'Please Change the Culture of Surgery'

[W19]

Doximity | Please Change the Culture of Surgery



It is December 2017. I have been on the road for the last five months, completing my five months of elective rotations. I am a fourth-year medical student aspiring to specialize in family medicine. I also want to learn procedures, so I did two months of surgery, three months of family practice electives. At the beginning of this process, I had wanted to be a general surgeon, but I ended up choosing family medicine.

Back in third year, I had very auspicious rotations in rural Appalachia where I was one on one with a few general surgeons. I loved it; the hours were not too bad and the weekend calls were thrilling. Three attending surgeons whom I loved suggested to me that I go on to a surgical residency; I went and set up two auditions to see what surgical life was truly like.

On my first surgical rotation in Pennsylvania, I was devastated, yelled at, berated. Repeatedly surgical residents told me I was not good enough, chastised me for tying a knot too tight or too loose, or one centimeter to the left. I worked over 80 hours a week, sometimes in the 100s. But still, this was not good enough for them. After hearing the vascular attending go insane because insurance denied his patient from getting a recovery enhancing blood treatment, I began to experience dissociation. Mornings became nights and nights became mornings. To the residents, I was simply a body to be used: “Hold this retractor here.” I did not move for four hours. Later, “take this paper to the nursing station.” A paper scut monkey, as they called us. After one month of being told I would be “speared and bled out” if I messed up, I finished my audition rotation, packed my bags, and vowed never to return to this town ever again.

On my second surgical audition in New Jersey, I thought I would see a better side of medicine. After all, Jersey is warmer, so maybe people would be nicer? Nope. Even worse. After a brutal week of 28-hour shifts, nights, and weekend calls, the residents took me in a room, closed the door behind me, and yelled at me for an hour straight. They told me every single mistake I made. I cried later, in the solace of the second-floor bathroom in the surgical suite. I was becoming someone I was not: I yelled at some random person’s dog on my way home and felt miserable for doing so. Where was the happy med student who had felt so successful in third year? My last day on service, I told the “friendliest” chief resident that I could not take it anymore. She apologized to me for the behavior of her residents and agreed I should not pursue surgery. So I quit.

Patients and surgeons lost a great doctor that day. As a third year I was assisting on bariatric and general surgeries, and as a fourth year, I assisted on cancer operations. My nurses loved me; my rural general surgeons loved me. I just could not see myself in a surgical residency anymore.

Fast forward to three months of family medicine auditions, and I have been so much happier. I am treated like a human. My patients love me and smile at me. My nurses talk to me with respect. My attendings let me be who I want to be. I wake up at a decent hour, and I am back at a decent hour. I have some weekends for myself. I have most nights for myself. I found some residencies that care about mental health: They have work-life balance in family medicine. Yes the salary prospects are not great, and I have nearly 250k in educational loans, but the fact remains that I probably saved myself from true death by switching out of the tunnel of gloom that is surgery. So I send the message to the surgeons out there: Please change the culture of surgery.

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[0ncogene]

I think it is changing, but very slowly, as new attendings replace the older generation. The general surgery program at my hospital has some of the happiest residents I've ever seen.

 

[deleted480308]

Scut work is no big deal, I never thought students should have more hours than residents but 80 is doable

But an actual threat to cut me and bleed out? (If it actually happened) That would not be looked over

 

[HomeSkool]

As a med student and intern, I did half a dozen surgical rotations at four different hospitals in three different states, and not a single one of them was even in the same hemisphere of malignancy that this student describes. I agree the culture should change, but I also think there's some serious snowflaking going on here.

 

[Skiiiiiing]

What she reports does have a lot of emotional content, but then again that's what she reports.

If true, they could probably clean up some of the personal attacks, but their culture of being hard on mistakes is broadly comparable to that of early NASA or the Navy Seals.

Her reports of her experience in Jersey don't even allege that they did anything wrong:

On my second surgical audition in New Jersey, I thought I would see a better side of medicine. After all, Jersey is warmer, so maybe people would be nicer? Nope. Even worse. After a brutal week of 28-hour shifts, nights, and weekend calls, the residents took me in a room, closed the door behind me, and yelled at me for an hour straight. They told me every single mistake I made. I cried later, in the solace of the second-floor bathroom in the surgical suite. I was becoming someone I was not: I yelled at some random person’s dog on my way home and felt miserable for doing so. Where was the happy med student who had felt so successful in third year? My last day on service, I told the “friendliest” chief resident that I could not take it anymore. She apologized to me for the behavior of her residents and agreed I should not pursue surgery. So I quit.

Telling someone they did something poorly and need to clean it up is in no way inappropriate. Frankly its the fastest way to improve - good academics often love it when you offer constructive criticisms.

 

[Brahnold Bloodaxe]

As a med student and intern, I did half a dozen surgical rotations at four different hospitals in three different states, and not a single one of them was even in the same hemisphere of malignancy that this student describes. I agree the culture should change, but I also think there's some serious snowflaking going on here.

