'Please Change the Culture of Surgery'

[akwho]

She sounds like she was a terrible student. I've had some bad students on rotation with me, and we still haven't had to pull them into the cheif's room for a talk about areas of improvement. When you tell fellow surgeons you want to be one of them, they will scrutinize you closely to see 1) if you are telling them the truth, 2) if you would be a good, hardworking, trustworthy future colleague, 3) if they can help you improve for future sub-i's or make you look good in front of the attending.

The flip side of it is when you are a terrible student no one wants you to apply into their speciality so people make it obvious you are unwelcome. I've seen that happen before, and that's probably what happened here. If you can't handle 28-hour calls as a med student with no real responsibility on a 4 week rotation, you will crumble when you have to handle 30+ hour calls q2 or q3 for 4 months straight with real responsibility as a resident.

---

Members don't see this ad.

 

[Crayola227]

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.

Article didn't specify gender.

 

[Stagg737]

Its not just ghana. Theres a similar call at a Canadian university.

I'm pretty sure Gandhi was basically a good dude.

Eh, I've read enough about him to think he was not "a good dude". A person can accomplish incredible feats and still be a complete POS as a person, the two aren't mutually exclusive. Not saying he was evil or anything to that extent, but not someone that would make the short list of people I'd invite to dinner for their ethical behavior.

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.

I don't doubt any of that, and I'm sure the possibility that this article is being blown out of proportion is very real. However, I've also talked to friends irl and have had 1 or 2 surgical experiences in the past (though not along the same lines or to the same extent) that make the person's story seem well within the realm of possibility and even likely in certain places. I also think it's highly program dependent, as my experiences with med school rotations were very different from other people's experiences and even different than my pre-med surgical environment. The reason I think it comes up at all is because a lot of these behaviors either don't occur in other fields or are extremely rare, yet there are plenty of horror stories about experiences surgical fields that make most people say 'wtf'.

 

[neoexile]

Article didn't specify gender.

I understand that Surgery is one of the highest intensity specialties there are. However, I have to ask: Why the toxicity? Because if you want students to be good at everything as soon as they walk in the door, what is the purpose of rotation?

Why not just ask the students to bring their textbooks and ask them to read somewhere and have them take a shelf at the end?

My point is that it is unfair to expect the student to know what he is or she is doing from the start. It IS fair to evaluate him or her based on improvement and effort.

 

[Anti-PD1]

Article didn't specify gender.

I'm sexist.

 

[Crayola227]

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.

First of all, it's not only surgery where this sort of acuity and high stress decision making and procedures happen. Anesthesia has its tense moments, EM sure as **** does, and so does critical care, and don't even get me started on the NICU or the PICU. Yet, in those situations, on average, I have haven't observed the same level of toxicity. That said, there is a high level of toxicity in medicine, period.

Most of what you said describes a lot of doctors, not just surgeons. Still not a good reason to be an a-hole.

I described surgeons both behaving badly and behaving admirably.

Rather than excusing being caustic, we are to be holding ourselves to the highest standards of professionalism. That means providing timely, effective, and constructive feedback. Keeping your emotions in check. You need to correct your team, but there's a lot more to leadership than that. You describe comraderie and making the team feel appreciated for what they do right. That's great.

And no one suggests that you can have it all, or that you shouldn't work long hard hours.

 

[Perrotfish]

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.

Yes, we should really leave the reform of our abusive training to the people who benefit from the abuse.

 

[Psai]

Article didn't specify gender.

Sounds like a lady

 

[Nucleophile1]

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.

Considering that 1. The trainees are paying six figures for their education and 2. Trainees care about the kind of education that they are receiving, there is nothing wrong with a trainee speaking up if they have issues with their education. If a surgeon threatened to stab me when I made a mistake or I was yelled at for an hour by a group residents, I would definitely take issue with that because that is not conducive to a good learning environment. I have no issue with criticism when I make a mistake, but the examples given by OP are excessive.

 

[Crayola227]

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.

Everything you said here is true.

