads about rotations, the waste of tuition, the disservice, etc.

I am a PGY-5 now and I can say, with confidence, that I have never come across a medical student after my intern year where I would say, "wow they know a lot about medicine." You don't. The person who stated that you go to medical school for the credentials is pretty much correct. Because you don't really learn any real practical medicine until you are a resident. And the third years that think they are "making a difference," you probably aren't. I give you just enough responsibility to make you feel important, but I don't rely on you in any way. you aren't learning surgeries in your third year. 10 cases per day and 2 cases per day isn't likely to matter at all.

so enjoy your rotation, and those of you on crappy rotations, try to get the best out of it and prepare yourself in other ways. When people start intern year, knowing the EMR and not knowing any medicine at all will make you appear significantly stronger than the person who graduated number one in their class and has never used the EMR. So it balances out after a couple months.

You guys are arguing the minuscule benefits on something that doesn't really matter.

I’m not arguing cause I’ve heard the same from other residents, but I’ve always been a bit confused by the idea that you learn most of medicine in residency. Aren’t you expected to treat and prescribe from day one of intern year?

maybe I’ve got the wrong notion of how the start of residency goes

 

[FrkyBgStok]

I’m not arguing cause I’ve heard the same from other residents, but I’ve always been a bit confused by the idea that you learn most of medicine in residency. Aren’t you expected to treat and prescribe from day one of intern year?

maybe I’ve got the wrong notion of how the start of residency goes

yeah you are. but you are naive to think that you will feel comfortable with that.

 

[ciestar]

I’m not arguing cause I’ve heard the same from other residents, but I’ve always been a bit confused by the idea that you learn most of medicine in residency. Aren’t you expected to treat and prescribe from day one of intern year?

maybe I’ve got the wrong notion of how the start of residency goes

What you learn in the classroom is not the same thing as actual medical management.

And yes, you’re supposed to be treating and doing all the doctor things on day 1.

 

[ohmanwaddup]

yeah you are. but you are naive to think that you will feel comfortable with that.

Oh I don't think I'll ever be truly comfortable lol

 

[DO2015CA]

I’m not arguing cause I’ve heard the same from other residents, but I’ve always been a bit confused by the idea that you learn most of medicine in residency. Aren’t you expected to treat and prescribe from day one of intern year?

maybe I’ve got the wrong notion of how the start of residency goes

yes but your senior will be following behind you and checking your order

 

[Giovanotto]

I think it is funny reading the comments on the goods and bads about rotations, the waste of tuition, the disservice, etc.

I am a PGY-5 now and I can say, with confidence, that I have never come across a medical student after my intern year where I would say, "wow they know a lot about medicine." You don't. The person who stated that you go to medical school for the credentials is pretty much correct. Because you don't really learn any real practical medicine until you are a resident. And the third years that think they are "making a difference," you probably aren't. I give you just enough responsibility to make you feel important, but I don't rely on you in any way. you aren't learning surgeries in your third year. 10 cases per day and 2 cases per day isn't likely to matter at all.

so enjoy your rotation, and those of you on crappy rotations, try to get the best out of it and prepare yourself in other ways. When people start intern year, knowing the EMR and not knowing any medicine at all will make you appear significantly stronger than the person who graduated number one in their class and has never used the EMR. So it balances out after a couple months.

You guys are arguing the minuscule benefits on something that doesn't really matter.

Ha, we clearly train at different places. As an intern now, I am honestly amazed by most M3/M4 that rotates here. They are mostly coming from top1-20 MD schools. Doesn't even make sense how they can be that prepared and knowledgeable. I've had early M4s that dare I say, were better than me and were a huge help to team, got no shame admitting that.

 

[DO2015CA]

Ha, we clearly train at different places. As an intern now, I am honestly amazed by every M3/M4 that rotates here. They are mostly coming from top5-20 MD schools. Doesn't even make sense how they can be that prepared and knowledgeable.

must be where you’re at lol. I am in the other posters group. Regardless of MD or DO students rotating through, none can really manage much. They know a lot of details and medicine but none really understand the flow of management yet. That will come with residency

 

[Giovanotto]

must be where you’re at lol. I am in the other posters group. Regardless of MD or DO students rotating through, none can really manage much. They know a lot of details and medicine but none really understand the flow of management yet. That will come with residency

Yeah, the bolded is what doesn't make sense to me. It's not even their medicine knowledge, it's their ability to blend in and have a flow of management equal to that of an intern as early as M3.

 

[Cranjis McBasketball]

Yeah, the bolded is what doesn't make sense to me. It's not even their medicine knowledge, it's their ability to blend in and have a flow of management equal to that of an intern as early as M3.

Did a lot of them have experience before medical school working as scribes or EMTs or nurses? I've seen, with my class, the strongest clinically are the ones with a lot of experience in clinical/hospital positions

 

[FrkyBgStok]

Ha, we clearly train at different places. As an intern now, I am honestly amazed by most M3/M4 that rotates here. They are mostly coming from top1-20 MD schools. Doesn't even make sense how they can be that prepared and knowledgeable. I've had early M4s that dare I say, were better than me and were a huge help to team, got no shame admitting that.

I also said outside of intern year. You are barely above them. My intern year I saw some good med students. But when you’ve put a year or two into it, you really start to see the gap.