No way man, she's a great doctor and a credit to her profession. She said so herself:

Patients and surgeons lost a great doctor that day

For real though, if you can't take the heat, get out of the kitchen. And I'm not usually one to tell women to leave the kitchen, either.

 

[Stagg737]

Telling someone they did something poorly and need to clean it up is in no way inappropriate. Frankly its the fastest way to improve - good academics often love it when you offer constructive criticisms.

Right, but taking someone into a back room and screaming/berating them for an hour straight isn't constructive criticism or even appropriate. It's a great way to make someone feel like absolute crap without doing anything to help them though. Even if the student did something incredibly stupid that warranted some punishment or even berating, what was described is not the way to handle it.

 

[Crayola227]

I find none of this outside the norm.

I do think it is harmful.

I know for a fact that one surgeon reported on SDN that their program director essentially told them to have an abortion when they got pregnant; this came up as other female surgeons discussed feeling a similar pressure in the field. I should dig that up. I went into a specialty that is not nearly as competitive or high pressure and I was asked flat out if I planned on getting pregnant during residency. So do not even try to tell me this sort of thing doesn't happen. Too late. It already actually happened to me.

The culture is such that I have been told by medical students with DM1 that they couldn't scrub out to check take care of it, other students who said they felt they couldn't scrub out or report getting sprayed by blood in the eye or poked with a needle.

Why do they feel this way during a surgical rotation and not others? They're just crazy? Culture has nothing to do with it?

I saw a surgical resident accidentally stab themselves with the needle of a filled syringe. They then went to change the needle and then use the same syringe to inject the patient. I said something. I think fatigue and the time pressure contributed to a sense of "oh geez" about taking the time and effort to do this. Getting a whole new syringe and needle was the right thing to do.

ETA: and **** the pyxis. I can't even believe what a PITA it was for surgeons to get some lidocaine and gauze. I've seen people coding in the ICU and everyone is like a chicken trying to get a nurse to get some ketamine. I've seen someone bleeding to death, and the nurses are more worried about scanning the blood products into the EHR.

 

[Crayola227]

The highest grade I ever had on my clerkships was in surgery, which is almost as far from where I went in medicine as you can get. Still, I was also taken aside in a room to be given feedback, just as this student was. And it went very differently for me, but it still exposed me to the malignant culture.

The only negative feedback I received was how I wasn't standing stiff at attention during rounds. Like "as if you are in the military." I was told that while this chief wasn't holding it against me, "others might," and that they just wanted me to be aware of the sort of things that I would be "judged for later in the year." They were actually trying to help poise me for success. No pun intended.

Seriously, someone had a problem with how I was standing.

I was an impressionable young med student. Of course I took all this to heart. Of course I didn't feel that was the time to admit that I was hiding an injury that I sustained on service, which was why I wasn't standing still straight at attention, but trying to just soldier on best as I could. I was being judged for the way I was standing and being inducted into a militant culture, no way did I think empathy was coming my way if I opened my mouth. I feared how I would be perceived, and going from the chief's words, rightly so.

I went to my school's dean about what to do with this dilemma, and all I was offered was the poisoned fruit of time off; time off that might not see my injury healed, and if I couldn't change some of the conditions of how I did my surgical rotation, might likely recur, and time off that certainly could hurt my residency chances later. And I still had to do surgery to graduate. I pointed all this out. They just sorta shrugged. I say poisoned fruit because it was obvious the way the dean said, "you could take time off and then come back...." that it was code for, keep going no matter what, or hurt your career.

So I took my chances. At the operating table, I bit my cheek until it bled and soldiered on, holding retractors, being oh so useful. (Later it was so bad I was forced to do more to address it, and that was when I learned about disability accommodations from someone at my institution that oversees that. They are not in medicine but see to it the ADA is enforced. That is why I now provide this sort of advice. In any case, there was a way to deal with my injury and continue, and that was what I did later, but it was too late.)

That injury was the start of what has been chronic pain I've endured for years now. In some ways, my life was ruined that rotation. I will likely spend the rest of my life wondering what if I'd just been in a culture where I felt I could have spoken up and gotten support, what if it all wasn't so crazy competitive, what if we didn't have to act so tough all the time, what if we could tolerate "weakness" in one another more. What if, especially in surgery, where this happened to me, which I think is sort of the epitome of the militant nature of medical education, things had been different.

That's one reason why I always sound so bitter about the medical culture.

I know in my heart it needs to change. What happened to this student, and to me, never should have happened. Full stop.

 

[Crayola227]

Seriously, **** the current medical culture.

 

[Crayola227]

Most that don't agree that there's an issue in the culture, just haven't experienced it for whatever reasons, or overcame them, or just don't see it as a problem. They weren't crippled or affected in some way that has convinced them change is needed.

I love medicine and I also love and appreciate its high standards. I don't believe it has to be like this. I do believe the problems are real and need change.