But the last paragraph. Pretty sure surgeons like the taste of trainee tears and actually extend their own life by sucking out some portion of their souls.

 

[Crayola227]

Its a pathological movement with a lot of ASPD elements; give them an inch and they'll read it as weakness. Solution to all their "problems" is for them to grow up. Not creepy authoritarian interventions into every fascet of life.

But your view is also a creepy authoritarian view. Likely less invasive due to how hard it is to hear your whining about millennials over the whining of the actual millennials.

 

[neoexile]

She sounds like she was a terrible student. I've had some bad students on rotation with me, and we still haven't had to pull them into the cheif's room for a talk about areas of improvement. When you tell fellow surgeons you want to be one of them, they will scrutinize you closely to see 1) if you are telling them the truth, 2) if you would be a good, hardworking, trustworthy future colleague, 3) if they can help you improve for future sub-i's or make you look good in front of the attending.

The flip side of it is when you are a terrible student no one wants you to apply into their speciality so people make it obvious you are unwelcome. I've seen that happen before, and that's probably what happened here. If you can't handle 28-hour calls as a med student with no real responsibility on a 4 week rotation, you will crumble when you have to handle 30+ hour calls q2 or q3 for 4 months straight with real responsibility as a resident.

I don't favor just immediately blaming the student. The student DOES probably have partial responsibility but medical culture has become a theme of "don't ask me questions", "shut up and watch" or "I'm in a bad mood, so you are dead today."

I mean this is why I have >13,000 ankis I keep reviewing because "asking questions" is a felony to a lot of attendings especially if the questions are "unintelligent". I often distance myself and practice history taking/presentation skills for the same reason without having to rely on attendings.

No one learns anything in a toxic culture and it's not healthy for anyone either. It SHOULD be addressed.

Resisting authoritarianism is authoritarian itself

War is peace

Freedom is slavery

And 2+2=You're a racist

If you call any opinion different than yours "authoritarianism" then no one can have any conservation with you. You cannot show constant disrespect of a group of people and expect a lot of us to take you seriously.

I don't like SJWs, but I also dislike people that inject hyperbole into conversations. It's like talking to a wall.

 

[Crayola227]

#gandhimustfall is roughly analogous in terms of tone and subjective merits to "Newtons Principia is a rape manual"

what thread on surgical abuse is complete without the word millennial or rape thrown around

lol, thanx SDN

 

[neoexile]

Save me from an argument I'm losing please mods

Is the objective to "win" an argument? Why do we want to "win"? What is the purpose of us trying to "win" against other people?

 

[BombsAway]

@Tiger Tank
Here's an excerpt from a speech a friend of mine gave in response to your chosen view of us "millennials".

"...And yet, over the years, I’ve heard the same folks who extol the same sacrifices of the military assign to our generation such titles as ‘selfish,’ ‘narcissistic,’ ‘eternally dissatisfied.’

"My experience has been the opposite. We are a group that has been asked to shoulder two of the longest wars in our country’s history, to weather a great recession, to surmont crippling student loan debt.

"And yet we are emerging as leaders in business, medicine, the law, the arts…

"As we look ahead, a new problem is emerging. What we now face is the problem of reaffirmation, reaffirmation of forgotten core values. We are a generation tasked with affirming that empathy is not weakness, and that strength only exists if it’s in service of something bigger.

“We must reaffirm that we are strong because we are fearlessly inclusive. Human potential is our greatest commodity, and if only some of us realize that, it’s far too few.

“We must reaffirm that we are a generation unimpressed with individual achievement and careerism. One that refuses to be fool by cynicism that masquerades as wisdom.

“And we must reaffirm that we have the courage to live a purpose-driven life, and that we know full well that our actions, our sacrifices, our triumphs will never be quantified...

 

[The Physician Philosopher]

Save me from an argument I'm losing please mods

Maybe if you'd make some real contribution to the discussion, instead of trolling it, you wouldn't be losing like this. I'm all ears for different point of views, even ones that fly in the face of my own... but your comments are only inflammatory on this thread.

 

[neoexile]

I will freely admit that my #1 political issue is the obliteration of cultural marxism and their SJW brownshirts

-_-.

You want to obliterate an idea and the people that follow that idea. This is insanity. You have to realize the people that have those ideas live in this country too. Whether you like it or not. You have to get along with everyone in the class or stay the hell away.

This is what is destroying the country. People want to destroy the other side rather than discuss actual solutions to real problems that we have. How about we realize that we ALL have common issues and we all need to take some level of responsibility to resolve them?

 

[neoexile]

There's no accord with a movement whose central koan is "racist white males" because its a status-seeking contradiction.

There's no reasoning with them because they cry to authority figures to squash speech they don't like.

I can call attention to their hypocrisy when publicly expressed. Sometimes that expression is allowed, mostly it is squashed by alt lefty types.

There's no accord with people that refuse to show respect. SJWs, alt-right are all the same people to me. Racism does exist. Yes it does. And it can go both ways. And I'm against it.

However, if we cannot show respect in a conversation, there is no way we can make ground. Our objective isn't to make war against people to live here, but to find a common ground and build from there.

 

[Brahnold Bloodaxe]

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. =/

Wait...are you saying you are against such an obviously logical decision? Given that all I know about 2 potential Asian doctors is their MCAT (a rough proxy for intelligence/work ethic), who wouldn't select the Asian doctor with the higher MCAT over the Asian doctor with the lower MCAT? Only an insane person.

Would my decision change if I was told the Asian doctor with the low MCAT was actually not Asian but black? Not unless I was a huge racist against Asians.

 

[neoexile]

Wait...are you saying you are against such an obviously logical decision? Given that all I know about 2 potential Asian doctors is their MCAT (a rough proxy for intelligence/work ethic), who wouldn't select the Asian doctor with the higher MCAT over the Asian doctor with the lower MCAT? Only an insane person.

Would my decision change if I was told the Asian doctor with the low MCAT was actually not Asian but black? Not unless I was a huge racist against Asians.

No. What I'm saying is that using metrics like MCAT/USMLE and race should not be the tools you use to decide if someone is a good doctor. I addressed this in the other thread. If someone is well respected by his peers, shows high patient satisfaction consistently and low rate of complications consistently then this is the metric you should be using if you wanted to even select a doctor. Not race or what he got on a test which has little to do with how well you will be cared for.

And by "people who show respect" you mean "people who agree with my politically correct viewpoints"

Of course racism and the alt right are ugly, but this is not cassus belli on the first amendment.

No. I mean people who show respect. Ben Shapiro for example has a lot of views I disagree with. However, I CAN have a conversation with him. I also disagree with a lot of conservative posters in here, but I CAN have a conversation with them.

However, I will not have anything to say to people who are alt-right, Nazis or white supremacists.

 

[Crayola227]

Save me from an argument I'm losing please mods

I thought your joke was funny. That was the point of what I said. But of course you read it as millennial complaining, rather than someone far too conservative to be a good millennial, being good natured and finding humor.

 

[Crayola227]

lol

Ghandi, rape, millennials, MCAT scores, URM admissions, Asians, cultural marxism, Nazis. Almost none of it even related to the OP. By page 2. Never change, SDN.

 

[W19]

You guys/gals are welcome to comment about OBGYN culture as well.

 

[neoexile]

While I agree Nazism and actual white supremacy are very ugly, the notion that someone holding an ugly opinion gives you the right to use force to squash their rights to political expression is a notion I very sharply disagree with.

I'll agree with that up to the point a threat is made against a person. If a threat is made and it seems imminent, then the party responsible must be arrested. Otherwise, I'll agree. However, it doesn't mean that I need to have a conversation with people like that especially if it goes nowhere. Same goes for SJWs.

 

[Crayola227]

While I agree Nazism and actual white supremacy are very ugly, the notion that someone holding an ugly opinion gives you the right to use force to squash their rights to political expression is a notion I very sharply disagree with.