 

[jw3600]

Crayola. I love you and think your posts are invaluable to SDN. That being said, W19 is infamous for their social ineptness and infamous “journal.” I suspect there are jackasses in surgery but there also are people like that in every field (including and especially outside medicine). I don’t think surgery really has such a large problem with this kind of thing that really needs to be a national issue. I know plenty of surgery applicants and residents that are fine. I think it is the hours (an unfortunate aspect of the field) that’s brutal, not this hyperbolic cultural issue.

 

[Moose A Moose]

Can’t stand the heat, git out the kitchen.

 

[Crayola227]

Can’t stand the heat, git out the kitchen.

This is a stupid response to real issue.

 

[Crayola227]

Crayola. I love you and think your posts are invaluable to SDN. That being said, W19 is infamous for their social ineptness and infamous “journal.” I suspect there are jackasses in surgery but there also are people like that in every field (including and especially outside medicine). I don’t think surgery really has such a large problem with this kind of thing that really needs to be a national issue. I know plenty of surgery applicants and residents that are fine. I think it is the hours (an unfortunate aspect of the field) that’s brutal, not this hyperbolic cultural issue.

Thank you. I don't know much about W19, I just read the article.

I agree with you there's jackasses all over medicine. I think the tough guy attitude is worse in surgery, but not everyone agrees.

I think that those that go into surgery are clearly willing to accept the culture, and I'm not surprised that they take less issue with it and cope well with it overall. I still think it's an issue for those that have to deal with it - nurses, students, other physicians outside the field as well as within it.

I also don't know that this needs to be a national issue beyond the fact that I think if we took certain steps we could reduce the strain on providers, which I think would help the culture. We can agree to disagree about the culture of medicine as a whole.

 

[Crayola227]

Can’t stand the heat, git out the kitchen.

As far as people who act like the solution is not to have anyone with medical issues start medical school, or just "too bad too sad," I'll point out that the average matriculant is in their 20s, even with the admission trends including older folks. The average really high achieving 20 something has no real medical issues, or usually have them under control enough to succeed (ie DM1, epilepsy, etc).

I had zero medical problems besides some well-controlled depression which had never stopped me from being the sort of success that is admitted to medical school. I was young and healthy.

What happened to me was an on-the-job injury that might have been prevented.

So I seriously hope that at no point the heat of the kitchen gives you a medical problem, so you can see how the culture that created it, and then doesn't give a damn about helping you with it.

 

[Crayola227]

There was only over a 100 students in my class, and being the sort that you see on this board, people came to me and I became quite the collector of horrible little anecdotes.

That might be all it is. Anecdotes. Still, some of them were considered actionable by my institution. I think the attention to burnout and suicide prevention and wellness, I think that's pretty generous endorsement that

#thestruggleisreal

 

[Crayola227]

As far as malignancy, my own institution's clerkship directors in surgery and ob/gyn acknowledged having a well-earned reputation for malignancy towards medical students in particular, and in general.

As such, pains were taken to try to elicit reports from bullied students, so that the leadership could try to course correct. Because when that sort of thing goes around as a reputation, it can weaken a program.

People in a surgical field's leadership don't want students to be discouraged from going into a field because the specialists were bastards. That doesn't make your field stronger which is what any leader in an academic position should be doing; advancing their own field.

The best applicants don't have to want to go to a malignant program even if the training is good. There's places that aren't malignant AND the training is good.

TLDR:
I know of institutions and residents that acknowledge malignancy and take steps to address it. It matters to them, and there's good reason.

 

[Crayola227]

The institution talked about what steps they had taken to stop surgeons yelling, throwing tools, and impatiently "laying hands on someone" such as literally elbowing them out of the way when they are slow (versus using their words to take over the procedure, or doing so to reach in and do something emergent for the patient's safety), that sort of thing.

I mean, that's because that stuff was happening. And it still happens. And what I just described? Totally inappropriate for the workplace, I hope we can agree.

This sort of stuff was more common I think because surgery is higher acuity and more tools are used. I don't see neurologists doing any of the above (not often, they could go berserk yelling in the office away from the patients, or go whole ham with their hammers, or elbowing you literally out of the way in their impatience to get a plantar reflex) for a lot of reasons.

 

[Crayola227]

I will say that bitching about scut work does not go well with me. GTFO.

This article has its points but it also smacks of some attitude problems from the author.

OTOH, calling med students scut monkeys when you are their superior, that is totally unacceptable. It's a fine joke for this forum and strictly between equals like students. There might be a lighthearted joke in the right setting - the one where you know your student feels loved by the care you take of them. If I heard residents talk like that in contempt I would shut that shyte down.

 

[kb1900]

Correcting mistakes is pretty important in surgery, and man, millenials' feelings are really important too. Apparently just as important as properly performing a surgery.

I appreciate that there are often more tactful ways of doing so than others, but bottom line is that correcting mistakes take precedence over sparing feelings in a surgical environment.

Have they added some spiciness to correcting mistakes? Sure, a lot of work cultures that are exacting about details do in order to help you remember those details in the future.

Trying to change a company's culture is rarely a good idea unless you are the boss. If you do try, you invite jihad and you've violated hierarchy. Trying to change an industry's?

the stuff described in op is not even remotely the case at plenty of places. How do you think that change happened?

I'm totally with you that plenty of people are sensitive to less-than-tactful criticism. Maybe they just didn't experience people yelling at them out of frustration or a strict culture or high pressure environment growing up. In fact, sometimes I feel that my preceptors at my school just blow smoke up my *** just to avoid having a remotely confrontational talk that mayhurt my feelings.

Having said that, it is insanely hypocritical to hold a a professional to a high standard and berate mistakes - and at the same time not realize that hour long tirades on a few issues are not effective uses of time or energy and do far more harm than good. A focused talk on the seriousness of someone's mistakes in the field can be sobering, level headed, and still be consoderd "getting chewed out". But at least it won't promote a socially inept form of delivering criticism to a colleague. This issue described in op is hardly about correcting mistakes and far more about correcting a selfperpetuating attitude. Despite what surgeons at some places make think, it's not a zero sum game

I'm at a place with apparently the happiest GS residents around - many of whom say they would not survive residency elsewhere. Yet not that long ago (less than 15 years) it was an environment of "get an abortion or go into anesthesia" - anecdotal but I completely believe it. How did this change happen?

 

[The Physician Philosopher]

Correcting mistakes is pretty important in surgery, and man, millenials' feelings are really important too. Apparently just as important as properly performing a surgery.

I talk a lot about this exact "millenial" sentiment in my post about why no one cares about wellness. I am not saying that the millenial generation doesn't show any entitlement or that they don't have any difficulty dealing with constructive criticism, but this kind of criticism just isn't helpful.

The fact is that constructive criticism can be given in a way that accomplishes both correcting someone's actions while not belittling them. Medicine has a notorious history for berating it's young trainees. I trained at the same institution where I now work, but distinctly remember even the scrub techs feeling it was okay to lay into me because I was a "med student" on a surgical rotation. The culture can be so acceptable of derogatory remarks that everyone takes a chance to kick the dog while it's down. [In fact, one surgical attending even told me "**** roles down hill" (i.e. you have to take the lumps, but cannot give any). This same surgeon wrote me a letter of Rec for residency after we ended up liking each other following a rough start]. As an attending anestheisologist at the same institution, I now work with some of these same scrub techs and surgeons who give me complete and total respect. Only difference? I am a little older and further along in the process. Same person. Same hard-working team player. Just don't have a short white coat and I've "earned my stripes."

To think that this only happens to the snowflakes just shows a total lack of empathy and understanding. I am sure there are people who need to have thicker skin, but this doesn't mean the culture doesn't need to change.

While it is important for medical students (and residents and attendings) to build resilience so that they can learn to overcome confrontational circumstances and tough life-issues, it is also important to treat humans as humans. Pretty sure the Golden Rule doesn't stop applying because we went into the medical field.

 

[Crayola227]

One of the leadership on my surgical rotation, that I was talking about, that was changing the culture, at one point we were across the room frakking something up, and it was an emergent thing that put the patient at risk of injury. We were simply following instructions in a common sense manner, but like many things, we hadn't been taught and didn't know how to do it correctly.

They yelled "Stop!" and ran across the room and took over the situation. Once the patient was safe and there was time, they were like, "I'm sorry, I hope you understand that I only raised my voice as a knee jerk response to protect the patient." They corrected our mistake calmly and without making us feel like idiots.

Far from having our feelings hurt, we were totally impressed with how thoughtful and professional this attending was, and a good teacher.

The clerkship director, when things got terse during a procedure, had to take over, etc. was similarly calm, or if not for whatever reason, tactful about it after.

Other surgeons took similar pains to remain calm, or if they lost some composure, regain it, and smooth things over with the team.

Many programs, including the one I was rotating at, felt that one could perform surgeries, correct mistakes, and also have some tact. I don't see why being a surgeon should mean you have any less tact than any other doctor, or act less professionally.

That's the sort of culture you want, and a simple way to go about it. Similarly, later it was reported that I was being verbally abused by some of the residents (I did not make this report). The leadership met with the residents and an apology was made to me. Perhaps that won't change a damn thing, and I won't assert that they were actually sorry, but maybe that slap on the wrist was enough to teach them to act more professionally towards students, if only to avoid any trouble about it. I suspect it was actually one of the residents that heard the abuse that spoke up, since after all this they said something to me about how they didn't like their colleagues' behavior towards me.

There is no jihad. The bosses, as I pointed out, decided how they wanted their program to be, and worked towards that end, and for good reasons as I stated. It also reduces nurse turnover when these changes are made, and good experienced surgical nurses are actually a valuable commodity (it requires more training than being a floor nurse, so I'll say they are more "valuable" in the sense they are more difficult to replace).

Yes, some of the change might not be possible without significantly changing the whole system (work hours, volume, turnover, etc).

 

[The Physician Philosopher]

Millenials triggered over pretty much everything also triggered by notion thar their feeling may be less important than the surgical outcomes of their patients

Can you rewrite this so that it makes sense ? I don't even know how to respond because I don't know what you are saying.