Similarly with toxic millennial victimhood calling surgeon elitism toxic.

wait, why again is calling surgical elitism toxic, toxic millenialism? couldn't it just be, well, toxic?

that's unheard of. Surgical elitism is like vitamins, might taste bitter, but absolutely good for you

 

[Crayola227]

You guys/gals are welcome to comment about OBGYN culture as well.

that's why I keep saying surgical fields and the like. Ob/gyn is considered a surgical subspecialty when it's inpt.

 

[neoexile]

that's why I keep saying surgical fields and the like. Ob/gyn is considered a surgical subspecialty when it's inpt.

Can medical education be reformed in such a way that it is like practicing for a sport? My current system is that I review flash cards on Anki everyday to keep myself current and ready to dispense should the need arise. I also practice my presentation/history and physical skills as well to keep myself uptodate. (Pun intended)

I feel like current medical education makes it so that you attend lecture, you take a test, and the material is never touched again until much later, by then, you've forgotten everything. I feel like it needs to feel more like going to the gym where you are repeatedly training your mind to remember and recall all this information so you can use it as it becomes necessary.

And then AFTER that, you go on rotations and attendings can grill you as they please.

 

[Perrotfish]

There's no accord with a movement whose central koan is "racist white males" because its a status-seeking contradiction.

There's no reasoning with them because they cry to authority figures to squash speech they don't like.

I can call attention to their hypocrisy when publicly expressed. Sometimes that expression is allowed, mostly it is squashed by alt lefty types.

Are you actually in medical school? Have you hit clinicals?

 

[neoexile]

brace yourself for exclusion and ad hom lads, a cultural marxist disagrees witn you

Why is he a cultural marxist now?

 

[Strider_91]

Do yourselves a favor and read this in a imitation little girls voice. Priceless.

Sucks the author has such a lousy experience tho. Comical they thought jersey would be warmer people tho. Jersey has the rep of being some of the nastiest people in the country.

 

[Lucca]

The handwringing over 'millenials' sideline in this thread stops now or this thread gets closed. Entertaining at first. Just derailing now. Stay on topic.

 

[Crayola227]

:troll::troll::troll::troll:

 

[Perrotfish]

brace yourself for exclusion and ad hom lads, a cultural marxist disagrees witn you

Is that a no?

 

[Anti-PD1]

I think we can all agree the nature of the resident feedback in the OP was unprofessional and unnecessary. Doesn't matter your political axis.

 

[NotYou20]

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."

Bonus points if you use "snowflake" too!!!1!1

 

[neusu]

Yes, we should really leave the reform of our abusive training to the people who benefit from the abuse.

I think you missed my point.

If you are in training, and feel like it's just information you'll never need or abusive, take a mental note. Then, when you are in charge, resolve to not continue the cycle.

I for one, looked at scut in a different light after intern year. As a med student, it was annoying having to do blood draws or run stuff to the lab by hand, or pick up reports etc. As the intern, I was happy i had the insight to do these tasks when phlebotomy decided not to show up, the tubes were down, or so forth. My patients still got treated and I looked like a rock star compared to my co interns because I got the message to Garcia, while the others had excuses.

 

[Perrotfish]

If you are in training, and feel like it's just information you'll never need or abusive, take a mental note. Then, when you are in charge, resolve to not continue the cycle.

I for one, looked at scut in a different light after intern year. As a med student, it was annoying having to do blood draws or run stuff to the lab by hand, or pick up reports etc. As the intern, I was happy i had the insight to do these tasks when phlebotomy decided not to show up, the tubes were down, or so forth. My patients still got treated and I looked like a rock star compared to my co interns because I got the message to Garcia, while the others had excuses.

The problem with our current system, though, is that our training is centralized and only a small percentage of attendings take part in it, and those are almost inevitably the ones who don't see a problem with the system. You can't just resolve to do better when you're an attending, because the attendings who would have done better end up in private practice. As long as we keep this model for academic medicine then reforms are going to need to be driven by trainees. An average attending might have better insight about medical training than a trainee, but not an average academic attending.

 

[neusu]

I think we can all agree the nature of the resident feedback in the OP was unprofessional and unnecessary. Doesn't matter your political axis.