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[mehc012]

Can you rewrite this so that it makes sense ? I don't even know how to respond because I don't know what you are saying.

Sent from my XT1710-02 using Tapatalk

It's easy. He's learned that if he just sprinkles the word 'millenials' into any comment and delivers it with enough derision, people will laugh and agree with him even if it makes zero sense because everyone likes to pretend there were 'good old days' and that all problems are the current generation's fault. So you can translate pretty much every comment he's made in this thread to "I have 99 problems and instead of solving them, I'm going to blame them all on millenials."

 

[sliceofbread136]

It's easy. He's learned that if he just sprinkles the word 'millenials' into any comment and delivers it with enough derision, people will laugh and agree with him even if it makes zero sense because everyone likes to pretend there were 'good old days' and that all problems are the current generation's fault. So you can translate pretty much every comment he's made in this thread to "I have 99 problems and instead of solving them, I'm going to blame them all on millenials."

Damn millennials!

 

[kb1900]

Millenials triggered over pretty much everything also triggered by notion thar their feeling may be less important than the surgical outcomes of their patients

your attitude is insufferable.

not sure what interactions you've had with "millennials" but you sounds wholly dull screeching "damn millennials!!" as a knee jerk rxn to anything in this thrwad

 

[DNC127]

IDK. I feel like anytime you train for something at a high level the best way to correct form is to do so quickly through immediate (sometimes overblown) action / feedback. As an example, when training as a college hockey goalie, one time my trainer was pissed because I wasn't holding my glove at the correct angle. So he made me play the rest of the training session (focusing on glovework and high shots) without a helmet. Guess what? My form immediately corrected and stayed corrected until I stopped playing hockey... Maybe its just me but if a surgeon told me he would stab me for doing something wrong I would definitely not mope around about it and would make sure I fixed my form. As has been said by others, if you cant stand the heat stay out of the kitchen.

 

[Nucleophile1]

IDK. I feel like anytime you train for something at a high level the best way to correct form is to do so quickly through immediate (sometimes overblown) action / feedback. As an example, when training as a college hockey goalie, one time my trainer was pissed because I wasn't holding my glove at the correct angle. So he made me play the rest of the training session (focusing on glovework and high shots) without a helmet. Guess what? My form immediately corrected and stayed corrected until I stopped playing hockey... Maybe its just me but if a surgeon told me he would stab me for doing something wrong I would definitely not mope around about it and would make sure I fixed my form. As has been said by others, if you cant stand the heat stay out of the kitchen.

There are so many different ways to correct someone without threatening to stab them. Threatening to stab someone is way beyond "overblown" feedback. Additionally, there is no way of really knowing if that person is serious about stabbing you so it could become a safety issue is the physician is unhinged or has violent tendencies. On a side note, I would not have agreed to play hockey without a helmet. Brain damage is something you don't want to chance.

 

[Anti-PD1]

That sucks her experience in surgery was so poor. It's very department dependant. The general surgery residents at my hospital are almost universally unhappy, and it shows. However, not the case when I've done aways.

 

[DNC127]

There are so many different ways to correct someone without threatening to stab them. Threatening to stab someone is way beyond "overblown" feedback. Additionally, there is no way of really knowing if that person is serious about stabbing you so it could become a safety issue is the physician is unhinged or has violent tendencies. On a side note, I would not have agreed to play hockey without a helmet. Brain damage is something you don't want to chance.

If we are playing odds, odds are a physician isn't going to stab you IMO. If a physician said "hey DNC imma stab you if you make that mistake again" it would be registered in my brain as "Hey DNC imma be pissed if you make that mistake again". Too much value placed on words these days.

 

[Obnoxious Dad]

On my second surgical audition in New Jersey, I thought I would see a better side of medicine.

I have perused SDN virtually everyday for the past 10 years and I must say this is the funniest thing I have ever seen on SDN. How could anyone believe that things would get better in New Jersey?

If the OP had rotated in the Midwest or the South, then she might have seen a more humane side of surgery. A big part of the problem on the east coast is the constant fear among physicians that they will be sued for malpractice. If you were in their shoes, you might be just as miserable and caustic as they are.

 

[Nucleophile1]

If we are playing odds, odds are a physician isn't going to stab you IMO. If a physician said "hey DNC imma stab you if you make that mistake again" it would be registered in my brain as "Hey DNC imma be pissed if you make that mistake again". Too much value placed on words these days.

It's just completely unnecessary and I don't see how it is conducive to a good learning environment.

 

[The Physician Philosopher]

It's just completely unnecessary and I don't see how it is conducive to a good learning environment.

That's my question. Why is this necessary? I don't berate my residents, but encourage them when they do well and I am firm when they need correction. Firm doesn't mean threaten someone. It means direct and to the point.

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[jhamaican]

snowflake

 

[DrSnips]

Surgery definitely has stronger personalities to deal with than other specialties. Is it the nature of those who choose surgery or the nurture of a surgery residency that causes this? It's hard to say. Regardless, I would say your surgery rotation served its purpose, which is to help you figure out if you want to go into surgery. Turns out you don't.