I'm going to go ahead and disagree with you here.

This story reaks of a misguided student. As I mentioned in other/earlier posts, the student likely was having issues and more subtly corrected. Being subtle, and passive aggressive, the OP probably missed the hints. This precipitated the meeting.

Malignant programs go both ways. If this student was a stud, and truly kicking ass and taking names, they would have tons of high fives and slaps on the back for being so great. This is not the narrative at all. The opinion was blind-sided by big negative feedback meeting. Color me surprised. Again, the more likely narrative is the student was not able to pick up the more subtle cues and needed the baseball bat to the face approach.

 

[Perrotfish]

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. .

BTW, OP, the studies I have seen show that FM and GenSurg actually have surprisingly close hourly salaries. Surgeons just tend to work a lot more hours. If you pick up extra call/late clinics/urgent care work you for a year or two you can easily pay down that debt.

 

[W19]

BTW, OP, the studies I have seen show that FM and GenSurg actually have surprisingly close hourly salaries. Surgeons just tend to work a lot more hours. If you pick up extra call/late clinics/urgent care work you for a year or two you can easily pay down that debt.

I am not the author of the post. I got it from doximity.

 

[Crayola227]

The problem with our current system, though, is that our training is centralized and only a small percentage of attendings take part in it, and those are almost inevitably the ones who don't see a problem with the system. You can't just resolve to do better when you're an attending, because the attendings who would have done better end up in private practice. As long as we keep this model for academic medicine then reforms are going to need to be driven by trainees. An average attending might have better insight about medical training than a trainee, but not an average academic attending.

I've said it before, so it's creepy, but I just have you on a pedestal.

 

[THEBACKANDFORTH]

I will freely admit that my #1 political issue is the social obliteration of cultural marxism and their SJW brownshirts

Thankfully "social obliteration" of complex ideological and political philosophies cannot be achieved by pointless platitudes expressed on SDN

 

[Stagg737]

#gandhimustfall is roughly analogous in terms of tone and subjective merits to "Newtons Principia is a rape manual"

There are plenty of reasonable arguments for removing the statue in that setting and I pointed a few out earlier. You could address those without denigrating an entire generation and assuming everyone uses hashtags, or you can just continue to troll. Your choice.

I'm going to go ahead and disagree with you here.

This story reaks of a misguided student. As I mentioned in other/earlier posts, the student likely was having issues and more subtly corrected. Being subtle, and passive aggressive, the OP probably missed the hints. This precipitated the meeting.

Malignant programs go both ways. If this student was a stud, and truly kicking ass and taking names, they would have tons of high fives and slaps on the back for being so great. This is not the narrative at all. The opinion was blind-sided by big negative feedback meeting. Color me surprised. Again, the more likely narrative is the student was not able to pick up the more subtle cues and needed the baseball bat to the face approach.

I think the issue isn't just rooted with the malignant programs though. There are plenty malignant individuals in medicine in general, but somehow certain surgical fields (and more specifically certain programs within these fields) tend to select for a greater proportion of them, otherwise you wouldn't see malignant programs continue to exist year in and year out. It's an issue deeper than just surgery, but for some reasons some places seem to foster that environment when it's neither necessary or helpful to the field. Idk how to solve that problem, but I don't think it's something that should just be brushed off as a lack of understanding and say "you'll get it when you're an attending". At least not with some of the stories I've heard.

 

[SunsFun]

I'm going to go ahead and disagree with you here.

This story reaks of a misguided student. As I mentioned in other/earlier posts, the student likely was having issues and more subtly corrected. Being subtle, and passive aggressive, the OP probably missed the hints. This precipitated the meeting.

Malignant programs go both ways. If this student was a stud, and truly kicking ass and taking names, they would have tons of high fives and slaps on the back for being so great. This is not the narrative at all. The opinion was blind-sided by big negative feedback meeting. Color me surprised. Again, the more likely narrative is the student was not able to pick up the more subtle cues and needed the baseball bat to the face approach.

You seem to be making multiple assumptions about the student without much support in the text. Sure, "the patients lost a great doctor.... my nurses loved me" shows some degree of entitlement, but it doesn't automatically discredit the experiences described. We can't really have an argument here if your position is going to be "I don't believe him/her".

Now, assuming this story is at least partly accurate, there is really no way to tip-toe or explain away a threat of physical violence. This is inappropriate if not illegal. Period. That's kind of the climax of the story, IMO.

The story of the second rotation is more open to various interpretations, but it looks like the residents in the program have failed to provide constructive criticism. Properly identifying and addressing deficiencies is something that must be taught and exemplified by everyone in the program starting from chair and PD, and ending with interns.

There is plenty of evidence that multiple programs simply fail to address the issues that result in attrition problems, duty hours violations, and overall politics that are played by the departments. Let's also not forget the IMG prelim slaves, recruited on bogus promises, that have no future in multiple programs and are abused and discarded every year.

 

[KnuxNole]

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.

Exactly. If they said that, I'd make sure he gets fired for life

Or, I would pee in his coffee, and purposely mess up his service!

 

[operaman]

Something I’ve wondered about as a potential start at a solution:

What if the ACGME adapted and published the annual surveys we all do to produce a document that ranks programs by specialty along such metrics as perceived culture, QOL, etc?

While I’m hesitant to say a real systemic problem exists at all, if it does, it must be highly program specific. It might even depend heavily on the current crop of trainees in any given program. Would some good old fashioned ranking be helpful here? My prediction would be a skewed distribution that showed most programs would cluster around a fairly good/high mean with a sprinkling of country club cushy programs above and some really malignant ones below.

I could see this being helpful for many reasons. A few worth mentioning:
1) poor performing programs would see themselves ranked very low compared to their peers, possibly spurring measures for change
2) students would have another highly valuable piece of objective data about programs when making their application and ranking decisions.
3) rankings seem to have a mythical power to provoke change. We all see medical schools and hospitals trying to game the USNWR rankings. We all remember the collective yawn when the Doximity residency rankings came out, followed by big pushes by programs in the following years to get all their eligible alumni to vote.

 

[WingedOx]

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.

Yeah, but a venn diagram of "Goalie" and "normal and well-adjusted" is two non-touching circles.

 

[Tsunnami]

There was an old engineer guy I enjoyed talking with a few years ago.

He was born in the 60s. His father was a tough guy, but a professional jerk as well. So when his son ( the engineer guy ) turned 18, his father cut off his funding completely - overnight, the guy didn't see a penny from his father anymore.
He got into engineering school and he also had to get himself a job, and he didn't get any kind of job, he got a job also in engineering field ( something he could do without a degree, but he still wasn't a cashier at the supermarket ), and because he had a full time job all day long, he went to school in the evening, then after school he went home and studied until he collapsed and then the next day at 5 AM he had to be up again and go to his job.
And it went like this for 5 years, after this he became an engineer and he spent his first years as an engineer doing hard physical labor job besides engineering ( note that this was not America, this was a 3rd world country, and his life was work 24/7, otherwise he wouldn't had got ahead to make it to middle-class at least ).

Now the point is: this old engineer guy, due to the circumstances, became an incredibly tough and raw fella as well. You can't complain to him, there is no such thing as complaining in his dictionary.
I respect the hell out of him, but he just has no filter: if any co-worker or employee or intern goes to him and starts to even slightly make a hint about something that is too difficult ( in a real or perceived way ), he just discards it instantly. In his mind, things have to be handled. Period.

Most persons who come from similar circumstances have the same mentality that he has.
In their minds, if one can't rise to the high standards, he's weak.

They also have a theory that goes like this: if we lower the bar, people will be satisfied by their performances at first; but after a time, they won't be willing to raise to that standard either, so the bar will have to be lowered again and so it goes on and on. - Difficulty is a matter of perception, as they say, and there are plenty of resources that aren't used to increase performance.
For example, the engineer guy said how comical it is to him that he sees the younger ones complaining about the difficulty of their work, but at the same time they have daily social network activity, they browse the internet, they are active members on forums, they know what goes on the 6th season of Game Of Thrones, and they go at least 1x/week to the club/bar/caffeteria/etc.
He has no sympathy therefore when an intern goes to him and shows signs of inability to cope with a deadline, with the pressure or with the difficulty of a task: If you'd invest your time and energy into developing your brain more instead of entertaining it, you wouldn't have these problems.