 

[mehc012]

IDK. I feel like anytime you train for something at a high level the best way to correct form is to do so quickly through immediate (sometimes overblown) action / feedback. As an example, when training as a college hockey goalie, one time my trainer was pissed because I wasn't holding my glove at the correct angle. So he made me play the rest of the training session (focusing on glovework and high shots) without a helmet. Guess what? My form immediately corrected and stayed corrected until I stopped playing hockey... Maybe its just me but if a surgeon told me he would stab me for doing something wrong I would definitely not mope around about it and would make sure I fixed my form. As has been said by others, if you cant stand the heat stay out of the kitchen.

Sure, if someone makes you do something at risk of serious injury or death, that lesson will tend to stick. But the point is that there are plenty of ways to make lessons stick WITHOUT risking/threatening bodily harm. So why not pick one of those?

 

[operaman]

Whenever I read things like this, I wonder what my impression would be if i had been a fly on the wall seeing all these incidents take place. I believe the article reflects accurately that person’s experience, but I wonder how we would all interpret it if we could see the instant replay.

All my surgery experiences have been lovely and nothing remotely approaching any of the bad experiences described here. I’m in a surgical sub now, but had gen surg clerkships, sub I, and intern year. Not once between 2 institutions did I ever experience anything even beginning to approach what people have described. I got my first needlestick as a med student and wasn’t even given a choice - I was sent straight to student health to report it and have blood drawn. The residents and attending even followed up with me in the days and weeks ahead to make sure I was ok.

This is the dilemma I hit every time people argue so passionately that the culture needs to change. While I respect my colleagues and believe their stories are real, deep down I struggle to identify because my personal experience has been so different. How can a widespread culture issue impacting an entire field fail to so much as touch me during my fairly extended time within it.

 

[letsdoit]

As your future colleague, I welcome you to Family Medicine! It's great, you'll continue loving it. It is like having a new puzzle to solve on a daily basis. That is why it is so much fun. My toughest rotations were also in General Surgery, both in medical school and in residency. And yes, I also experienced the General Surgery culture and found it very toxic. Though what you experienced seems to be a lot worse than my experience. Be proud of the fact that you made it through your Surgery rotations! That in itself is an achievement! You just showed your mettle and you will need that in your future, especially to advocate for your patients. I know a couple of people who switched from General Surgery to IM and FM residency and they are both excellent doctors who are compassionate towards their patients and friendly towards their colleagues.

Also, the pay in Family medicine has improved considerably in the last decade and it is continuing to improve.

Good luck to you in the future.

 

[Stagg737]

IDK. I feel like anytime you train for something at a high level the best way to correct form is to do so quickly through immediate (sometimes overblown) action / feedback. As an example, when training as a college hockey goalie, one time my trainer was pissed because I wasn't holding my glove at the correct angle. So he made me play the rest of the training session (focusing on glovework and high shots) without a helmet. Guess what? My form immediately corrected and stayed corrected until I stopped playing hockey... Maybe its just me but if a surgeon told me he would stab me for doing something wrong I would definitely not mope around about it and would make sure I fixed my form. As has been said by others, if you cant stand the heat stay out of the kitchen.

I'm actually fine with that as long as it's not a valid threat. The issue with the OP statement isn't that the team corrected her harshly, or even that they berated her. It's that they didn't give her immediate feedback, waited for a week, then ganged up on her as a group and literally yelled at her for an hour. How does that accomplish anything positive? Even if it weren't someone who was sensitive like myself, I wouldn't walk out of that session thinking "Oh my gosh, they were so right, I need to work harder and correct all my mistakes!". I'd walk out thinking "what a bunch of a-holes" and tell everyone I know how crappy their program is. If they really wanted to train her to be a better student, they'd have done what you said and corrected her early on when she made the mistakes. Instead, they used her as their personal punching bag, likely to vent their own frustrations which is, again, neither constructive or appropriate.

If the situation were "normal", you could tell someone to stay out of the kitchen if they couldn't stand the heat. But if the chefs are grabbing knives and pans and throwing them at you, it's not a problem with you not being able to handle the heat...

 

[mehc012]

Whenever I read things like this, I wonder what my impression would be if i had been a fly on the wall seeing all these incidents take place. I believe the article reflects accurately that person’s experience, but I wonder how we would all interpret it if we could see the instant replay.

All my surgery experiences have been lovely and nothing remotely approaching any of the bad experiences described here. I’m in a surgical sub now, but had gen surg clerkships, sub I, and intern year. Not once between 2 institutions did I ever experience anything even beginning to approach what people have described. I got my first needlestick as a med student and wasn’t even given a choice - I was sent straight to student health to report it and have blood drawn. The residents and attending even followed up with me in the days and weeks ahead to make sure I was ok.

This is the dilemma I hit every time people argue so passionately that the culture needs to change. While I respect my colleagues and believe their stories are real, deep down I struggle to identify because my personal experience has been so different. How can a widespread culture issue impacting an entire field fail to so much as touch me during my fairly extended time within it.