All this being said, it's complicated to find a formula that works for all people.
As I was listening to this engineer guy, I realized that he is hard-headed for sure, but he has some valid points.
Why is the internet full of Medical students complaining ? Why do a lot of Medical students know every episode of Scrubs/Grey's Anatomy/Dr House ? Why are Medical students/residents known for being the biggest party animals ?
There wouldn't be a problem with this, if the result wouldn't be a decrease in performance, but for many students/residents it is, and they won't even admit it.

Live a life that you can afford, this isn't just about finance, it's about time management as well: if you know that you're going to get to work in a hospital and you can't memorize and learn all the 50 books that are required for your residency, then cut down on distraction, cut down on leisure time, cut down on whatever cuts down your performance as a doctor/medical student.

I think we've got to loosen the belt a bit so that we can breath, but I don't think we have to exaggerate with it either.
Medicine is Medicine.
Service is service.
It's done in a tough way, because it's a tough field. While I subscribe to a balanced lifestyle, I also think that people are inclined to find problems in the system when things get rough, rather than admitting that they can't handle it.

 

[WingedOx]

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.

I get what you're trying to get at here and agree the original article is dripping in hyperbole, but there are some problems here. It's one thing to harsh as hell with your junior residents who are screwing up (I wasn't good at hiding my irritation at one of the interns I was dealing with earlier this month on call when he was presenting a case to me on call and was barely competent despite it being January by now), but students don't know f-ck about f-ck despite their best efforts and in a lot of cases these types of problems are due to the appropriately people not actually giving appropriate ongoing feedback and instruction. I've seen this in action on both sides of the student/resident divide and in some ways have to admit that I've been guilty of it myself looking back.

Ironically enough, my surgery rotation back as an MS3 started miserable for a number of reasons then got changed to a different hospital (with a different program's residents) and the difference was night and day. At the first program I always felt like I couldn't ask questions without being berated, I'd try to be proactive and read up in detail on the next day's cases only to have them switch OR team at the last minute, then get feedback that was barely more charitable than insults when I'd be forced to scrub in for a case I didn't know I'd be in. Didactics were cancelled at the last minute, all 3 students at the site were pretty sick of it quickly and it didn't take long for me to just check out. At that point in my MS3 career I was pretty confident that surgery was just "like that."

For some personal reasons I had to finish the end of rotation at our school's main hospital and program and was dreading it, and yet it was actually a lot of fun and I learned SO much more. The residents took time to teach. I wasn't made to feel like a ******* for asking questions during the case. My technique on the stuff I got to be hands-on with improved dramatically (I had previously been making a mistake on my one-handed ties that a resident picked up on and showed me how to correct it). The hours were the same, as was the patient load and level of rigor. I left the experience feeling like a learned a ton rather than just pissed off and disillusioned like I was at the first site. I complained to my school's student affairs dean about the first site and its problems, but was told that it was probably just me who sucked as a student. Was that true? Eh, probably, but I saw first hand that it could have absolutely been a better experience and I hate to think what I would have thought or what I wouldn't have learned if I didn't need to switch sites due to a family issue. It would have been a huge waste of everyone's time and energy.

My world is different than surgery, obviously, but there are certainly parallels in how we train. A big part of my job as chief was to calm the junior residents down and get them to understand that some of the stuff they were pissed off about actually made sense (or that the things they were proposing in response to them had serious unintended consequences). Students and juniors don't know what they don't know, but that doesn't mean programs can't and shouldn't evaluate how they're training, because there's always ways to improve upon it.

 

[Matthew9Thirtyfive]

Yeah, but a venn diagram of "Goalie" and "normal and well-adjusted" is two non-touching circles.

This made me lol because I was a goalie for 6 years.