Oddly enough, I did a shadowing program that basically had me being the fly on the wall for sh¡t like this, and was definitely worried about it until I got to my med school, where all of the surgeons have been really friendly and welcoming.

 

[Gorne]

All we can do is be the change we want to see. I have been fortunate enough to work with excellent attending's and residents thus far who pimp with the intent to teach, ask for feedback of themselves, etc. Remember the feeling and strive to be a better than those who came before you.

 

[DNC127]

I'm actually fine with that as long as it's not a valid threat. The issue with the OP statement isn't that the team corrected her harshly, or even that they berated her. It's that they didn't give her immediate feedback, waited for a week, then ganged up on her as a group and literally yelled at her for an hour. How does that accomplish anything positive? Even if it weren't someone who was sensitive like myself, I wouldn't walk out of that session thinking "Oh my gosh, they were so right, I need to work harder and correct all my mistakes!". I'd walk out thinking "what a bunch of a-holes" and tell everyone I know how crappy their program is. If they really wanted to train her to be a better student, they'd have done what you said and corrected her early on when she made the mistakes. Instead, they used her as their personal punching bag, likely to vent their own frustrations which is, again, neither constructive or appropriate.

If the situation were "normal", you could tell someone to stay out of the kitchen if they couldn't stand the heat. But if the chefs are grabbing knives and pans and throwing them at you, it's not a problem with you not being able to handle the heat...

I guess I also don't trust that OP that it was as bad as they said... so I guess I should have started with that. All you have to do is get on twitter for 20 min to see how over exaggerated and sensationalized everything is not days. I seriously doubt that a surgeons had the time or need to yell at someone for and hour straight. 10-20 min? Sure. Not an hour. What did OP have a stop watch ready when they pulled them in the room? OP also said they "dissociated" because of it.. not buying it. To me it just sounds like someone who had a romanticized view of surgery, went on some tough rotations and hated it / couldn't hang with the hours and work load, and is blaming the culture not themselves.

 

[neusu]

I do not pretend to have all of the answers, but thought I would weigh in on the discussion.

Can we please, please, please stop criticizing training programs while we are still trainees? You have neither the experience, nor the perspective to understand why you are being treated the way you are, nor the capacity to determine what you need to know, or what you do not.

The millennial generation has been vocal about their beliefs on how things should be run. Excellent. When you are in charge, feel free to make the consummate changes. Until then, sit down, and shut up. Surgery is hard. It is exceptionally hard. The culture of surgery is how it is for a reason. We take the responsibility for the actions we perform, on other human beings. I agree, the vast majority of the surgeries go swimmingly, and we can feel good, and high five each other, and go for lattes between cases. Our paranoia, and edge, however, comes from the fear of the unknown, and being burned. Every surgeon, every trainee, has a case that haunts them. It dramatically affects how we view medicine, and the world around us. We compulsively check on things, and obsess over the minutiae. Those beneath us, over whom we watch, supervise, become our extenders. Mistakes are not tolerated, as they lead to those doomsday scenarios. Having that hang on our own head is bad enough, but to subject our team to it as well, is even worse. Unfortunately, we are only human, and the cycle repeats itself. Our interns, junior residents, etc. inevitably make a mistake, overlook a lab value, cut the wrong tube or whatever the case may be and kill a patient. I can't be everywhere every minute of every day. They are the one who did it, missed it; who are to take responsibility. Then they too will be just as paranoid, on edge, and un-accepting of those who seem to not take these menial tasks as seriously as they do.

So yes, we can change surgery. We can be happier, and do amazing cases, take a long lunch, be home by 4:30 to make dinner for the family, and have it all. We just can not do this, and maintain the same rigor we have now.

 

[neoexile]

Ubiquitous millennial victimhood is a far more damaging social trend than surgeon elitism.

Are you the same guy who wanted the Asian with the high USMLE/514 over the URM with a low USMLE/498 or something to treat you as a doctor? O_O

I'm against victim mentality, but I feel like your judgement is misguided. =/

 

[Stagg737]

I guess I also don't trust that OP that it was as bad as they said... so I guess I should have started with that. All you have to do is get on twitter for 20 min to see how over exaggerated and sensationalized everything is not days. I seriously doubt that a surgeons had the time or need to yell at someone for and hour straight. 10-20 min? Sure. Not an hour. What did OP have a stop watch ready when they pulled them in the room? OP also said they "dissociated" because of it.. not buying it. To me it just sounds like someone who had a romanticized view of surgery, went on some tough rotations and hated it / couldn't hang with the hours and work load, and is blaming the culture not themselves.

Sure, I agree that it's probably overblown and out of perspective. But even 20-30 minutes of being screamed at is unnecessary. If she was so bad that they felt that was warranted, they should have just taken 5 minutes to tell her she's awful at surgery and to stay out of the way. The whole story could be made up which would make this entire discussion irrelevant, but I'm just taking the article at face value as I'm aware of other students and friends who have had experiences with extremely malignant programs/surgeons.

Can we please, please, please stop criticizing training programs while we are still trainees? You have neither the experience, nor the perspective to understand why you are being treated the way you are, nor the capacity to determine what you need to know, or what you do not.

I agree with most of your post and with the sentiment that criticizing training programs as trainees without understanding the "why" of certain aspects is counter-productive. However, if the story in the article is accurate, tell me how ganging up and berating someone for an hour is productive to anyone. What is she supposed to get out of that? That's not just an unreasonable situation if it happens in surgery, it's unreasonable in any setting and helps no one.

I'm saying this as someone who actually liked the overall culture of my surgical experiences, even the ones where I worked with blunt jerks who were generally unpleasant. But you have to agree that some behaviors aren't appropriate in any setting, and when those behaviors occur they should be addressed and corrected if possible.

 

[Stagg737]

Orwellian perspectives on race are where millenials are the worst.

In Ghana, calls to tear down a statue of ‘racist’ Gandhi

#gandhimustfall

Considering Ghandi did actually have some pretty f*ed up views on race and this statue is in Ghana, do you really find it that surprising? It would be like putting up a statue of Christopher Columbus in a Native American town then calling them too sensitive when they want it taken down...

 

[neoexile]

Orwellian perspectives on race are where millenials are the worst.

In Ghana, calls to tear down a statue of ‘racist’ Gandhi

#gandhimustfall

I agree that SJWs are a problem. But so is malignancy. My perspective is that you hold yourself to a decent standard and everyone else to a decent standard. Medical training DOES have a lot of problems and some of it needs to be fixed. Not to say people shouldn't take responsibility for their own education, but we need to realize that just because the student shares partial responsibility doesn't mean the institution doesn't also have partial responsibility.

 

[neusu]

I agree with most of your post and with the sentiment that criticizing training programs as trainees without understanding the "why" of certain aspects is counter-productive. However, if the story in the article is accurate, tell me how ganging up and berating someone for an hour is productive to anyone. What is she supposed to get out of that? That's not just an unreasonable situation if it happens in surgery, it's unreasonable in any setting and helps no one.

I'm saying this as someone who actually liked the overall culture of my surgical experiences, even the ones where I worked with blunt jerks who were generally unpleasant. But you have to agree that some behaviors aren't appropriate in any setting, and when those behaviors occur they should be addressed and corrected if possible.

My experience has been that students are hyperbolic, the encounter she describes was more than likely 10 minutes at most. Second, the encounter itself is not an issue, in my mind. These sorts of meetings take place due to a progressive, persistent, failure on the student's part to get with the program. Many/most residents are actually rather gun-shy about berating students, being direct, and communicating clear expectations and feedback on performance. Thus, the failure of the student to meet the hidden expectation, and lack of feedback on the performance, can result in a bigger/worse situation than initially necessary. When I was chief, I made a point to intervene and convey to the students/interns/jr residents early on what they were doing wrong, what we expected, and how to avoid further/more aggressive attitudinal adjustments. Only rarely, did we have to call the residents or medical students in to our office for a talking-to. Finally, any student who ends up in the situation she describes, had failure on multiple levels, in multiple disciplines, over a protracted course. Indeed, it may have been an uncomfortable experience for her, but part of medicine is learning to handle constructive criticism and improve. I was not in the meeting with the resident or the author, but I can assure you, I have had many similar meetings, on both side of the desk, and it always feels like you are being berated, no matter how kind the more senior surgeon is in the discussion.

We can sway minds very effectively with our rhetoric, and certainly the way the author describes the story of her SubIs makes surgery sound like robotic maniacs, hell bent on crushing precious young idealistic medical students hopes and dreams. While I can neither confirm, nor deny secret meetings on our part to condone, or research new and innovative ways to destroy medical students, it seems a bit far fetched. Indeed, there are likely some truths to the story, but as all stories have 3 sides (hers, the residents, and reality), we will never know what actually happened.

 

[The Physician Philosopher]

People get hung up on specific examples, and what the OP said may be an overblown example that didn't happen exactly as stated. It may have been more perception than reality. The truth remains that the culture in a lot of surgical subspecialty training programs needs to change.

I find the line of reasoning "surgeons are this way for a reason" a bit strange. That's similar to when people are like "oh yeah, that guy is a total jack ass, but that's just the way he is."

That kind of justification doesn't make anything the way it should be and actually encourages wrongful actions to continue. It's not about tough skin or being a snowflake.

We have to remember that this same mentality used to accompany the "surgeons are God's" mentality which led to worse outcomes in the surgical care of patients. Having a culture that allows people to be questioned (no matter their rank) and encourages constructive criticism actually saves lives. The same change happened in the aviation industry when it became okay to check the captain flying the plane. No longer did mistakes like the Tenerife crash ( Tenerife airport disaster - Wikipedia) need to happen. What prevents this these days is a safety culture full of checks and balances that allows people to speak up.

Someone speaking up and saying that the culture isn't right should not be bemoaned... Because there is a better way to teach that can be direct, firm, and even blunt... Without needing to be threatening, derogatory, or condescending.





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